Professional Introduction

 

Diagnostic Summary: Disease and Adaptive Models of Addiction Impact on DSM-5-TR

Diagnoses

M. Aly’ce Wilson

College of Allied Health, Walden University

CPSY-8781-2: Psychopathology from a Clinical Perspective

Dr. Megan Corley

May 4, 2025

Diagnostic Summary: Disease and Adaptive Models of Addiction Impact on DSM-5-TR

Diagnoses

Introduction

             Understanding the psychopathology of diseases including the homotypic and heterotypic continuity is foundational.  Diagnostic process’ includes person-centered symbiotic holistic assessments for competently and effectively treating individuals.  The DSM-5-TR (American Psychiatric Association, 2022) (APA) and the ICD-11 (World Health Organization, 2019) (WHO) provide standardizations for nosography classification, criteria, differential aspects, as well as possible comorbidities, and other factors to be considered for conceptualization.  However, it is important for individuals not to be reduced as mere diagnostic codes; functional deficits are the bedrock.  Diagnostic summaries are important snapshots as tools for the clinician and individual to recognize the application of the diagnosis as supported by the pragmatic deficiencies for which the client has sought help to mitigate.  Diagnosing as a clinical psychologist has real world societal implications.  The clinician also has a responsibility to check bias, ensure ethical principles are being conducted, cultural sensitivity is administered and for the assessment, diagnosis, and treatment plans be rooted in evidence-based empirical data (APA, 2017).  Part One will establish understanding of diagnostic summary to include: diagnosis, codes, evidentiary support, differential, and other considerations for Jane Doe as observed in the Symptom Media (2018) video interview.  Part Two analysis considers how the disease and adaptive models of addiction impact the DSM-5-TR diagnosis. 

Part One: Diagnostic Summary

Diagnostic Impression: Opioid Use Disorder DSM 304.00/(F11.20) ICD-11 Moderate

Jane Doe states her main concern for current presentation is her “chronic pain official pain syndrome.”  Jane attributes her pain in neck and shoulders that “lingers for days” to affecting her sleeping.  There are times the pain is so bad Jane cannot “get out of bed in the morning.”  Jane’s appearance is well groomed, appropriate, clean, and hygienic.  Jane’s eye-contact was fitting, normative gate and a minor slouching posture.  Jane’s orientation indicates a decline in cognitive functioning as evidence by her statements of, “I'm sorry, because you're making me confused with your questions… I don't know. I'm sorry. What was… What did you ask?” and that she is “fucking terrible with names.”  Jane’s thought process is indicative of once having the ability to be goal-directed/logical, however her inability to answer questions without giving excessive and unnecessary details is circumstantial.  Observation of Jane’s irritable affect and oppositional behavior intensified when presented with evidence that did not align with her goal achievement as evidence by her tone, body language, and impatience towards an office assistant.  Jane’s thought content appears to be distorted with the preoccupation of obtaining “oxycodone” for her myofascial pain manifestations.  Jane states she ran out of her (15mg) Oxycodone prescription from Dr. Wade, her primary care physician (PCP) a week before it was due to be filled; the PCP refilled that prescription with another 15 pills that had been consumed before her next refill was due to be filled as well.  Jane’s PCP lowered the dosage for Jane calling it a “trial.”  Jane states “the (50mg) dose of OxyContin is really the only dose that helps” indicating the need for increased amounts with diminished effect as evidence by the high tolerance.  Jane admits to having two additional prescriptions, but did not indicate the dosage.  Jane has a history of “trying to get all the way off” only because she ran out of the pharmaceutical as well as having “to call out for work.”  Jane’s having “seen 5 doctors in 2 days” indicates a considerable amount of time dedicated toward med seeking behavior and away from occupational responsibilities.  Jane has not completed the physical therapy that she was referred for pain management due to her “not liking the guy.”  Jane denies interest in finding another physical therapist or alternatives such as acupuncture, except for massage therapy that she does not have insurance coverage to participate.  Jane states she “might” take Oxycodone on days she does not have pain.  Jane states she “sometimes crushes or chews” her Oxycodone.  Jane acknowledges side effects from Oxycodone such as “dizziness.”  Jane denies the use of any other substances except for “sometimes” alcohol consumption and in high school where she “piggy-backed off her friends Adderall.”  Jane denies prior drug or alcohol arrests.  Jane denies prior inpatient or outpatient treatment for drugs or alcohol.              

Jane meets the provisional diagnosis of opioid use disorder with moderate severity that without intervention homotypic continuity will worsen the severity and impact her life functioning to a greater degree.  Further evaluation is needed to assess for and rule out if opioid withdrawal diagnosis and treatment is appropriate.  There is no factual knowledge at this time of Jane’s last acquisition of Oxycodone.  However, her presence in the fifth doctor’s office in two days is an indication of cessation with symptomatic dysphoric mood not having been able to obtain another prescription, muscle aches, and insomnia causing significant pragmatic deficits in life functioning attributed to missing work.  While Jane currently denies excessive stress and anxiety, continuing evaluation is needed to assess heterotypic continuity as life functioning deficits typically continue to worsen without intervention.         

Part Two: Disease and Adaptive Models of Addiction Impact DSM-5-TR Diagnosis

Addiction is complex with many subtypes.  The symbiotic effects emergent through symptomatic behavioral expression in individuals can be reversely traced when a baseline agreement becomes attainable, “substance abuse disorders do not develop in isolation” (Substance Abuse and Mental Health Services Administration, 2012, p. 170) (SAMHSA).  Discourse with several models of addiction have been deployed over the years, offering partial theory to a controversial age-old problem such as: moral, free-will, psychological, social, biopsychosocial, etc.  Empirical research, including efficacy after implementation has evolved to some degree what Carl Jung described as a numinous solution for a phenomenological problem treating a patient in the 1920’s for alcoholism “spiritus contra spiritum” translated “spirit against spirit” (Jung, 1963).  The implications for individuals, families, communities, and nations continue to be a global crisis.  At one end of the controversial spectrum is the adaptive model of addiction and the other the disease model.  The DSM-5-TR is impacted for which clinicians are asked to adhere to as a foundational tool for the use in standardization with individuals whose pragmatic functional deficits have been adversely affected by addictive behaviors.       

Disease Model

            Jellinek (1960) promoted a “new approach” regarding the disease concept of alcoholism theory.  The disease model closely aligns with the medical model Dr. Silkworth (1939) pioneerd withis his application of alchol dependence (Alcoholics Anonymous, 2002) (Hunt, 2015).  Jellinek incorporated social, cultural, economic factors as well as neurological symptoms of craving and compulsion, physciological susceptibility, and the most controversal to date being loss of control, a major concern forensicly.  This revolutionary theory has evolved into well-established emperical evidence proving the heredability of addiction both genetically and external enviornmental development factors such as adverse childhood events (ACE’s), early onset drinking, and trauma (Tsermpini, et al., 2024).  The advantages, drawbacks and impact on the DSM remain significant. 

Advantage

            Evolutionary advancement toward a societal problem that has been deemed a moral turpitude for millennia, being found erroneous scientifically has given way to social reform on a global scale.  Research and application on homotypic and heterotypic continuity of disease intertwining with substance-related and addictive disorders has transformed society.  Continued research finding causation has influenced the beginning of protections for children, women and other marginalized and otherwise under-represented minorities such as racial over-incarceration.  Social support has been made available on a socioeconomic level that was previously available only to the wealthy, veterans, or men.

Drawback

            Allowing behaviors associated with addiction to be classified as a disease begs the hypocritical dilemma on moral deficiency of those who claim empathy for the sick as virtuous.  This pits the cultural domains of religion and government who have tried to eradicate addiction against scientific and academic communities.  Cultural evolution is a slow-moving process.  The balance between responsibility for one’s own actions and the inability to control them place this at the center of debate.  For example: Individuals with a physical disease diagnosis of lung cancer if the cause is socially unacceptable behavior and preventable such as smoking are arguably undistinguishable within a society for whom it affects .049% of which 10-20% having never smoked (National Cancer Institute, 2024).  Neurologic disorders account for 16% of the population in the United States (Somnath, 2018).  Neither of these diseased populations account for any percentage of crime rate.  “Individuals ages 18-24 years have relatively high prevalence rates for the use of virtually every substance” (APA, 2022, p. 549).  SAMHSA (2023) reported substance use disorder in the United States at 17%.  Drugs or alcohol abuse by up to 80% of prison inmates creates pubicly outcry for reasons of accountability and safety amont other socioeconomical controversy regardless of the model used, cause, or correlaction.  The debate will rage on as society and science seek harmonious balance with truth.  Both legislation in law and the judicial branch holding individuals accountable are relyant to the DSM with the evolution of science as well as clincial practice (Norko & Fitch, 2014).  This is recognizable in the evolution of the DSM. 

DSM-5-TR Impact

            The first DSM published by the APA (1952) identified drug addiction and alcoholism catagorically with sociopathic personality disturbance although there were not any diagnostic systems ensuring relability or validity (Suris, Holliday, & North, 2016).  As pathology of disease increased so too did the etiological understanding evolve with the development of assessments more reliable and valid to measure citera for diagnosis with the DSM-II (APA, 1968).  There were minimal changes to substance-related and addictive disorders despite Jellinek (1960) introduction of the disease model.  Such terms as “functioning”, “episodic”, and “physical health” were introduced indicating a slow, but evoluationary none the less, greater conseptualized understanding of addiction and the necessity to differenciate severity and functional deficits.  “DSM-III heralded a paradigm shift in the history of psychiatric diagnosis, with its incorporation of empirically-based, atheoretical and agnostic criteria for psychiatric diagnosis” (Suris, Holliday, & North, 2016, p. 7).  The DSM-III APA (1980) not only added behavioral addictions such as gambling, but nuanced dependence from abuse, tolerance and withdrawal.  This foundational change was the beginning for social change in healthcare and legal reform recognizing the disease model.  On the seemingly oposite spectrum of addiction model is the adaptive modal.  It too produced advantages, drawbacks, and influential impacts to the DSM-5-TR.                     

Adaptive Model

            Alexander and Hadaway (1982) introduce an adaptive orientation model in opiate addiction.  Alexander (1987) postulates addiction is a substitute for failing to “reach or maintain adult integration” ultimately leading to suicide (p. 49).  He argues drugs and/or alcohol are an “adaptation” for mitigating a worse outcome.  The adaptive model differentiates an individual who is addicted to be “sick” not diseased.        

Advantage

            The adaptive model recognizes and introduces a new theory of cause-and-effect in that addiction is not the cause of the pragmatic deficits of function, but a solution for the individual despite the consequences of maladaptive behavior.  Alexander (1987) opines there is no addict per se, there is a mere societal change that now demonizes drugs and alcohol where before when it was more socially acceptable there were less individuals with functional deficits.  Society he discoursed should be accountable for the problems it faces rather than look for a scapegoat.  “Large numbers of people suspected of distributing drugs have been intimidated, deprived of their jobs, property, crops, and civil rights, and subjected to long prison terms” (Alexander, 1987, p. 57).  These views have led to social change.  Reassessing drug classifications such as marijuana not only decriminalizes the use but allows for medicinal application.  This alternative discourse and controversy have led to harm reduction research and study.    

Drawback

            The adaptive model fails to consider early onset adolescent addiction.  The adaptive model opines a “search and choice” as if anyone in the US need “search” for alcohol, tobacco, or caffeine sold at every corner store as a “convenience.”  Alexander (1987) fails to recognize obsessive compulsive urges and craving that can occur without prolonged exposure.  His arguments of either/or with several sub-associations including: behavior, treatment, and environment, etc. fail to recognize two opposing truths coexisting simultaneously.  The introduction of polarizing models of addiction while both beneficial and lacking in some asspects contributed to the evolution of the DSM-III at the time, into the DSM-IV and current DSM-V-TR, respectively.          

DSM-5-TR Impact

            The DSM-IV focused heavily on functional deficits for the individual including criminal activity.  The DSM-IV nuanced “abuse” from “dependence” as well as adding severity specifiers such as mild, moderate, and severe (APA, 2000).  The current DSM-5-TR removed judicial consequences focusing instead on differentiating intoxication and withdrawl.  Criteria including: nuanced differences with nonpathaological use, there are comorbidity acknowledgments, functional consequence applications, advances in clinical and emperical evidence with the symbiotic nature of human development, personality, and sociological and economical cobtributions to risk and protective factors, as well as development and course beyond the gentic, bio, and neurological predispositions.  While evolution is slower than the metaphorical wheels of justice, social reform prompted by the disease model of addiction has undoubably ushered in chang.  The infulenctail impacts to the DSM-5-TR began with a theory and developed objectifiable drawbacks and advantages. 

Conclusion

             Standard diagnostic processes, assessments, models, foundational understanding of homotypic and heterotypic continuity in psychopathology of disease, human development, personality, social, cultural sensitivity, awareness of bias’, as well as objectively and critically analyze discourse in research are applied holistically, individually for those who are experiencing pragmatic functional deficits, for which they are seeking help to mitigate as a person, symbiotically experiencing an expansive-small world.     

 

 

References

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Substance Abuse and Mental Health Services Administration. (2012). Brief Interventions and Brief Therapies For Substance Abuse (Vol. TIP 34). Rockville, MD, USA: U.S. Department of Health and Human Services. Retrieved from https://store.samhsa.gov/sites/default/files/d7/priv/sma12-3952.pdf

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