Addiction Diagnoses May Rise under New Guidelines

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WASHINGTON -- In what could prove to be one of their most far- reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation's arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.

The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or DSM, would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the website of the American Psychiatric Association, which produces the book.

In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category -- "behavioral addiction -- not otherwise specified" -- that some public health experts warn would be too readily used by doctors to diagnose addictions to shopping, sex, Internet use or playing video games.

Part medical guidebook, part legal reference, the manual dictates whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will expand financing for certain special-education services. Courts also use it to assess whether a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research.

The broader language involving addiction, which was debated this week at the association's annual conference, is intended to promote more accurate diagnoses, earlier intervention and better outcomes, the association said.

"The biggest problem in all of psychiatry is untreated illness, and that has huge social costs," said James H. Scully Jr., chief executive of the group. …