Diagnosis

Diagnostic Systems

There are two diagnostic systems used in different parts of the world to describe mental disorders, including substance use disorders: (1) the International Classification of Diseases, now in its 10th edition, developed by the World Health Organization, and (2) the Diagnostic and Statistical Manual of Mental Disorders (DSM), developed by the American Psychiatric Association. In the later editions of the DSM, psychologists helped develop the diagnostic system, which is currently in its fourth edition, with text revision (DSM-IV-TR).

History of Diagnosis of Substance Use Disorders

The history of psychiatric classification started in antiquity. However, the beginning of the modern classification of psychiatric symptoms started with Emil Kraepelin, a German psychiatrist who, beginning in the 1870s, meticulously described schizophrenia, manic-depressive psychosis, and the cognitive disorders, among others. His descriptions were of a clinical nature, and they laid the groundwork for the diagnostic system as it is known today. Diagnostic classifications have been studied since that time. Kraepelin also advocated a thorough diagnostic interview which, today, is an important aspect of diagnosis.

The International Classification of Diseases (ICD), now in its 10th edition, is the latest in a series that had its origins in the 1850s. The World Health Organization took responsibility for the development of the ICD after World War II; it has now been endorsed by 43 countries. The ICD has become the international standard classification for all general epidemiological and health management purposes. It describes diagnostic characteristics for acute intoxication, harmful use of psychoactive substances, withdrawal states with or without delirium, dependence syndrome, and amnesic syndrome associated with substance dependence. There are substantial similarities between the ICD-10 and the DSM-IV-TR. However, the DSM-IV-TR is used mostly in the United States, while the ICD-10 is used around the world, including in developing countries.

After World War II, several state hospital psychiatrists in the United States decided to work together to simplify and unify the then-chaotic diagnostic system. The results, the first two DSM editions, DSM-I, published in 1952 and DSM-II, published in 1968, are considered consensus documents; they were not built on quantitative research. However, in the 1960s and 1970s, support from the National Institute on Mental Health increased funding for diagnostic research on mental disorders, and the more recent versions—DSM-III, published in 1980; DSM-III-R, published in 1987; and DSM-IV, published in 1994—were based far more on research than were earlier versions. The different editions of the DSMs have seen many changes for most of the mental health disorders, including the evolution of the diagnosis of substance abuse and dependence.

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