I had the opportunity to sit in a Symposium at the recent American Society of Addiction Medicine (ASAM) Medical Scientific Conference moderated by members of the work group that is creating the section of DSM-5 about Substance Use and Addictive Disorders. I was impressed by the sensible, well-thought out processes that went into the formulation of the DSM-5 criteria. For example, “legal problems” is not going to be a criterion for addiction, since data sets for this symptom do not correlate with the disease. Also, there is no clear evidence that abuse is related to addiction so “abuse” will not be included in the diagnoses. Now for the bad news: The DSM committee has proposed ten criteria for the diagnosis of addiction – they are proposing that “tolerance” and “physical dependence” be excluded from making the diagnosis of addiction if medications are prescribed by a physician. I believe this is an attempt to exclude people who are taking medications as prescribed. My concern is that many people with addiction are getting their medications from physician (s) and are in trouble with their addictive disorder. This exclusion effectively makes it “harder” to diagnose addiction in someone who is using/abusing prescription drugs. I don’t think this is logical or sensible. I encourage you to contact the APA regarding your opinions about the DSM-5. I have enclosed the APA/ASAM information about this: “An American Psychiatric Association (APA) workgroup is addressing diagnostic criteria for substance-related disorders which would appear in the Fifth Edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is facing challenges with respect to basic terminology: some advocate for the use of the term “addiction” and others advocate for retention of the term “dependence” to describe significant substance-related disorders. Please read ASAM’s response to this issue. From my time with the DSM representatives who are working on this chapter at the ASAM meeting, it appeared that they read each communication and factor them into the decision process. Here’s our chance to impact the system. With best personal regards, Mel Pohl, M.D. Medical Director