Drug dependence is not addiction—and it matters

Accurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive disorders can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, undue scrutiny of both...

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Main Authors: Maia Szalavitz, Khary K. Rigg, Sarah E. Wakeman
Format: Article
Language:English
Published: Taylor & Francis Group 2021-01-01
Series:Annals of Medicine
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Online Access:https://www.tandfonline.com/doi/10.1080/07853890.2021.1995623
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author Maia Szalavitz
Khary K. Rigg
Sarah E. Wakeman
author_facet Maia Szalavitz
Khary K. Rigg
Sarah E. Wakeman
author_sort Maia Szalavitz
collection DOAJ
description Accurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive disorders can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, undue scrutiny of both patients and physicians, and even criminal consequences. A recent study raises significant concerns about the accuracy of diagnosis code data, likely rooted in confusingly-worded International Classification of Diseases (ICD)-9 and ICD-10 codes and a general misunderstanding of the difference between addiction and physiologic dependence. It is hardly surprising that physicians frequently mislabel patients when the ICD terms used to code for addiction are themselves misleading. ICD codes have not been updated to reflect current understanding of addiction, unlike those in the DSM-5. To explore this issue further, this commentary briefly discusses new information regarding coding data inaccuracies, how coding inaccuracies can lead to misdiagnosis, and the dangers of conflating “addiction” with “dependence.” The commentary concludes with a call for the ICD to update their codes to reflect current understanding of addiction.Key messagesIt is not surprising that physicians frequently conflate patients with “addiction” and “dependence” when the ICD terms used to code for addiction are themselves misleading.ICD codes have not been updated to reflect what we know about the nature of addiction, unlike those in the DSM-5.This commentary calls for the ICD to update their codes to reflect current understanding of addiction.
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spelling doaj-art-5dd47cd065fd4197b33a1b9a2a0396c72025-08-20T03:43:57ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602021-01-015311989199210.1080/07853890.2021.1995623Drug dependence is not addiction—and it mattersMaia SzalavitzKhary K. Rigg0Sarah E. Wakeman1Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USADepartment of Medicine, Harvard Medical School, Boston, MA, USAAccurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive disorders can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, undue scrutiny of both patients and physicians, and even criminal consequences. A recent study raises significant concerns about the accuracy of diagnosis code data, likely rooted in confusingly-worded International Classification of Diseases (ICD)-9 and ICD-10 codes and a general misunderstanding of the difference between addiction and physiologic dependence. It is hardly surprising that physicians frequently mislabel patients when the ICD terms used to code for addiction are themselves misleading. ICD codes have not been updated to reflect current understanding of addiction, unlike those in the DSM-5. To explore this issue further, this commentary briefly discusses new information regarding coding data inaccuracies, how coding inaccuracies can lead to misdiagnosis, and the dangers of conflating “addiction” with “dependence.” The commentary concludes with a call for the ICD to update their codes to reflect current understanding of addiction.Key messagesIt is not surprising that physicians frequently conflate patients with “addiction” and “dependence” when the ICD terms used to code for addiction are themselves misleading.ICD codes have not been updated to reflect what we know about the nature of addiction, unlike those in the DSM-5.This commentary calls for the ICD to update their codes to reflect current understanding of addiction.https://www.tandfonline.com/doi/10.1080/07853890.2021.1995623Drug addictionICDDSMopioid use disorderoverdose crisisphysiological dependence
spellingShingle Maia Szalavitz
Khary K. Rigg
Sarah E. Wakeman
Drug dependence is not addiction—and it matters
Annals of Medicine
Drug addiction
ICD
DSM
opioid use disorder
overdose crisis
physiological dependence
title Drug dependence is not addiction—and it matters
title_full Drug dependence is not addiction—and it matters
title_fullStr Drug dependence is not addiction—and it matters
title_full_unstemmed Drug dependence is not addiction—and it matters
title_short Drug dependence is not addiction—and it matters
title_sort drug dependence is not addiction and it matters
topic Drug addiction
ICD
DSM
opioid use disorder
overdose crisis
physiological dependence
url https://www.tandfonline.com/doi/10.1080/07853890.2021.1995623
work_keys_str_mv AT maiaszalavitz drugdependenceisnotaddictionanditmatters
AT kharykrigg drugdependenceisnotaddictionanditmatters
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