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Implications for clinical practice

Conceptualizing substance use disorders as a continuum

The DSM-5 is not intended as a treatment guide, but as a system for grouping individuals based on the nature of their illness. Needless to say, any classification system has potential legal and clinical implications.

In reconceptualizing substance use problems as occurring on a continuum of severity and eliminating "abuse" and "dependence" terminology, the DSM-5 carries its own implications for clinical practice and for how patients perceive their disorder and recovery.

While many addiction specialists continue to use the old labels of abuse and dependence, the DSM-5 reflects a conceptual shift that places substance use problems along a continuum, where individuals shift back and forth in the level of severity of their disorder. This new view has significant implications for treatment and for people in recovery:

  • Some people find the continuum concept uncomfortable because it may challenge ideas that keep them safe.
  • People in an intermediate range of severity in their substance use may find it liberating that their problematic behaviours can be brought under control.

It remains to be seen how clinicians in the field will interpret this.

Many people who have completed addiction treatment must never use substances again, whereas there are others whose problematic behaviours can become stable and manageable. Distinguishing between these two populations is part of the art of addiction work and is often only clarified over time.