Commentary: Craving diagnostic validity in DSM-5 Substance Use Disorders.

Drs. Norko and Fitch examine questions raised by DSM-5 in the forensic context of criminal defendant diversion to treatment, where eligibility has commonly relied on the view that addiction to alcohol or drugs is distinct from alcohol or drug use, misuse, and abuse. The creation in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), of the new unidimensional spectrum diagnosis of Substance Use Disorder (SUD), which includes three Abuse criteria from DSM-IV, has resulted in a need to re-examine policies that evolved with the DSM-III-R/DSM-IV biaxial abuse-dependence conceptual paradigm. DSM-5 acknowledges the common usage of the term addiction to describe severe problems, and that some clinicians choose to use the word to describe more extreme presentations. Limiting the concept of addiction to the severe form of DSM-5 SUD would maximize validity and support for an expert opinion that an individual has an addiction, as well as facilitate research inquiry into the underlying psychobiological nature of addiction. However, in some contexts, such as criminal diversion, achieving such specificity at the expense of sensitivity may be undesirably restrictive if it excludes appropriate candidates. Future research and experience in both clinical and forensic settings are needed for a fuller understanding of the DSM-5 SUD diagnoses and associated real-world implications.