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Guide to the DSM-5 for Substance Use Disorders in Michigan DUI Cases

Sep 22nd, 2016 DUI Penalties DUI

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a compendium setting forth a standardized classification system for mental disorders that is used throughout the United States.  Consequently, if you are charged in Michigan for intoxicated driving, and you decide to have a substance abuse evaluation (SAE) performed, then any diagnosis of a substance use disorder should be based on the DMS-5 criteria.

Also, if you end up being convicted of a drunk driving case in Michigan, then the law requires the judge to order you to be screened for a possible alcohol use disorder.  According to Michigan Vehicle Code Act 300 of 1949, found in section 257.625b(5) of the Michigan Motor Vehicle Code, the purpose of the substance abuse evaluation is to determine if you might benefit from alcohol or drug education or treatment. A SAE will also be required if you are attempting to have your driver license restored after multiple drunk driving convictions.

In Michigan, all courts use the NEEDS assessment for this purpose.  This assessment contains 130 questions, 129 of which can be answered yes/no.  Of the 130 questions, 46 are directly related to alcohol and/or drug use.  The government, and particularly courts, are the only place a NEEDS assessment would be administered for this purpose.  It is a simple standardized test that probation officers with little or no mental health training can administer and score.

Prior to being convicted, your lawyer may suggest that you have a “private” substance abuse evaluation (SAE).  There are many therapists who specialize in substance use disorders who can prepare this SAE. Most private therapists use either the MAST (Michigan Alcohol Screening Test) and/or SASSI (The Substance Abuse Subtle Screening Inventory).  The purpose of both these tools is to assist the therapist in determining if you meet the criteria for a DMS-5 diagnosis.

According to the DMS-5, “The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.”  These clusters include more specific categories, such as impaired control, social impairment, risky use, and pharmacological criteria.

The DMS-5 was published in 2013.  Prior to that time, there were essentially two possible diagnoses for an alcohol use disorder; person either suffered from an alcohol abuse disorder or an alcohol dependence disorder.  Neither diagnosis is currently used.  The approach of the DMS-5 is to look at the issue of the misuse of alcohol use as a spectrum of severity, which can range anywhere from mild, which means having “only” the presence of 2-3 symptoms, 305.00 (F10.10), or moderate, with 4-5 symptoms, 303.90 (F10.20), or severe, having 6 or more symptoms. 303.90 (F10.20)

According to the DSM-5, a symptom is scored, “if there is a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.”

There are 10 total possible symptoms, and these include (1) alcohol being taken in larger amounts or times than intended; (2) unsuccessful attempts to stop or cut down use; (3) cravings; (5) continued use despite bad consequences and outcomes (such as a prior drunk driving arrest); (6) giving up other important social or occupational activities to pursue or because of alcohol use; (7) use despite facing health consequences.  Also considered are tolerance and withdrawal.