A Critical Look at the Concept of Addiction in DSM-5 and ICD-11

Abstract

The article begins by providing an overview of the conceptual roots of addiction as a disorder as described in DSM-5 and ICD-11. The underlying organ-pathological perspective is then criticized and an alternative social-science perspective is presented: The “dependence syndrome” defines addiction independently of the cultural, socio-demographic and situational context. States of inebriation are reduced to the effects of substances described in pharmacological terms. Diagnoses are based on only a few abstract criteria. The biography of the person affected is not taken into account; neither are the severity of the disorder (e.g. quantity and frequency of consumption or activity), sociodemographic characteristics or defense structure. The core concept of “impaired control” is a metaphor: The individual’s hierarchically structured ability to control her addictive behavior is not clarified. Neurobiological models contain overgeneralizations and speculative connections between brain processes and addictive behavior. One aspect which remains unconsidered is that addiction is primarily social. Addiction is rooted in a continuing lack of social integration and requires a wide range of inebriation-specific incentives. Addictive behavior can be seen as a purposeful coping mechanism for excessive burdens. In order to overcome an addiction, the sufferer’s autonomy needs to be strengthened in order to ensure the regeneration of physical health, individual competences and interpersonal relationships. This requires the cooperation of the relevant professional groups.