Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions includ...

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DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale

The phrase primum non nocere (''first, do no harm'') is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of haz- ardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psycho- therapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practi- tioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide in- sight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies.

/pdf/psychological-treatments-that-cause-harm-of9m032hsy.pdf

Psychological Treatments That Cause Harm

In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: (a) briefly reviews definitions of discrimination, illustrated with examples from the United States; (b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; (c) concisely summarizes extant evidence--both robust and inconsistent--linking discrimination and health; and (d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.

https://journals.sagepub.com/doi/pdf/10.2190/HS.44.4.b

Discrimination and health inequities.

There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation - better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys - one cohort study and one randomized clinical trial - that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

Can Patient Self-Management Help Explain the SES Health Gradient?

Self-compassion is a self-attitude construct derived from Buddhist psychology (Neff, 2003a). It entails being kind rather than harshly critical toward oneself, perceiving one's experiences as part of the larger human experience, and holding painful feelings in mindful awareness. Given that self-compassion is an Asian construct, this study compares self-compassion levels in the United States, Thailand, and Taiwan. Results indicate that self-compassion is highest in Thailand and lowest in Taiwan, with the United States falling in between. Interdependence is linked to self-compassion in Thailand only, whereas independence is linked to self-compassion in Taiwan and the United States. Results suggest that self-compassion levels in these societies are linked to specific cultural features rather than general East—West differences. However, self-compassion is significantly associated with well-being in all three cultures.

/pdf/self-compassion-and-self-construal-in-the-united-states-4c9moi0cju.pdf

Self-Compassion and Self-Construal in the United States, Thailand, and Taiwan

FINALIST FOR THE LOS ANGELES TIMES BOOK PRIZE IN SCIENCE What can't neuroscience tell us about ourselves? Since fMRI--functional magnetic resonance imaging--was introduced in the early 1990s, brain scans have been used to help politicians understand and manipulate voters, determine guilt in court cases, and make sense of everything from musical aptitude to romantic love. But although brain scans and other neurotechnologies have provided groundbreaking insights into the workings of the human brain, the increasingly fashionable idea that they are the most important means of answering the enduring mysteries of psychology is misguided--and potentially dangerous. In Brainwashed, psychiatrist and AEI scholar Sally Satel and psychologist Scott O. Lilienfeld reveal how many of the real-world applications of human neuroscience gloss over its limitations and intricacies, at times obscuring--rather than clarifying--the myriad factors that shape our behavior and identities. Brain scans, Satel and Lilienfeld show, are useful but often ambiguous representations of a highly complex system. Each region of the brain participates in a host of experiences and interacts with other regions, so seeing one area light up on an fMRI in response to a stimulus doesn't automatically indicate a particular sensation or capture the higher cognitive functions that come from those interactions. The narrow focus on the brain's physical processes also assumes that our subjective experiences can be explained away by biology alone. As Satel and Lilienfeld explain, this "neurocentric" view of the mind risks undermining our most deeply held ideas about selfhood, free will, and personal responsibility, putting us at risk of making harmful mistakes, whether in the courtroom, interrogation room, or addiction treatment clinic. A provocative account of our obsession with neuroscience, Brainwashed brilliantly illuminates what contemporary neuroscience and brain imaging can and cannot tell us about ourselves, providing a much-needed reminder about the many factors that make us who we are.

Brainwashed: The Seductive Appeal of Mindless Neuroscience

One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance

The common-sense use of the term addiction is that regular consumption is irresistible and that it creates problems. Caffeine use does not fit this profile. Its intake does no harm to the individual or to society and its users are not compelled to consume it. Though cessation of regular use may result in symptoms such as headache and lethargy, these are easily and reliably reversed by ingestion of caffeine. Some have argued that continued caffeine use is an attempt to suppress low grade withdrawal symptoms such as sleepiness and lethargy. In some moderate users, this is possible; however, in experimental contexts, the phenomenon is too inconsistent to constitute a reliably valid syndrome.

https://www.sallysatelmd.com/html/2006-12-05_IsCaffeineAddictive.pdf

Is Caffeine Addictive?—A Review of the Literature

at m a k e s us s ick? P o i s o n c h e m i c a l s , vises, s m o k i n g . T h e s e and h u n d r e d s o f o t h e r th ings . But w h a t a b o u t m o d e r n m e d i c i n e itself?. More a n d m o r e , soc ia l ac t iv is t s , s cho la r s , a n d e v e n h e a l t h p r o f e s s i o n a l s a re t e l l i ng us t ha t t h e cult u re o r m e d i c i n e is to b l a m e for m a n y i l lnesses . No, t h e y a re n o t t a lk ing a b o u t h e a l t h i n s u r a n c e w o e s , f i f t e e n m i n u t e o f f i ce vis i ts , o r m e d i c a l mist akes . He re is w h a t t h e c r i t i c s a re u p to:

How political correctness is corrupting medicine

ON JUNE 26, 2000, the White House announced to the world that the human genome had been sequenced (with the final, polished version due perhaps by 2002). Though the precise functions of all our genes have yet to be deciphered -- Nobel laureate David Baltimore foresees a "century of work ahead of us" -- it is clear that we are on the threshold of knowledge that could revolutionize the way we predict, diagnose, and treat disease. The momentous discovery was lauded for something else as well: It supposedly laid to rest the idea that race is a biological category. "Researchers have unanimously declared there is only one race -- the human race," said the New York Times in an article headlined "Do Races Differ? Not Really, DNA Shows." Much heralded was the finding that 99.9 percent of the human genome is the same in everyone regardless of race. "The standard labels used to distinguish people by 'race' have little or no biological meaning," claimed the Times. Said Stephen Jay Gould, evolutionary biologist at Harvard: "The social meaning [of race] may finally liberate us from [that] simplistic and harmful idea." That point has found its way into the rhetoric of politicians. As former President Clinton has said, "in genetic terms all human beings, regardless of race, are more than 99.9 percent the same. . . . The most important fact of life on this earth is our common human ancestry." We were reminded by former GOP vice presidential candidate Jack Kemp that "the human genome project shows there is no genetic way to tell races apart. For scientific purposes, race doesn't exist," he averred. In Hollywood, too, notice was taken. When a television talk show host asked actor Rob Reiner about the sparring his character did with Archie Bunker on the long-running television program "All in the Family," Reiner (aka "Meathead") explained that Archie's signature bigotry stemmed from ignorance. "We are all the same, though," Reiner said, "the human genome project taught us that." The human genome project, in the view of many, helped pound the final coffin nail in place: Race was at long last dead. It is noble, of course, to celebrate spiritual kinship within the family of man, and now even to suggest that race has biological meaning, it seems, can be something close to professional suicide. The mere mention of race and biology together sends many physicians and scientists scrambling to protest (too much) against a possible connection. The facts, however, paint a more complex picture, one with clinical implications: race does have biological dimensions, and if we regard it solely as a social construct, we may forfeit opportunities to enlarge our medical treatment repertoire. Wanting it both ways THE SENTIMENTS FUELING the impulse to regard race as an arbitrary biological fiction should be taken seriously, especially given the shameful history of race and biology. People properly shudder at the memory of the Tuskegee Syphilis Experiment, in which hundreds of black sharecroppers were never told they had the disease nor offered penicillin for its treatment. Many now worry that genetic determinism might be used as the sole explanation for social differences between races or, worse, as justification for new eugenics movements and programs of ethnic cleansing. Nevertheless, the corrective is not obfuscation or outright censorship of inquiry. It is a clear-eyed understanding of the intertwining of race and biology. Denying the relationship flies in the face of clinical reality, and pretending that we are all at equal risk for health problems carries its own dangers. We were reminded last May of the controversy about the role of race in biomedical research when the New England Journal of Medicine (NEJM) published two papers describing the responses of black and white patients to medications used to treat heart disease. The researchers sought to compare racial groups in light of the well-documented observation that, on average, African Americans with high blood pressure and other cardiovascular conditions do not fare as well as whites when given the same medications. …

Sally Satel

Papers

Brainwashed: The Seductive Appeal of Mindless Neuroscience

One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance

Is Caffeine Addictive?—A Review of the Literature

How political correctness is corrupting medicine

Medicine's Race Problem