Michigan Driver's License Restoration - Changes in the DSM Diagnosis

April 26, 2013

In the previous article, I examined the new Request for Hearing form required as of April 1, 2013, by the Michigan Secretary of State's Driver Assessment and Appeal Division (DAAD). This new form must be filed along with a Substance Abuse Evaluation and Letters of Support in order to begin a formal license appeal. I pointed out that the form only serves to make the license appeal process less clear, and in any number of places, asks for the same information provided by the substance abuse evaluator in the Substance Abuse Evaluation itself. As if that wasn't enough, the DAAD has (once again) completely missed the boat about alcohol and substance abuse issues by failing to prepare for an upcoming and dramatic shift in that field.

In just a few days (May of 2013), the American Psychiatric Association will release the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). This will replace the current edition (DSM-IV TR) and will change the entire landscape of alcohol and addiction diagnosis and treatment. The DSM is the "bible" of diagnoses. If a person is diagnosed as having anxiety disorder, autism, bi-polar disorder, depression or even schizophrenia, it is because he or she meets the specific criteria set forth in the DSM.

questionmark 1.2.jpgThe DAAD requires a DSM diagnosis as part of the Substance Abuse Evaluation form. Only a trained professional can make such a diagnosis. As it stands now, the Substance Abuse Evaluation form has a section that requires the evaluator to provide a DSM-IV diagnosis. That's perfectly fine, but it won't be once the new manual comes out in the coming days. Once the new manual is published, current diagnoses of alcohol abuse and alcohol dependence won't exist anymore.

This is worth repeating: The DSM-5 is expected to eliminate the diagnoses of alcohol abuse and alcohol dependence. In their place, a new category, called alcohol use disorder, will take over. This is really heavy stuff, and I will likely examine the implications in upcoming articles. This is, of course, very relevant to me, not only as a lawyer, but also as someone who formally studies, at the post-graduate University level, the diagnosis and treatment of alcohol and substance abuse issues. For now however, we'll just focus on how the DAAD missed this, and what that means.

To put this in perspective, one of many other anticipated changes in the DSM-5 will be the elimination of Asperger's syndrome as a separate diagnosis. Somewhat related to autism, anyone who has a child receiving treatment for Asperger's syndrome will suddenly find that their insurance company will no longer pay for such treatment once the new manual is published. After all, how can you be covered for a condition that no longer exists? Of course, most of those with a diagnosis of Asperger's will be re-diagnosed under the expanded continuum of Autism disorders, but the point is that, until that's formally done, there will be no insurance coverage.

In the same way, we may expect some fallout for anyone receiving outpatient treatment for alcohol abuse when that diagnosis is eliminated. Sure, such a person may very well be thereafter diagnosed as having "alcohol use disorder," but the one thing we can say for sure is that once the DSM-5 comes out, "alcohol abuse" will no longer exist. How then, can the state ask for and make legal decisions based upon clinical criteria that no longer exist?

Well, the diagnosis itself may no longer exist in the clinical setting but it will still live on the current version of the DAAD's Substance Abuse Evaluation form. Bravo, State of Michigan; you added one new useless form just as the other required form becomes clinically obsolete. And it's not like this DSM some new idea, either. It takes years and years for a new DSM to come out, or to be revised, and anticipation builds as the work is done and a publication date is projected. The DSM-5 has been big news for quite a while. If anything you do has anything to do with any kind of mental health diagnosis, then you know all about the DSM. The license appeals decided by the DAAD rely upon the DSM for diagnosis. In other words, the DSM is central to every license appeal. The Substance Abuse Evaluation form specifically requires a DSM-IV diagnosis. The DSM-IV becomes obsolete this month (May of 2013). The DSM-5 takes over, not just to become the new standard, but the only standard by which alcohol and substance abuse issues are measure and ultimately diagnosed.

And the state just ignored this.

So what does all this mean?

It means that, on the day the DSM-5 is published, the DAAD's Substance Abuse Evaluation form will be asking for a diagnosis that no longer exists.

This probably sounds worse than it is, because it 's not like any evaluator is going to forget, overnight, how they've been doing things since 1994 (the DSM-IV was revised in 2000). Even so, as these professionals implement the profound changes in diagnostic criteria, they'll have to find a way to reconcile the way things are supposed to be done with the formally out-of-date way the state will still require.

Because of my involvement in formal, University post-graduate level studies of alcohol and addiction studies, and particularly the diagnosis and treatment of alcohol and drug problems, I will necessarily have one foot in each world. As a Michigan driver's license restoration lawyer, this means I will be fluent in the language of diagnosis, both old and new. This should be of particular interest to anyone looking to hire a driver's license restoration attorney. Eventually, the state will catch up. Yet it should not be lost upon the reader that if anyone drives a car with a license plate or tab that's even one day out of date, he or she can be charged with and convicted of a crime. Here, however, the state can do (or rather just not do) whatever it likes, rather unlike its citizens.