DSM-5 and substance use disorders: clinicolegal implications.

Presumed distinctions between substance dependence and substance abuse have been at the heart of the development and utilization of substance-based diversion from criminal prosecution to treatment for the past several decades, including its use in drug courts. These distinctions have been promulgated by organized psychiatry since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980. With the release of DSM-5 and the replacement of abuse and dependence categories with a single use disorder construct, the legal grounds for diversion in many states now stand at odds with organized psychiatry and its adoption of recent science. This article reviews the scientific basis for the DSM's new classification scheme, the dilemmas posed for states with statutes that rely on the abuse/dependence distinction, and potential remedies for legislatures wishing to keep pace with evolving research and clinical practice.