James Giordano
Georgetown University Medical Center, USA
Posters & Accepted Abstracts: J Psychol Psychother
The DSM-5 is frequently used, either alone or in combination with the ICD, to categorize psychiatric disorders and in so doing, establish better criteria from which to plan and execute clinical care. Clarifying diagnostic terms is vital to standardize what they signify, and this may be even more important when considering the dual diagnosis and the care comorbidity may require. In this lecture, the author will address practical ethico-legal issues and concerns generated by dual diagnosis of chronic pain and substance-use/addictive disorder. Specifically, the author will describe how diagnostic labels and particularly those related to mental illness can be stigmatizing and may evoke medical, legal and social biases that affect the ways by which patients are regarded and treated. The author will explicate the complexities of these disorders apropos of the current opioid crisis and argue that diagnosis demands action. The author will posit that the philosophy of medicine defines a moral obligation to develop improved assessment and care of those who are burdened by chronic pain and substance use/addictive disorders. To this end, the author will propose ways that newly developing neurotechnologies, such as types of genetic assays, neuroimaging, novel pharmaceutical preparations, non-invasive and deep brain stimulation could and should be engaged to improve the focus, scope, safety, effectiveness and efficiency of care. As well, the author will describe how the realization of any such effort will require conjoint participation of economic and administrative infrastructures of medicine, as well as the development of supportive guidelines, policies and law(s).
