DSM-IV: was it worth all the fuss?

As the Chair of the DSM-IV Substance Use Disorders Workgroup, the author reflects on the costs, benefits, and processes involved in producing diagnostic and classification systems. This paper explores the need for producing such systems, and briefly describes the historical development of diagnostic approaches dealing with alcohol and other substance use disorders. The development of the new criteria for substance use disorders in DSM-IV is reviewed, and the relationship to ICD-10 is presented. A major conclusion of the paper is that DSM-V should only appear after a long-enough period of time has elapsed to allow any deficiencies in the present manual to become apparent and alternative approaches to be fully explored.