A glimps into the Future

Although what exactly will happen remains to be seen, I want to briefly highlight the "innovations" in the ongoing — and likely continuing until 2027 — transition from ICD-10 to ICD-11. The new "catalog" has been available since 2022 and is officially in effect, but it will probably take at least another 5 years for accurate translation and implementation. This involves ensuring correct semantic alignment across language versions, plus a revised coding system that places higher demands on software systems.

Here’s how the changes compare:

ICD-11	ICD-10
The diagnosis requires that 2 or more of the 3 core criteria be present over a period of at least 12 months, but can also be made if the substance is used continuously (daily or almost daily) for at least one month.	In order to diagnose addiction syndrome, three or more criteria must be present simultaneously for at least one month or repeatedly within 12 months.
First: Impaired control over substance use – in terms of the onset, amount, circumstances, or cessation of use. This is often, but not necessarily, accompanied by subjective feelings of urge or craving to use the substance.	Firstly: A strong craving or a kind of compulsion to consume the substances. Second: Reduced control over substance use, i.e., over the start, end, or amount of consumption, clearly evident in the fact that more of the substance is often consumed than planned, or over a longer period of time than planned, or in the persistent desire or unsuccessful attempts to reduce or control substance consumption.
Second: Physiological characteristics (indicative of substance-related neuroadaptation) manifest as: (i) tolerance, (ii) withdrawal symptoms after consumption—cessation or reduction, or (iii) repeated consumption of the substance to reduce or prevent withdrawal symptoms. Withdrawal symptoms must correspond to the withdrawal syndrome of the substance and are not attributable to persistent effects of the substance.	Thirdly: Development of tolerance to the effects of the substance. In order to achieve intoxication or the desired effect, larger amounts of the substance must be consumed, or significantly lower effects occur with continued consumption of the same amount. Fourth: A physical withdrawal syndrome when the substance is reduced or discontinued, with withdrawal symptoms typical of the substance, or also detectable through the use of the same or a very similar substance to alleviate or avoid withdrawal symptoms.
Thirdly: Substance use progressively becomes a priority in life, meaning that the substance takes precedence over other interests, pleasures, daily activities, obligations, or health or personal care. Substance use increasingly takes center stage in the person's life, pushing other aspects of life to the periphery, and often continues despite the emergence of problems.	Fifth: Restriction to substance use, clearly evident in the abandonment or neglect of other important pleasures or areas of interest due to substance use; or a great deal of time is spent obtaining, consuming, or recovering from the substance. Sixth: Continued use despite clear harmful consequences, as evidenced by continued use even though the person is aware or could be aware of the nature and extent of the harm.

Shadow Talk

Subject to a few minor adjustments still anticipated, the transition presents as follows:

Single symptoms become double symptoms.

The 3-out-of-6 rule fundamentally shifts to a 2-out-of-3 rule. Considering that only individual criteria within these double symptoms need be sufficiently met, the number of diagnoses will necessarily increase.

Although these innovations bear no relevance for me or my work, they substantially constrict the leeway for dependents and will provoke activism that the healthcare system and economy must address.

Sooner or later, it will grow increasingly difficult to sustain certain constructs and continue deceiving oneself through life as before.

Conversely, companies may find themselves compelled to intensify preventive measures to safeguard their "human capital" long-term.

This effect will prove uncontainable within specific substances.

In conclusion, such semantic broadening of formulations opens the floodgates to coercive measures — measures from which escape may prove impossible, given that the erosion of self-control has been tacitly accepted.