OnlineMedEd: Psychiatry - Addiction

Question 1

What was the big change in addiction diagnosis from the DSM-IV to the DSM-V?

Answer 1

The DSM-IV used terms like abuse, use, and dependence, while the DSM-V has abandoned those words in favor of the “substance use disorder” spectrum.

Question 2

Part of the diagnostic criteria for a substance use disorder involves lack of control. What things might indicate control issues?

Answer 2

• Excessive intake
• Inability to stop
• Too much time spent doing the substance or seeking out the substance
• Cravings

Question 3

Part of the diagnostic criteria for a substance use disorder involves social impairment. What things might indicate social impairment?

Answer 3

• Failure to meet obligations due to substance abuse
• Destruction to relationships due to substance abuse
• Not maintaining hobbies/activities due to substance abuse

Question 4

What two subcategories fall under the “risk” criterion?

Answer 4

• Hazardous behavior (like sex work or driving under the influence)
• Complications from substance abuse (like legal or medical fallout)

Question 5

“Physical” criteria also fall under the diagnostic workup. What two physical symptoms of substance abuse should you look for?

Answer 5

• Tolerance

* Withdrawal

Question 6

What is the CAGE criteria?

Answer 6

• Cutting down (“Have you tried to cut down but can’t?”)
• Anger (“Has your family/friends ever gotten mad at you for using?”)
• Guilt (“Do you ever feel guilty for using?”)
• Eye opener (“Do you ever need to use to start the day?”)

Question 7

As far as adolescents and substance use, _________________.

Answer 7

experimentation is considered normal, but the earlier people try something, the more likely they are to develop a substance use disorder

Question 8

What screening test is often used in pediatric settings?

Answer 8

CRAFFT
•Car (“Do you ever use this substance and then drive?”)
•Relax (“Do you ever use this substance to relax?”)
•Alone (“Do you ever use this substance alone?”)
•Forget (“Do you ever use this substance to forget?”)
• Friends (“Have you lost friendships due to this substance?”)
• Trouble (“Have you gotten in trouble with the police or at school because of this substance?”)

Question 9

How is the severity of substance use disorders graded?

Answer 9

• 2-3 mild
• 4-5 moderate
• 6+ severe

Question 10

What are the components of substance use treatment?

Answer 10

• Pharmacologic intervention (for alcohol, tobacco, and opiates)
• Psychotherapy
• Group work (like AA)
• Encourage them to persist through relapses

Question 11

What is the FRAMES mnemonic for psychotherapy for those with SUDs?

Answer 11

• Feedback: encourage what they do well and discourage risky or self-destructive behavior
• Responsibility: make them accountable for their actions
• Advice: tell them what options they have
• Menu of options: if one therapy tool doesn’t work, then just try another
• Empathy: many have been resented by their families; show them you care!
• Self-efficacy: show them that they can make themselves better!