Substance-Related and Addictive Disorders

Question 1

Q: What major structural change occurred in the DSM-5 for Substance-Related Disorders?

Answer 1

A: The DSM-5 combines substance abuse and substance dependence into a single category: Substance Use Disorder. This reflects the understanding that the two conditions represent different degrees of severity within a single disorder.

Question 2

Q: How does the DSM-5 indicate the severity of Substance Use Disorder?

Answer 2

**A: The DSM-5 introduces severity specifiers based on the number of criteria met:

Mild: 2-3 criteria
Moderate: 4-5 criteria
Severe: 6 or more criteria.**

Question 3

Q: What changes were made to the diagnostic criteria for Substance Use Disorder in DSM-5?

Answer 3

A: The DSM-5 removes the criterion related to legal problems and adds a new criterion for craving or a strong desire or urge to use a substance.

Question 4

Q: What new disorders were added in the DSM-5 under Substance-Related and Addictive Disorders?

Answer 4

A: The DSM-5 adds Gambling Disorder as a behavioral addiction and includes Cannabis Withdrawal as a diagnosable condition.

Question 5

Q: How does the DSM-5 recognize behavioral addictions?

Answer 5

A: The DSM-5 includes Gambling Disorder in the category of Substance-Related and Addictive Disorders, acknowledging that behaviors can lead to addiction-like conditions.

Question 6

Q: How are substance-specific diagnoses handled in the DSM-5?

Answer 6

A: The DSM-5 provides specific criteria for various substance-related disorders, such as Alcohol Use Disorder, Opioid Use Disorder, Stimulant Use Disorder, and others, with tailored criteria for each substance.

Question 7

Q: What disorder was removed in the DSM-5?

Answer 7

A: The DSM-5 removes the diagnosis of Polysubstance Dependence, recognizing that individuals often have multiple substance use disorders rather than a single diagnosis for polysubstance use.

Question 8

Q: What new course specifiers are included in the DSM-5 for Substance Use Disorders?

Answer 8

A: The DSM-5 adds specifiers such as “in early remission” and “in sustained remission” to provide more detailed information about the individual’s recovery status.

Question 9

Q: How does the DSM-5 define remission for Substance Use Disorders?

Answer 9

**A: The DSM-5 defines remission as follows:

Early Remission: 3 to 12 months without meeting substance use disorder criteria (except craving)
Sustained Remission: Over 12 months without meeting criteria (except craving).**

Question 10

Q: Why was craving added as a criterion in the DSM-5?

Answer 10

A: The addition of craving as a criterion highlights the importance of the intense desire to use a substance as a key aspect of addiction.

Question 11

Q: What does the category of Substance-Related and Addictive Disorders in DSM-5 include?

Answer 11

A: This category includes substance-use and substance-induced disorders for 10 classes of substances: alcohol; caffeine; cannabis; phencyclidine and other hallucinogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco; and other/unknow

Question 12

Q: What are Substance-Use Disorders characterized by according to DSM-5?

Answer 12

A: Substance-Use Disorders are characterized by “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.”

Question 13

Q: What categories of symptoms are included in Substance-Use Disorders?

Answer 13

A: Symptoms fall into four categories: impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal).

Question 14

Q: How many symptoms and for what duration are required for a diagnosis of Substance-Use Disorder?

Answer 14

A: The person must have two or more symptoms within a 12-month period.

Question 15

Q: Can Substance-Use Disorder be diagnosed for all classes of substances?

Answer 15

A: No, Substance-Use Disorder can be diagnosed for all classes of substances except caffeine.

Question 16

Q: How is the severity of Substance-Use Disorder determined?

Answer 16

A: The severity is determined by the number of symptoms present.

Question 17

Q: What are some of the evidence-based interventions for treating Substance-Use Disorders?

Answer 17

A: Evidence-based interventions include cognitive behavioral therapy, motivational enhancement therapy, contingency management, family behavior therapy, the community reinforcement approach, and 12-step facilitation.

Question 18

Q: What medications are used to treat Alcohol Use Disorder?

Answer 18

A: Disulfiram, naltrexone, acamprosate, and topiramate are used to treat Alcohol Use Disorder.

Question 19

Q: What is the Community Reinforcement and Family Training (CRAFT) approach?

Answer 19

A: CRAFT is designed for individuals who refuse to seek treatment for substance abuse. It works with a concerned significant other (CSO) to help influence the identified patient to enter treatment, reduce substance use, and improve the CSO’s quality of life.

Question 20

Q: What combination of interventions is often most effective for Substance-Use Disorders?

Answer 20

A: Combined interventions, such as therapy and medication, are often most effective. For example, combining therapy with nicotine nasal spray or varenicline is most effective for tobacco use disorder.

Question 21

Q: What is Marlatt and Gordon’s relapse prevention therapy (RPT)?

Answer 21

A: RPT is a cognitive-behavioral approach that views substance addiction as a “learned habit pattern” and focuses on helping clients recognize and deal more effectively with high-risk situations to prevent lapses from becoming full-blown relapses.

Question 22

Q: What disorders are included in Substance-Induced Disorders?

Answer 22

A: Substance-Induced Disorders include substance intoxication, substance withdrawal, substance withdrawal delirium, and substance/medication-induced mental disorders.

Question 23

Q: What are the criteria for Alcohol Intoxication?

Answer 23

A: Alcohol Intoxication involves problematic behavioral and psychological changes with at least one of six symptoms: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory, stupor or coma.

Question 24

Q: What are the criteria for Alcohol Withdrawal?

Answer 24

A: Alcohol Withdrawal requires at least two of eight symptoms within several hours to a few days following cessation or reduction of heavy and prolonged alcohol use: autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, anxiety, psychomotor agitation, generalized tonic-clonic seizures.

Question 25

Q: What is Alcohol-Induced Major Neurocognitive Disorder?

Answer 25

A: This diagnosis requires evidence of a significant decline in one or more cognitive domains that interferes with independence in everyday activities, with a specifier indicating if the disorder is the nonamnestic-confabulatory type or amnestic-confabulatory type (Korsakoff syndrome).

Question 26

Q: What are the criteria for Opioid Intoxication?

Answer 26

A: Opioid Intoxication involves significant problematic behavioral or psychological changes plus pupillary constriction and the development of at least one of three symptoms during or shortly after opioid use: drowsiness or coma, slurred speech, impaired attention or memory.

Question 27

Q: What are the criteria for Opioid Withdrawal?

Answer 27

A: Opioid Withdrawal requires the development of at least three of nine symptoms following cessation of heavy and prolonged opioid use or administration of an opioid antagonist after opioid use: dysphoric mood, nausea or vomiting, muscle aches, diarrhea, yawning, fever, insomnia.

Question 28

Q: What are some examples of opioids?

Answer 28

A: Opioids include opium, heroin, morphine, codeine, methadone, oxycodone, hydrocodone, and fentanyl.

Question 29

Q: What are the criteria for Sedative, Hypnotic, or Anxiolytic Intoxication?

Answer 29

A: This disorder involves maladaptive behavioral and psychological changes with at least one of six symptoms that develop during or shortly after use: slurred speech, incoordination, unsteady gait, nystagmus, impaired cognition, stupor or coma.

Question 30

Q: What are the criteria for Sedative, Hypnotic, or Anxiolytic Withdrawal?

Answer 30

A: Sedative, Hypnotic, or Anxiolytic Withdrawal requires the development of at least two of eight symptoms within several hours to a few days after cessation or reduction of use: autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures.

Question 31

Q: What is Korsakoff syndrome and what causes it?

Answer 31

A: Korsakoff syndrome, linked to a thiamine deficiency, involves anterograde and retrograde amnesia and confabulation, and is a specifier for Alcohol-Induced Major Neurocognitive Disorder.

Question 32

Q: What characterizes Stimulant Intoxication?

Answer 32

A: Stimulant Intoxication is characterized by maladaptive behavioral and psychological changes (e.g., euphoria, hypervigilance, anxiety, impaired judgment) and at least two of nine symptoms during or shortly after stimulant use: tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, respiratory depression or cardiac arrhythmia, seizures or coma.

Question 33

Q: What are some examples of stimulant drugs?

Answer 33

A: Stimulant drugs include amphetamines, methamphetamines, and cocaine.

Question 34

Q: What is required for a diagnosis of Stimulant Withdrawal?

Answer 34

A: Stimulant Withdrawal requires a dysphoric mood and at least two of five physiological changes within a few hours to several days after cessation of prolonged stimulant use: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation.

Question 35

Q: What are the criteria for Tobacco Withdrawal?

Answer 35

A: Tobacco Withdrawal involves at least four of seven symptoms within 24 hours of abrupt cessation or reduction of tobacco use: irritability, anger or anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia.

Question 36

Q: How long do tobacco withdrawal symptoms typically last?

Answer 36

A: Withdrawal symptoms typically peak 48 to 72 hours following cessation of nicotine use and then gradually wane over several weeks.

Answer 37

Q: What can cause early and late relapses in tobacco cessation?

A: Cravings for nicotine, which last longer than withdrawal symptoms, can cause early and late relapses.