Week 4b: DSM5 SUD Diagnosis

Question 1

DSM4 Diagnostic Categories:

Answer 1

Substance Use Disorders

Substance abuse; less severe; may or may not lead to substance dependence

Substance dependence; more severe; corresponds roughly with addiction

—Substance-Induced Disorders

• Intoxication
• Substance withdrawal
• Also Substance-induced mental Disorders

Question 2

DSM-5 Diagnostic Criteria

Answer 2

DSM-5 replaces categories with Substance Use Disorder:

The individual has manifested a maladaptive pattern of substance use for at least 12 months that has led to significant impairment or distress.

Minimum of 2 (of 11) criteria must be met:

• 2-3 is a mild substance use disorder diagnosis;
• 4-5 is moderate;
• 6+ is severe

​criteria can be considered to fit within groupings:

• Impaired control (1-4)
• Social impairment (5-7)
• Risky use (8 & 9)
• Pharmacological criteria (10 & 11)

Question 3

Impaired Control (criteria 1-4)

Answer 3

Impaired Control (Criteria 1-4)

1. Using greater amounts or using over a longertime period than intended
2. Persistent desire or unsuccessful efforts to cut down or control substance use
3. Spending a lot of time obtaining, using, or recovering from using the substance
4. Craving = A strong desire or urge to use the substance

• May occur at any time
• Most likely to occur when in an environment where the drug was previously used or obtained

➡︎ Classical conditioning

➡︎ Associated with activation of specific reward structures in the brain

• Ask: Has there ever been a time when you’ve had such strong urges to take the drug that you couldn’t think of anything else?
• Current craving is often used as a treatment outcome measure (impending relapse?)

Question 4

Social impairment (criteria 5-7)

Answer 4

Social impairment (criteria 5-7)

5. Repeatedly unable to carry out major role obligations at work, school, or home due to substance use
6. Continued use despite persistent or recurring social or interpersonal problems caused or made worse by substance use
7. Stopping or reducing important social, occupational, or recreational activities due to substance use
8. Recurrent use of the substance in physically hazardous situations
9. Consistent use of the substance despite acknowledgment of persistent or recurrent physical or psychological difficulties that is/are likely to have been caused or exacerbated by the substance

* key issue is not existence of the problem, but the person’s failure to abstain despite the difficulty it’s causing

Question 5

Pharmacological criteria (10-11)

Answer 5

Pharmacological criteria

10. Tolerance: Requiring an increased dose to achieve the desired effect, or a markedly reduced effect when the usual dose is consumed.
    - Varies greatly (individuals, substance)
    - difficult to determine by history alone
11. Withdrawal
    - occurs when concentration of substance declines after prolonged, heavy use
    - individual likely to consume substance (or a closely related substance) for relief
    - variable
    - This criterion not included for PCP, hallucinogens, and inhalants

_______

• Neither is necessary for diagnosis of substance use disorder
• But, past history of withdrawal associated with a more severe clinical course
• If these symptoms occur during medical treatment (ex. Prescribed medications), they are not counted

Question 6

DSM Changes

Answer 6

Changes from DSM 4 to DSM 5

• Substance Use Disorder is specific to each substance of abuse within a new “Substance-related and Addictive Disorders” category
• cannabis & caffeine withdrawal are new
• tobacco use disorder included

Removed criteria

• Recurrent substance-related legal problems

​Remission

• early remission = at least 3 but less than 12 months without substance use disorder criteria (except craving)
• sustained remission = at least 12 months without criteria (except craving)
• sustained remission = at least 12 months without criteria (except craving)

Question 7

DSM-5: Substance Use Disorder

Answer 7

Impaired Control (1-4)

1. Taking the substance in larger amounts or for longer than they meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.

Social Impairment (5-7)

5. Not managing to do what should be done at work, home or school, because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational or recreational activities because of substance use.
8. Using substances again and again, even when it puts them in danger.
9. Continuing to use, even when a physical or psychological problem could have been caused or made worse by the substance.

Pharmacological Criteria

10. Needing more of the substance to get the effect they want (tolerance).

Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Question 8

Substance Intoxication

Answer 8

The following diagnostic criteria (APA, 2013):

1. The development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance.
2. Clinically significant maladaptive behavioural or psychological changes that are due to the effect of the substance on the CNS and develop during or shortly after use of the substance.
3. The symptoms are not due to general medical condition and are not better accounted for by another mental disorder.

Question 9

Substance Withdrawal

Answer 9

the following diagnostic criteria (APA, 2013):

1. The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged
2. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
3. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder

Question 10

DSM-5 Diagnostic Criteria 2

Answer 10

A cluster of cognitive, behavioural, and physiological symptoms indicating the individual continues using substance despite significant substance-related problems

• For certain classes, some symptoms are less salient
• For some classes, not all symptoms will apply
• Diagnosis of substance use disorder is based on a pathological pattern of behaviours related to use of the substance.
• To assist with organization, criteria can be considered to fit within groupings:
  
  • Impaired control (1-4)Social impairment (5-7)
  • Risky use (8 & 9)
  • Pharmacological criteria (10 & 11)

Answer 11

• May occur at any time
• Most likely to occur when in an environment where the drug was previously used or obtained​\
  
  • Classical conditioning
  • ​Associated with activation of specific reward structures in the brain
• Ask: Has there ever been a time when you’ve had such strong urges to take the drug that
• you couldn’t think of anything else?
• current craving often used as a treatment outcome measure (impending relapse?)