Substance Use Preload (Behave)

What substances does DSM focus on for substance use

Alcohol

Caffeine

Hallucinogens

Inhalants

Opioids

Sedatives

Hypnotics

Anxiolytics

Stimulants

Tobacco

What substances are grouped together in DSM

Sedatives, Hypnotics, and Anxiolytics

What is the timing for substance use disorder

2 criteria in 12 months

What are criteria to satisfy DSM substance use disorder symptoms

1. Larger amounts or over longer period of time than originally intended

2. Persistent desire to cut back

3. Great deal of Time spent obtaining, using or recovering from substance

4. Craving

5. Recurrent use that results in failure to fulfill major obligations (work, school, home)

6. Use continues despite having persistent or recurrent social/interpersonal problems due to/exacerbated by use

7. Social/occupational/rec activities are given up or reduced because of use

8. Recurrent substance use in situations when it is physically hazardous

9. Continued use despite knowing they are having a physical or psych problem either caused or exacerbated by the substance

10. Tolerance defined as either:

    1. A) need for markedly increased amounts

    2. B) markedly diminished effect with continue use of the same amount of substance

11. Withdrawal

Criteria for Intoxication

A. recent ingestion of the named substance

B. significant problematic behavioral or psychological changes that developed during or shortly after ingestion

C. s/s cannot be caused by another condition or another substance

Criteria for Alcohol Intoxication

A. Behavior changes: inappropriate sexual or aggressive behavior, mood lability, impaired judgement

B. 1 or more of the following:

• Slurred speech

• Incoordination

• Unsteady gait

• Nystagmus

• Impaired attention/memory

• Stupor/coma

Criteria for Alcohol Withdrawal

A. Cessation of use that was heavy and prolonged

B. 2 or more within several hrs to days after cessation

• Autonomic hyperactivity

• Increased hand tremor

• Insomnia

• N/V

• Transient visual, tactile or auditory hallucinations

• Psychomotor agitation

• Anxiety

• Generalized seizure

Criteria for Caffeine Intoxication

5 of the following:

• Restlessness

• Nervousness

• Excitement

• Insomnia

• Flushed face

• Diuresis

• GI disturbance

• Muscle twitching

• Rambling flow or thought/speech

• Tachycardia/cardiac arrhythmia

• periods of inexhaustibility

• Psychomotor agitation

Criteria for Caffeine Withdrawal

A. Prolonged daily use of caffeine

B. Abrupt cessation/reduction of use, followed w/in 24 hours by 3 or more:

• Headache

• Marked fatigue or drowsiness

• Dysphoric mood/depressed mood/ irritability

• Difficulty concentrating

• Flu-like symptoms

Criteria for Cannabis Intoxication

A. Behavior changes:

• impaired coordination,

• euphoria,

• anxiety,

• sensation of slowed time,

• social w/d,

• impaired judgement

B. 2 or more within 2 hours of use:

• Conjunctival injection

• Increased appetite

• Dry mouth

• tachycardia

Criteria for Cannabis Withdrawal

A. Use was heavy or prolonged

B. 3 or more of the following within 1 week of cessation

• Irritability/anger/aggression

• Nervousness/anxiety

• Sleep difficulty

• Decreased appetite/weight loss

• Restlessness

• Depressed mood

C. At least 1 of the following:

• abd pain,

• shakiness/tremors,

• sweating,

• fever,

• chills,

• headache

Criteria of PCP Intoxication

A. Clinically significant changes in behavior

• Belligerence

• Assaultiveness

• Impulsiveness

• Unpredictability

• impaired judgement

B. Within 1 hour of use

• Vertical or horizontal nystagmus

• Htn/tachycardia

• Numbness/dec responsiveness to pain

• Ataxia

• Dysarthria

• Muscle rigidity

• Seizure/coma

• hyperacusis

What substances do NOT have withdrawal symptoms recognized by DSM-5

PCP

Hallucinogens

Inhalants

Criteria for Other Halluncinogen Intoxication

A. Clinically significant behavior changes

• Marked anxiety/depression

• Ideas of reference

• ‘losing one’s mind’

• Paranoid ideation

• Impaired judgement

B. Perceptual changes

C. 2 More more of the following:

• Pupillary dilation

• Tachycardia

• Sweating

• Palpitations

• Blurred vision

• Tremors

• Incoordination

What substances are included “Other Hallucinogens” in DSM-5

Ketamine

Cyclohexamine

Dizocilipine

Salvia

LSD

MDMA

Criteria for Hallucinogen persisting perception disorder

A. following cessation of use, the re-experiencing of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucination

B. Causes significant distress/impairment

C. Not caused by something else

Criteria for Inhalants: Intoxication

A. Behavioral changes:

• belligerence,

• assaultiveness,

• apathy,

• impaired judgement

B. 2 or more:

• Dizzy

• Incoordination

• Unsteady gait

• Depressed reflexes

• Muscle weakness

• Stupor/coma

• Nystagmus

• Slurred speech

• Lethargy

• Tremor

• Change in vision

• Euphoria

  • Psychomotor retardation

Crtieria for Opioids: intoxication

A. Behavior changes:

• initial euphoria followed by apathy,

• dysphoria,

• psychomotor change,

• impaired judgement

B. Pupillary constriction AND an 1 or more:

• Drowsiness or coma

• Slurred speech

• Impairment in attention or memory

Criteria for Opioids: withdrawal

A) Cessation or reduction of use OR administration of opioid antagonist after use

B. 3 or more within several min to several days

• Dysphoric mood

• n/v

• Muscle aches

• Lacrimation/rhinorrhea

• Pupillary dilation, piloerection, or sweating

• Diarrhea

• Yawning

• Fever

• insomnia

Critera for Sedative/hypnotic/anxiolytics: intoxication

A. Change in behavior:

• inappropriate sexual or aggressive behavior,

• mood lability,

• impaired judgement

B. 1 or more:

• Slurred speech

• Incoordination

• Unsteady gait

• Nystagmus

• Impaired cognition

• Stupor/coma

Criteria for Sedative/hypnotic/anxiolytics: withdrawal

2 or more within hours to days of cessation:

• Autonomic hyperactivity

• Hand tremor

• Insomnia

• n/v

• Transient visual/tactile/auditory hallucination

• Psychomotor agitation

• Anxiety

• Grand mal seizures

Criteria for Stimulants: Intoxication

A. Behavior change:

• euphoria,

• affective blunting,

• change in sociability,

• hypervigilance,

• interpersonal sensitivity,

• anxiety/anger,

• impaired judgement

B. 2 or more:

• Tachy/brady

• Hi/lo BP

• n/v

• Muscle weakness, resp depression, Chest pain or arrhythmia

• Dilated pupils

• Perspiration/chills

• Weight loss

• Psychomotor changes

• Confusion, seizure, dyskinesia, dystonia, or coma

Criteria for Stimulants: withdrawal

2 or more within few hours to several days

• Fatigue

• Vivid, unpleasant dreams

• Insomnia or hypersomnia

• Increased appetite

• Psychomotor changes

What substance has no intoxication criteria in the DSM-5

Tobacco

Criteria for Tobacco Withdrawal

Within 24 hours, 4 or more

• Irritability, frustration, anger

• Anxiety

• Difficulty concentrating

• Increased appetite

• Restlessness

• Depressed mood

• insomnia