substance use disorder

alcohol use disorder

a. a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:

1. alcohol is often taken in larger amounts or over a longer period than was intended

2. there is a peristent desire or unsuccessful to cut down or control alcohol use

3. great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects

4. craving or a strong desire or urge to use alcohol

5. recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home

6. continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol

7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use

8. recurrent alcohol use in situations in which it is physically hazardous

9. alcohol use in continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol

10. tolerance, as defined by either of the following:

a. a need for markedly increased amounts of alcohol to achieve intoxication or desired effect

b. a markedly diminished effect with continued use of the same amount of alcohol

11. Withdrawal as manifested by either of the following:

a. the characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawl)

b. alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms

alcohol use disorder specifier

-in early remission: after full criteria was previously met, none of the criteria for alcohol use disorder have been met for at least 3 months, but for less than 12 months (with the exception that criteria A4, "craving, or a strong desire or urge to use alcohol," may be met)

-in sustained remission: after full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4, "craving, or a strong desire or urge to use alcohol" may be met)

-in a controlled envrionment: this additional specifier is used if the individual is in an environment where access to alcohol is restrcited.

alcohol intoxication

a. recent ingestion of alcohol

b. clinically significant problematic behavior or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion.

c. one (or more) of the following signs or symptoms developing during, or shortly after, alcohol use:

1. slurred speech

2. incoordination

3. unsteady gait

4. nystagmus

5. impairment in attention or memory

6. stupor or coma

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance

alcohol withdrawl

a. cessation of (or reduction in) alcohol use that has been heavy and prolonged

b. 2 or more of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in criterion A:

1. automatic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm)

2. increased hand tremor

3. insomnia

4. nausea or vomiting

5. transient visual, tactile, or auditory hallucinations or illusions

6. psychomotor agitation

7. anxiety

8. Generalization tonic-clonic seizures

c. the signs or symptoms in criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance

alcohol withdrawal specifier

with perceptual disturbances: this specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual or tactile illusions occur in the absence of delirium

opioid use disorder

a. a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:

1. opioids are often taken in larger amounts or e=over a longer period than was intended

2. there is a persistent desire or unsuccedddul efforts to cut down or control opioid use

3. a great deal of time is spent i activities necessary to obtain the opioid, use the opioid, or recover from its effects

4. craving, or a strong desire or urge to use opioids

5. recurrent opioid use resulting in failure to fulfill major role obligations at work, school, or home

6. continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids

7. Important social, occupational, or recreational activities are given up or reduced because of opioid use

8. recurrent opioid use in situations in which it is physically hazardous

9. continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that likely to have been caused or exacerbated by the substance

10. tolerance, as defined by either of the following:

a. a need for markedly increased amounts of opioids to achieve intoxication or desired effect

b. a markedly diminished effect with continued use of the same amount of an opioid

11. withdrawal, as manifested by either of the following:

a. the characteristic opioid withdrawal syndrome (refer to criteria A and B of the criteria set for opioid withdrawal)

b. opioids (or closely related substances) are taken to relieve or avoid withdrawal symptoms

opioid use disorder specifier

-in early remission: after full criteria for opiod use disorder were previously met, none of the criteria for opioid use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion A4, "craving, or a strong desire or urge to use opioids" may be met)

-in previously sustained remission: after full criteria for opioid use disorder were previously met, none of the criteria for opioid use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4, "craving or a strong desire or urge to use opioids" may be met)

-on maintenance therapy: this addition specifier is used if the individual is taking a prescribed agonist medication such as methadone or buprenorphine and none of the criteria for opioid use disorder have been met for that class of medication (except tolerance to or withdrawal from the agonist). This category also applies to those individuals being maintained on a partial agonist, an agonist/antagonist, or full antagonist, such as an oral naltrexone or depot naltrexone.

-in a controlled environment: this additional specifier is used if the individual is in an environment where access to opioids is restricted

opioid intoxication

A) Recent use of an opioid.

B) Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use.

C) Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use:

1) Drowsiness or coma.

2) Slurred speech.

3) Impairment in attention or memory.

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

opioid intoxication specifier

With perceptual disturbances: This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.

opioid withdrawal

A) Presence of either of the following:

1) Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer).

2) Administration of an opioid antagonist after a period of opioid use.

B) Three (or more) of the following developing within minutes to several days after Criterion A:

1) Dysphoric mood.

2) Nausea or vomiting.

3) Muscle aches.

4) Lacrimation or rhinorrhea.

5) Pupillary dilation, piloerection, or sweating.

6) Diarrhea.

7) Yawning.

8) Fever.

9) Insomnia.

C) The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

tobacco use disorder

a. a problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within 12 12-month period:

1. Tobacco is often taken in larger amounts or over time a longer period than was intended

2. there is a persistent desire or unsuccessful efforts to cut down or control tobacco use

3. a great deal of time is spent on activities necessary to obtain or use tobacco

4. craving, or a strong desire or urge to use tobacco

5. recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., interference with work)

6. continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (e.g., arguments with others about tobacco use)

7. important social, occupational, or recreational activities are given up or reduced because of tobacco use

8. recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking in bed)

9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco

10. tolerance as defined by wither of the following:

a. a need for markedly increased amounts or tobacco to achieve the desired effect

b. a markedly diminished effect with continued use of the same amount of tobacco

11. withdrawal as manifested by either of the following:

a. the characteristic withdrawal syndrome for tobacco (refer to criteria A and B of the criteria set for tobacco withdrawal)

b. tobacco (or a closely related substance such as nicotine) is taken to relieve or avoid withdrawal symptoms

tobacco use disorder specifier

-in early remission: after full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion A4 "craving or a strong desire or urge to use tobacco" may be met)

-in sustained remission: after full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4 "craving or a strong desire or urge to use tobacco" may be met)

-on maintenance therapy: the individual is taking a long term maintenance medication such as nicotine replacement medication, and no criteria for tobacco use disorder have been met for the class of medication (except tolerance to or withdrawal from the nicotine replacement medication)

-in a controlled environment: this additional specifier is used if the individual is in an environment where access to tobacco is restricted

tobacco withdrawl

a. daily use of tobacco for at least several weeks

b. abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed within 24 hours by 4 (or more) of the following signs or symptoms:

1. irritability, frustration, or anger

2. anxiety

3. difficulty concentrating

4. increased appetite

5. restlessness

6. depressed mood

7. insomnia

c. the signs or symptoms in criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the signs or symptoms are not attributed to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance

gambling disorder

a. persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4 (or more) of the following in a 12 month period:

1. needs to gamble with increasing amounts of money in order to achieve the desired excitement

2. is restless or irritable when attempting to cut down or stop gambling

3. has made repeated unsuccessful efforts to control, cut back, or stop gambling

4. is often preoccupied with gambling (e.g., having persistent thoughts or reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)

5. often gambles when feeling depressed (e.g., helpless, guilty, anxious, depressed)

6. after losing money gambling, often returns another day to get even ("chasing" one's losses)

7. lies to conceal the extent of involvement with gambling

8. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

9. relies on others to provide money to relieve desperate financial situations caused by gambling

b. the gambling behaviors is not better explained by a manic episode

gambling disorder specifiers

Mild: 4-5 criteria

Moderate: 6-7 criteria

Severe: 8-9 criteria

Optional specifiers:

Episodic: criteria met at more than one point in time, with symptoms subsiding for several months in between

Persistent: Continuous symptoms for several years

In early remission: 3-12 months of 0 symptoms

In sustained remission: more than 12 months of 0 symptoms

cannabis use disorder

a. a problematic pattern of cannabis use leading to clinically significant impairment or distress as manifested by at least two of the following occurring within a 12 month period:

1. cannabis if often taken in larger amounts or over a longer period than was intended

2. there is a persistent desire or unsuccessful efforts to cut down or control cannabis use

3. a great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects

4. craving, or a strong desire or urge to use cannabis

5. recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home

6. continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects or cannabis

7. Important social, occupational or recreational activities are given up or reduced because of cannabis use

8. recurrent cannabis use in situations in which it is physically hazardous

9. cannabis use is continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis

10. tolerance as defined by either of the following;

a. a need for markedly increased amounts of cannabis to achieve intoxication or desired effect

b. markedly diminished effect with continued use of the same amount of cannabis

11. withdrawal as manifested by either of the following:

a. the characteristic withdrawal syndrome for cannabis (refer to criteria a and b of the criteria set for cannabis withdrawal)

b. cannabis (or closely related substance) is taken to relieve or avoid withdrawal symptoms)

cannabis use disorder specifier:

-in early remission: after full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion A4 "craving or a strong desire or urge to use cannabis" may be met)

-in sustained remission: after full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4 "craving or a strong desire or urge to use cannabis" may be present)

-in a controlled environment: this additional specifier is used if the individual is in an environment where access to cannabis is restricted

cannabis intoxication

a. recent use of cannabis

b. clinically significant problematic behavior or psychological changes (e.g., impaired motor coordination, euphoric anxiety, sensation of slowed time, impaired judgement, social withdrawal) that developed during or shortly after cannabis use

c. two or more of the following signs or symptoms developing within 2 hours of cannabis use:

1. conjunctival injection

2. increased appetite

3. dry mouth

4. tachycardia

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance

cannabis intoxication specifier

with perceptual disturbance: hallucinations with intact reality testing or auditory, visual, or tactile illusions occurring in the absence or a delirium

cannabis withdrawal

a. cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months)

b. three or more of the following signs and symptoms develop within approximately 1 week after criterion A:

1. irritability, anger, or aggression

2. nervousness or anxiety

3. sleep difficulty (e.g., insomnia, disturbing dreams)

4. decreased appetite or weight loss

5. restlessness

6. depressed mood

7. at least one of the following symptoms causing significant discomfort: abdominal pain, shakiness/tremor, sweating, fever, chills, or headaches

c. the sign or symptoms in criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance

stimulant use disorder(including cocaine use)

a. a pattern of amphetamine-type substance, cocaine or other stimulant by at least two of the following occurring within a 12 month period:

1. The stimulant is often taken in larger amounts or over a longer period than was intended

2. there is a persistent desire in unsuccessful efforts to cut down or control stimulant use

3. a great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover its effects

4. craving, or a strong desire or urge to use the stimulant

5. recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home

6. continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant

7. Important social, occupational, or recreational activities are given up or reduced because of stimulant use

8. recurrent stimulant use in situations in which it is physically hazardous

9. stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant

10. tolerance as defined by either of the following:

a. a need for markedly increased amounts of the stimulant to achieve intoxication or the desired effect

b. a markedly diminished effect with continued use of the same amount of the stimulant

11. withdrawal, as manifested by either of the following:

a. the characteristic withdrawal syndrome for the stimulant (refer to criteria and B of the criteria set for stimulant withdrawal)

b. the stimulant is taken to relieve or avoid withdrawal symptoms

stimulant use disorder (including cocaine use) specifier

-in early remission: after full criteria is met, none of the criteria have been met for at least 3 months, but less than 12 months

-in sustained remission: after full criteria was previously met, none of the criteria have been met for 12 months

-in a controlled environment: if the individual is in an environment where access to stimulants is restricted

-mild: 2-3 symptoms

-mild, in early remission:

-mild, in sustained remission

-moderate: 4-5 symptoms

-moderate in early remission

-moderate in sustained remission

-severe: 6 or more symptoms

-severe in early remission

-severe in sustained remission

stimulant intoxication

A) Recent use of an amphetamine-type substance, cocaine, or other stimulant.

B) Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant.

C) Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use:

1) Tachycardia or bradycardia.

2) Pupillary dilation.

3) Elevated or lowered blood pressure.

4) Perspiration or chills.

5) Nausea or vomiting.

6) Evidence of weight loss.

7) Psychomotor agitation or retardation.

8) Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.

9) Confusion, seizures, dyskinesias, dystonias, or coma.

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

stimulant intoxication specifier

-particular intoxicant: (i.e., amphetamine type substance, cocaine, or other stimulant)

-the perceptual disturbances: this specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium

stimulant withdrawal

A) Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use.

B) Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:

1) Fatigue.

2) Vivid, unpleasant dreams.

3) Insomnia or hypersomnia.

4) Increased appetite.

5) Psychomotor retardation or agitation.

C) The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

stimulant withdrawal specifier

the particular substance that causes the withdrawal syndrome: (i.e., amphetamine, type substance, cocaine, or other stimulant)