Substance-Related and Addictive Disorders

What are the two broad groups in DSM-5-TR substance-related disorders?

Substance use disorders and substance-induced disorders.

What are the three main types of substance-induced conditions?

Intoxication, withdrawal, and substance/medication-induced mental disorders.

What is the essential feature of a substance use disorder?

Continued use despite significant substance-related problems.

What term does DSM-5-TR use instead of 'drug addiction'?

Substance use disorder.

What non-substance disorder is included in this DSM-5-TR chapter?

Gambling disorder.

Which proposed 'behavioral addictions' are not included because evidence is insufficient?

Behaviors like sex addiction, exercise addiction, and shopping addiction.

Which substance class in this chapter does not receive a substance use disorder diagnosis?

Caffeine.

What four broad groupings organize the 11 substance use disorder criteria?

Impaired control, social impairment, risky use, and pharmacological criteria.

Which criterion grouping includes taking more than intended, failed efforts to cut down, time spent, and craving?

Impaired control.

Which criterion grouping includes failure in roles, interpersonal problems, and giving up activities?

Social impairment.

Which criterion grouping includes hazardous use and continued use despite problems?

Risky use.

Which criterion grouping includes tolerance and withdrawal?

Pharmacological criteria.

How many symptoms are needed for a mild substance use disorder?

2–3 symptoms.

How many symptoms are needed for a moderate substance use disorder?

4–5 symptoms.

How many symptoms are needed for a severe substance use disorder?

6 or more symptoms.

What remission specifier means no criteria for at least 3 months but less than 12 months, except craving may remain?

In early remission.

What remission specifier means no criteria for 12 months or longer, except craving may remain?

In sustained remission.

What does the specifier 'in a controlled environment' mean?

Access to the substance is restricted.

Are tolerance and withdrawal required for a substance use disorder diagnosis?

No.

When should tolerance and withdrawal not count toward a substance use disorder diagnosis?

When they occur during appropriate prescribed medical treatment.

In general, what makes substance intoxication different from substance withdrawal?

Intoxication follows recent use; withdrawal follows cessation or reduction after prolonged use.

Does a positive lab test by itself diagnose a substance use disorder?

No.

What does normal functioning despite high blood levels of a substance suggest?

Tolerance.

What route pattern tends to increase intoxication intensity and escalation risk?

Faster routes like IV use, smoking, or intranasal use.

Are withdrawal symptoms established for phencyclidine, other hallucinogens, and inhalants?

No.

What must predominate in a substance/medication-induced mental disorder?

Symptoms characteristic of the relevant diagnostic class.

When must symptoms develop for a substance/medication-induced mental disorder?

During or soon after intoxication, withdrawal, or medication exposure/withdrawal.

What must be true about the substance or medication in a substance-induced mental disorder?

It must be capable of producing the symptoms.

What finding suggests an independent mental disorder rather than a substance-induced one?

The disturbance preceded the substance effect or persisted substantially after it ended.

What state rules out diagnosing a separate substance-induced mental disorder if symptoms occur only within it?

Delirium.

What final functional requirement is needed for a substance/medication-induced mental disorder diagnosis?

Clinically significant distress or impairment.

How many symptoms are required for alcohol use disorder?

At least 2 within 12 months.

What are the two pharmacologic criteria that can count toward alcohol use disorder?

Tolerance and withdrawal.

What is a hallmark wording for alcohol intoxication Criterion A?

Recent ingestion of alcohol.

Name one classic behavioral change in alcohol intoxication.

Impaired judgment.

What speech change is classic in alcohol intoxication?

Slurred speech.

What gait change is classic in alcohol intoxication?

Unsteady gait.

What eye movement finding may appear in alcohol intoxication?

Nystagmus.

What memory-related symptom may occur in alcohol intoxication?

Impairment in attention or memory.

What is required first for alcohol withdrawal?

Cessation or reduction of heavy and prolonged alcohol use.

How many symptoms are needed for alcohol withdrawal?

2 or more.

What autonomic sign is specifically listed in alcohol withdrawal?

Sweating or pulse over 100 bpm.

What tremor symptom is listed in alcohol withdrawal?

Increased hand tremor.

What dangerous neurologic symptom can occur in alcohol withdrawal?

Generalized tonic-clonic seizures.

What specifier is used when alcohol withdrawal includes hallucinations or illusions but reality testing remains intact?

With perceptual disturbances.

Does DSM-5-TR diagnose caffeine use disorder in this chapter?

No.

What amount pattern is typical for caffeine intoxication?

A high dose, typically well in excess of 250 mg.

How many symptoms are needed for caffeine intoxication?

5 or more.

What sleep symptom is common in caffeine intoxication?

Insomnia.

What heart-related symptom can appear in caffeine intoxication?

Tachycardia or cardiac arrhythmia.

What speech/thought symptom can appear in caffeine intoxication?

Rambling flow of thought and speech.

What must come before caffeine withdrawal?

Prolonged daily caffeine use.

How soon do caffeine withdrawal symptoms begin after cessation or reduction?

Within 24 hours.

How many symptoms are needed for caffeine withdrawal?

3 or more.

What is the most classic symptom of caffeine withdrawal?

Headache.

What mood symptom may appear in caffeine withdrawal?

Dysphoric mood, depressed mood, or irritability.

How many symptoms are needed for cannabis use disorder?

At least 2 within 12 months.

What are the two pharmacologic criteria that can count toward cannabis use disorder?

Tolerance and withdrawal.

What is required first for cannabis intoxication?

Recent use of cannabis.

How many physical signs are required for cannabis intoxication?

2 or more within 2 hours.

What eye finding is classic in cannabis intoxication?

Conjunctival injection.

What appetite change is common in cannabis intoxication?

Increased appetite.

What mouth symptom is common in cannabis intoxication?

Dry mouth.

What cardiac sign can occur in cannabis intoxication?

Tachycardia.

What specifier may be added to cannabis intoxication if hallucinations or illusions occur without delirium?

With perceptual disturbances.

What pattern of use usually precedes cannabis withdrawal?

Heavy and prolonged use, usually daily or almost daily for at least a few months.

How many symptoms are needed for cannabis withdrawal?

3 or more.

About when do cannabis withdrawal symptoms begin?

Within approximately 1 week.

What mood symptom is common in cannabis withdrawal?

Irritability, anger, or aggression.

What appetite-related symptom occurs in cannabis withdrawal?

Decreased appetite or weight loss.

What sleep symptom is listed in cannabis withdrawal?

Sleep difficulty, such as insomnia or disturbing dreams.

What physical discomfort category is required in cannabis withdrawal's last criterion cluster?

At least one physical symptom such as abdominal pain, tremors, sweating, fever, chills, or headache.

What key pharmacologic criterion does not apply to phencyclidine use disorder?

Withdrawal.

What key pharmacologic criterion does not apply to other hallucinogen use disorder?

Withdrawal.

What symptom timing is required for phencyclidine intoxication signs?

Within 1 hour.

What eye movement sign is classic in phencyclidine intoxication?

Vertical or horizontal nystagmus.

What pain-related symptom can occur in phencyclidine intoxication?

Numbness or diminished responsiveness to pain.

What coordination symptom can occur in phencyclidine intoxication?

Ataxia.

What sensory symptom can occur in phencyclidine intoxication?

Hyperacusis.

What is the hallmark perceptual requirement for other hallucinogen intoxication?

Perceptual changes in a state of full wakefulness and alertness.

Name one example of a perceptual change in other hallucinogen intoxication.

Synesthesias.

What pupil change is common in other hallucinogen intoxication?

Pupillary dilation.

What disorder involves reexperiencing perceptual symptoms after stopping hallucinogen use?

Hallucinogen persisting perception disorder.

What must HPPD cause besides symptoms?

Clinically significant distress or impairment.

What type of substance is involved in inhalant use disorder?

A hydrocarbon-based inhalant substance.

What pharmacologic criterion is included in inhalant use disorder?

Tolerance.

What pharmacologic criterion is not included in inhalant use disorder?

Withdrawal.

What kind of exposure is typical in inhalant intoxication?

Recent intended or unintended short-term, high-dose exposure.

How many signs are needed for inhalant intoxication?

2 or more.

What speech symptom is common in inhalant intoxication?

Slurred speech.

What gait/coordination symptom is common in inhalant intoxication?

Incoordination or unsteady gait.

What consciousness-related severe symptom can occur in inhalant intoxication?

Stupor or coma.

What caution applies to tolerance in opioid use disorder for people using opioids only under appropriate medical supervision?

Tolerance does not count.

What caution applies to withdrawal in opioid use disorder for people using opioids only under appropriate medical supervision?

Withdrawal does not count.

What special specifier can be used in opioid use disorder for people on methadone or buprenorphine?

On maintenance therapy.

What pupil finding is classic in opioid intoxication?

Pupillary constriction.

What severe exception to constricted pupils is noted in opioid intoxication?

Pupillary dilation due to anoxia from severe overdose.

Besides pupillary change, how many additional symptoms are needed for opioid intoxication?

1 or more.

What level-of-consciousness symptom is common in opioid intoxication?

Drowsiness or coma.

What speech symptom may appear in opioid intoxication?

Slurred speech.