Substance-Related and Addictive Disorders

What are the 10 DSM substance classes

Alcohol / caffeine / cannabis / hallucinogens / inhalants / opioids / sedatives hypnotics or anxiolytics / stimulants / tobacco / other or unknown substances

What 2 broad groups make up substance related disorders

Substance use disorders / substance induced disorders

What are the 3 major types of substance induced disorders

Intoxication / withdrawal / substance or medication induced mental disorders

What behavioral addiction is included in this DSM chapter

Gambling disorder

Is drug addiction the official DSM diagnostic term

No / substance use disorder is the official term

What is the essential feature of a substance use disorder

Continued substance use despite significant substance related problems

How many criteria generally establish a substance use disorder

At least 2 symptoms within 12 months

What are the 4 major substance use disorder criterion groups

Impaired control / social impairment / risky use / pharmacological criteria

What are the 4 impaired control criteria for substance use disorder

Larger amount or longer use than intended / unsuccessful attempts to reduce use / excessive time obtaining using or recovering / craving

What does using more than intended mean

Substance is taken in larger amounts or for longer than originally planned

What reduction criterion can indicate substance use disorder

Persistent desire or repeated unsuccessful attempts to cut down or stop

What time related criterion can indicate substance use disorder

A great deal of time is spent obtaining the substance / using it / or recovering from it

What is craving

Strong desire or urge to use a substance

What are the 3 social impairment criteria for substance use disorder

Failure to meet major obligations / continued use despite interpersonal problems / important activities reduced or abandoned

What role impairment can indicate substance use disorder

Repeated substance use interferes with major responsibilities at work / school / or home

What interpersonal criterion can indicate substance use disorder

Continued use despite persistent social or relationship problems caused or worsened by the substance

What activity criterion can indicate substance use disorder

Important social / occupational / or recreational activities are reduced or abandoned because of use

What are the 2 risky use criteria for substance use disorder

Use in physically dangerous situations / continued use despite physical or psychological harm

What hazardous use can indicate substance use disorder

Repeated use in situations where intoxication creates physical danger

What health related criterion can indicate substance use disorder

Continued use despite knowing it causes or worsens a physical or psychological problem

What are the 2 pharmacological criteria for substance use disorder

Tolerance / withdrawal

What is tolerance

Needing substantially more substance for the same effect OR experiencing less effect from the same amount

What is withdrawal

Characteristic syndrome after reduction or cessation of prolonged heavy substance use

Are tolerance and withdrawal required for substance use disorder

No

What severity is mild substance use disorder

2 to 3 symptoms

What severity is moderate substance use disorder

4 to 5 symptoms

What severity is severe substance use disorder

6 or more symptoms

How long is early remission for substance use disorder

At least 3 months but less than 12 months without criteria other than possible craving

How long is sustained remission for substance use disorder

At least 12 months without criteria other than possible craving

What does in a controlled environment mean

Person is in an environment where access to the substance is restricted

What does on maintenance therapy mean

Person is receiving prescribed medication treatment such as methadone or buprenorphine while otherwise meeting remission requirements

Do medically expected tolerance and withdrawal automatically establish substance use disorder

No

When should tolerance or withdrawal from prescribed medication not count toward SUD

When medication is taken appropriately under medical supervision and these are the only symptoms

Can someone taking prescribed opioids still have opioid use disorder

Yes / when other compulsive or problematic use criteria are present

Which substance class does not have a DSM substance use disorder

Caffeine

What substance classes do not have an established withdrawal criterion

Phencyclidine / other hallucinogens / inhalants

What is substance intoxication

A reversible substance specific syndrome caused by recent use with clinically significant behavioral or psychological changes

Does intoxication automatically indicate substance use disorder

No

What is the key distinction between intoxication and withdrawal

Intoxication follows recent substance exposure / withdrawal follows reduction or cessation after prolonged use

What is substance medication induced mental disorder

A psychiatric syndrome caused by the physiological effects of a substance / medication / or toxin

What timing supports a substance induced mental disorder

Symptoms develop during or soon after intoxication / withdrawal / medication exposure / or medication withdrawal

What suggests an independent mental disorder rather than a substance induced disorder

Symptoms preceded substance effects OR persist substantially after acute intoxication or withdrawal

What approximate persistence period often raises concern for an independent mental disorder

About 1 month after acute intoxication or withdrawal ends

Can substance induced symptoms look identical to primary psychiatric disorders

Yes

What diagnostic clue is especially important when separating substance induced and independent disorders

Temporal relationship between substance exposure and psychiatric symptoms

What should happen when psychiatric symptoms occur only during delirium

Diagnose the delirium rather than separately diagnosing the psychiatric syndrome

Can laboratory testing alone diagnose a substance use disorder

No

What does a positive toxicology result prove

Recent exposure may have occurred but it does not prove a substance use disorder

What does a negative toxicology result prove

It does not by itself rule out a substance related disorder

Why are rapid routes of administration associated with greater addiction risk

They produce faster and more intense drug effects

What routes can produce especially rapid substance effects

Intravenous use / smoking / intranasal use

What is alcohol use disorder

Problematic alcohol use meeting at least 2 of the general substance use disorder criteria within 12 months

What is alcohol intoxication

Problematic behavioral or psychological change after alcohol use accompanied by characteristic neurological impairment

What signs commonly suggest alcohol intoxication

Slurred speech / incoordination / unsteady gait / nystagmus / impaired attention or memory / stupor or coma

What is alcohol withdrawal

Characteristic syndrome after reducing or stopping heavy prolonged alcohol use

How many alcohol withdrawal symptoms are required

At least 2

What are the 8 alcohol withdrawal symptoms

Autonomic hyperactivity / hand tremor / insomnia / nausea or vomiting / transient hallucinations or illusions / psychomotor agitation / anxiety / generalized seizures

When does alcohol withdrawal usually begin

Within several hours to a few days after reduction or cessation

When do alcohol withdrawal symptoms often begin after blood alcohol falls

About 4 to 12 hours

When does alcohol withdrawal usually peak

Around the second day of abstinence

When does uncomplicated alcohol withdrawal usually improve substantially

By about the fourth or fifth day

Why is alcohol withdrawal clinically important

Severe withdrawal can involve seizures / hallucinations / delirium and require medical care

What withdrawal syndrome closely resembles alcohol withdrawal

Sedative hypnotic or anxiolytic withdrawal

What is caffeine intoxication

Clinically significant symptoms following recent caffeine consumption

What mental disorders can caffeine intoxication resemble

Panic disorder / generalized anxiety disorder / mania

What is caffeine withdrawal

Characteristic syndrome after abrupt reduction or cessation of prolonged daily caffeine use

How many symptoms are required for caffeine withdrawal

At least 3

What are the 5 caffeine withdrawal symptoms

Headache / marked fatigue or drowsiness / dysphoric depressed or irritable mood / difficulty concentrating / flu like symptoms

What are flu like caffeine withdrawal symptoms

Nausea / vomiting / muscle pain or stiffness

Is caffeine use disorder an official DSM diagnosis

No

What is cannabis intoxication

Problematic behavioral or psychological change during or shortly after cannabis use

What behavioral changes can occur in cannabis intoxication

Euphoria / anxiety / impaired coordination / slowed sense of time / impaired judgment / social withdrawal

How many characteristic physical signs support cannabis intoxication

At least 2

What physical signs are characteristic of cannabis intoxication

Conjunctival injection / increased appetite / dry mouth / tachycardia

Within what period do the characteristic physical cannabis signs develop

Within about 2 hours of use

What is cannabis withdrawal

Syndrome following cessation of heavy prolonged cannabis use

What pattern of prior cannabis use typically precedes withdrawal

Daily or almost daily use for at least several months

How many symptoms are required for cannabis withdrawal

At least 3

What common psychological symptoms occur in cannabis withdrawal

Irritability anger or aggression / nervousness or anxiety / sleep difficulty / restlessness / depressed mood

What appetite change occurs during cannabis withdrawal

Decreased appetite or weight loss

When do cannabis withdrawal symptoms usually emerge

Within approximately 1 week after stopping heavy prolonged use

What psychiatric complications can occur with cannabis use

Psychotic symptoms / anxiety symptoms / sleep problems

What are the 2 major hallucinogen diagnostic groups

Phencyclidine related disorders / other hallucinogen related disorders

Do hallucinogens have an established withdrawal syndrome

No

What symptoms can hallucinogen intoxication prominently produce

Perceptual changes / hallucinations / altered awareness / autonomic changes

What is hallucinogen persisting perception disorder or HPPD

Reexperiencing hallucinogen related perceptual symptoms after intoxication has ended

What visual symptoms may occur in HPPD

Geometric images / flashes of color / intensified colors / image trails / afterimages / halos / visual snow / objects appearing too large or small

How long can HPPD persist

Weeks / months / or years

Is reality testing intact in HPPD

Yes / the person recognizes the perceptual disturbance as drug related

How does HPPD differ from psychosis

Reality testing remains intact and symptoms represent recurrence of previous hallucinogen related perceptions

What is inhalant intoxication

Problematic behavioral or psychological change after short term high dose exposure to volatile substances

What signs commonly occur with inhalant intoxication

Dizziness / nystagmus / incoordination / slurred speech / unsteady gait / lethargy

Is inhalant withdrawal formally established in DSM

No

What is opioid intoxication

Problematic behavioral or psychological change during or shortly after opioid use with characteristic pupil and CNS findings

What pupil finding strongly suggests opioid intoxication

Pupillary constriction

What exception can occur to pupil constriction in severe opioid overdose

Pupils may dilate because of severe oxygen deprivation

What additional signs support opioid intoxication

Drowsiness or coma / slurred speech / impaired attention or memory

What dangerous physiological effect may accompany opioid intoxication

Respiratory depression

What classic clinical pattern suggests opioid intoxication

Constricted pupils plus CNS depression and respiratory depression

What is opioid withdrawal

Syndrome following cessation or reduction of prolonged opioid use or administration of an opioid antagonist after opioid use