Substance-Related and Addictive Disorders
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Substance-Related and Addictive Disorders
Substance-Related and Addictive Disorders
are a group of mental health conditions characterized by the harmful use of substances, such as alcohol, drugs, or prescription medications. These disorders can lead to a variety of problems, including addiction, health issues, and relationship difficulties.
self-control
individuals with lower levels of — , which may reflect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders,
suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.
Substance Use Disorders
The essential feature of a — is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.
An important characteristic of— is an underlying change in brain cir cuits that may persist beyond detoxification, particularly in individuals with severe disorders.
The behavioral effects of these brain changes may be exhibited in the repeated relapses and in tense drug craving when the individuals are exposed to drug-related stimuli.
These persistent drug effects may benefit from long-term approaches to treatment.
Overall, the diagnosis of a — is based on a pathological pattern of behaviors related to use of the substance.
To assist with organization, Criterion A criteria can be considered to fit within overall groupings of impaired control, social impairment, risky use, and pharmacological criteria
mild (substance use disorder)
(substance use disorder) is suggested by the presence of two to three symptoms
moderate (substance use disorder)
is suggested by the presence of four to five symptoms
severe (substance use disorder)
is suggested by the presence of six or more symptoms
substance intoxication (criteria)
The essential feature is the development of a reversible substance-specific syndrome due to the recent ingestion of a substance (Criterion A).
The clinically significant problematic behavioral or psychological changes associated with intoxication (e.g., belligsuberence, mood lability, impaired judgment) are attributable to the physiological effects of the substance on the central nervous system and develop during or shortly after use of the substance (Criterion B).
The symptoms are not attributable to another medical condition and are not better explained by another mental disorder (Criterion D).
tobacco
substance intoxication category does not apply to —
substance withdrawal (criteria)
The essential feature is the development of a substance-specific problematic be havioral change, with physiological and cognitive concomitants, that is due to the cessation of, or reduction in, heavy and prolonged substance use (Criterion A).
The substance-specific syn drome causes clinically significant distress or impairment in social, occupational, or other im portant areas of functioning (Criterion C).
The symptoms are not due to another medical condition and are not better explained by another mental disorder (Criterion D).
blood stream
Routes of administration that produce more rapid and efficient absorption into the —
(e.g., intravenous, smoking, intranasal “snorting”) tend to result in a more intense intoxication and an increased likelihood of an escalating pattern of substance use leading to withdrawal.
substance/medication-induced mental disorders
The —- are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or several toxins.
They are distinguished from the substance use disorders, in which a cluster of cognitive, behavioral, and physiological symptoms contribute to the continued use of a substance despite significant substance-related problems.
The — may be induced by the 10 classes of substances that produce substance use disorders, or by a great variety of other medications used in medical treatment.
A. The disorder represents a clinically significant symptomatic presentation of a relevant mental disorder.
B. There is evidence from the history, physical examination, or laboratory findings of both of the following:
1. The disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication; and
2. The involved substance/medication is capable of producing the mental disorder.
C. The disorder is not better explained by an independent mental disorder (i.e., one that is not substance- or medication-induced). Such evidence of an independent mental dis order could include the following:
1. The disorder preceded the onset of severe intoxication or withdrawal or exposure to the medication; or 2. The full mental disorder persisted for a substantial period of time (e.g., at least 1 month) after the cessation of acute withdrawal or severe intoxication or taking the medica tion. This criterion does not apply to substance-induced neurocognitive disorders or hallucinogen persisting perception disorder, which persist beyond the cessation of acute intoxication or withdrawal.
D. The disorder does not occur exclusively during the course of a delirium.
E. The disorder causes clinically significant distress or impairment in social, occupa tional, or other important areas of functioning.
diagnostic criteria for substance/medication-induced mental disorders
Alcohol Use Disorder
is a medical condition characterized by a pattern of problematic alcohol use that leads to clinically significant impairment or distress.
Individuals with — struggle to control their drinking, experience negative consequences due to alcohol use, and may continue to drink despite harmful effects
A. A problematic pattern of alcohol use leading to clinically significant impairment or dis tress, 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 persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A 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 is 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 withdrawal, pp. 499–500).
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Diagnostic Criteria for Alcohol Use Disorder
in early remission (AUD)
After full criteria for alcohol use disorder were 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 Criterion A4, “Craving, or a strong desire or urge to use alcohol,” may be met).
in sustained remission (AUD)
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 environment (AUD)
This additional specifier is used if the individual is in an environment where access to alcohol is restricted.
mild (AUD)
Presence of 2–3 symptoms. (AUD)
moderate (AUD)
Presence of 4–5 symptoms.
severe (AUD)
Presence of 6 or more symptoms.
Alcohol Intoxication
is the presence of clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develop during, or shortly after, alcohol ingestion
A. Recent ingestion of alcohol.
B. Clinically significant problematic behavioral or psychological changes (e.g., inappropri ate 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.
Diagnostic Criteria for Alcohol Intoxication
conduct disorder or antisocial personality disorder
Alcohol intoxication may occur comorbidly with other substance intoxication, especially in individuals with —
alcohol withdrawal
is a condition that occurs when a person who is physically dependent on alcohol suddenly stops or significantly reduces their alcohol intake. This can lead to a range of physical and psychological symptoms.
A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
B. Two (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. Autonomic 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. Generalized 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.
Diagnostic Criteria for Alcohol Withdrawal
With perceptual disturbances (AW)
This specifier applies in the rare instance when hal lucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. (Alcohol Withdrawal)
Caffeine Intoxication
is a condition that occurs when a person consumes a large amount of caffeine, typically more than 250 milligrams
experiences a cluster of physical and psychological symptoms.
A. Recent consumption of caffeine (typically a high dose well in excess of 250 mg).
B. Five (or more) of the following signs or symptoms developing during, or shortly after, caffeine use:
1. Restlessness.
2. Nervousness.
3. Excitement.
4. Insomnia.
5. Flushed face.
6. Diuresis.
7. Gastrointestinal disturbance.
8. Muscle twitching.
9. Rambling flow of thought and speech.
10. Tachycardia or cardiac arrhythmia.
11. Periods of inexhaustibility.
12. Psychomotor 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 bet ter explained by another mental disorder, including intoxication with another substance.
Diagnostic Criteria for Caffeine Intoxication
Caffeine Withdrawal
is a condition that occurs when a person who regularly consumes caffeine abruptly reduces or stops their intake.
This can lead to a range of physical and psychological symptoms.
A. Prolonged daily use of caffeine.
B. Abrupt cessation of or reduction in caffeine use, followed within 24 hours by three (or more) of the following signs or symptoms:
1. Headache.
2. Marked fatigue or drowsiness.
3. Dysphoric mood, depressed mood, or irritability.
4. Difficulty concentrating.
5. Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness).
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 associated with the physiological effects of another medical condition (e.g., migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
Diagnostic Criteria for Caffeine Withdrawal
Cannabis Use Disorder
is a mental health condition characterized by a problematic pattern of cannabis use that leads to clinically significant impairment or distress.
Individuals with — struggle to control their cannabis use, experience negative consequences due to cannabis use, and may continue to use cannabis despite harmful effects.
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 is 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 of 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 continued 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, pp. 517–518).
b. Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms
Cannabis Use Disorder
In early remission (CUD)
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 de sire or urge to use cannabis,” may be met).
In sustained remission (CUD)
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 (CUD)
This additional specifier is used if the individual is in an environment where access to cannabis is restricted.
Cannabis Intoxication
is the presence of clinically significant problematic behavioral or psychological changes that develop during, or shortly after, canna bis use
A. Recent use of cannabis.
B. Clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, 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 canna bis 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.
Diagnostic Criteria for Cannabis Intoxication
With perceptual disturbances (CI
(Cannabis Intoxication) Hallucinations with intact reality testing or auditory, vi sual, or tactile illusions occur in the absence of a delirium.
Cannabis Withdrawal
is the presence of a characteristic withdrawal syndrome that develops after the cessation of or substantial reduction in heavy and pro longed cannabis use.
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 physical symptoms causing significant discomfort: ab dominal pain, shakiness/tremors, sweating, fever, chills, or headache.
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.
Diagnostic Criteria for Cannabis Withdrawal
Phencyclidine Use Disorder
is a mental health condition characterized by a problematic pattern of phencyclidine (PCP) use that leads to clinically significant impairment or distress.
Individuals with — struggle to control their PCP use, experience negative consequences due to PCP use, and may continue to use PCP despite harmful effects
Phencyclidine
also known as angel dust, is a powerful dissociative drug that can cause a range of severe side effects, including hallucinations, delusions, and violent behavior.
less potent but similarly acting compounds such as ketamine, cyclohex amine, and dizocilpine.
These substances were first developed as dissociative anesthetics in the 1950s and became street drugs in the 1960s. They produce feelings of separation from mind and body (hence “dissociative”) in low doses, and at high doses, stupor and coma can result.
These substances are most commonly smoked or taken orally, but they may also be snorted or injected
A. A pattern of phencyclidine (or a pharmacologically similar substance) use leading to clinically significant impairment or distress, as manifested by at least two of the follow ing, occurring within a 12-month period:
1. Phencyclidine is often taken in larger amounts or over a longer period than was in tended.
2. There is a persistent desire or unsuccessful efforts to cut down or control phency clidine use.
3. A great deal of time is spent in activities necessary to obtain phencyclidine, use the phencyclidine, or recover from its effects.
4. Craving, or a strong desire or urge to use phencyclidine.
5. Recurrent phencyclidine use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to phencyclidine use; phencyclidine-related absences, suspensions, or ex pulsions from school; neglect of children or household).
6. Continued phencyclidine use despite having persistent or recurrent social or inter personal problems caused or exacerbated by the effects of the phencyclidine (e.g., arguments with a spouse about consequences of intoxication; physical fights).
7. Important social, occupational, or recreational activities are given up or reduced be cause of phencyclidine use.
8. Recurrent phencyclidine use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by a phencyclidine).
9. Phencyclidine use is continued despite knowledge of having a persistent or recur rent physical or psychological problem that is likely to have been caused or exac erbated by the phencyclidine.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the phencyclidine to achieve intoxi cation or desired effect.
b. A markedly diminished effect with continued use of the same amount of the phencyclidine.
Diagnostic Criteria for Phencyclidine Use Disorder
In early remission (PCUD)
After full criteria for phencyclidine use disorder were previously met, none of the criteria for phencyclidine 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 the phencyclidine,” may be met).
In sustained remission (PCUD)
After full criteria for phencyclidine use disorder were previ ously met, none of the criteria for phencyclidine 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 the phencyclidine,” may be met).
In a controlled environment (PCUD)
This additional specifier is used if the individual is in an environment where access to phencyclidines is restricted.
Other Hallucinogen Use Disorder
is a mental health condition characterized by a problematic pattern of using hallucinogens other than phencyclidine (PCP).
This includes substances like LSD, psilocybin mushrooms, ayahuasca, and ketamine.
A. A problematic pattern of hallucinogen (other than phencyclidine) use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. The hallucinogen is 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 hallucinogen use.
3. A great deal of time is spent in activities necessary to obtain the hallucinogen, use the hallucinogen, or recover from its effects.
4. Craving, or a strong desire or urge to use the hallucinogen.
5. Recurrent hallucinogen use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to hallucinogen use; hallucinogen-related absences, suspensions, or expulsions from school; neglect of children or household).
6. Continued hallucinogen use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the hallucinogen (e.g., arguments with a spouse about consequences of intoxication; physical fights).
7. Important social, occupational, or recreational activities are given up or reduced because of hallucinogen use.
8. Recurrent hallucinogen use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by the hallucinogen).
9. Hallucinogen 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 hallucinogen.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the hallucinogen to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of the hallucinogen.
Diagnostic Criteria for Other Hallucinogen Use Disorder
In early remission (OHUD)
After full criteria for other hallucinogen use disorder were previously met, none of the criteria for other hallucinogen 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 the hallucinogen,” may be met).
In sustained remission (OHUD)
After full criteria for other hallucinogen use disorder were previously met, none of the criteria for other hallucinogen 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 the hallucinogen,” may be met).
In a controlled environment (OHUD
This additional specifier is used if the individual is in an environment where access to hallucinogens is restricted.
Phencyclidine Intoxication
is a temporary condition characterized by significant behavioral and psychological changes due to recent PCP consumption.
A. Recent use of phencyclidine (or a pharmacologically similar substance). B. Clinically significant problematic behavioral changes (e.g., belligerence, assaultive ness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment) that developed during, or shortly after, phencyclidine use. C. Within 1 hour, two (or more) of the following signs or symptoms: Note: When the drug is smoked, “snorted,” or used intravenously, the onset may be particularly rapid. 1. Vertical or horizontal nystagmus. 2. Hypertension or tachycardia. 528 Substance-Related and Addictive Disorders 3. Numbness or diminished responsiveness to pain. 4. Ataxia. 5. Dysarthria. 6. Muscle rigidity. 7. Seizures or coma. 8. Hyperacusis. 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.
Diagnostic Criteria for Phencyclidine Intoxication
Other Hallucinogen Intoxication
is a temporary condition characterized by significant behavioral and psychological changes due to recent consumption of a hallucinogen other than phencyclidine (PCP).
A. Recent use of a hallucinogen (other than phencyclidine).
B. Clinically significant problematic behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of “losing one’s mind,” paranoid ideation, impaired judgment) that developed during, or shortly after, hallucinogen use.
C. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use.
D. Two (or more) of the following signs developing during, or shortly after, hallucinogen use:
1. Pupillary dilation.
2. Tachycardia.
3. Sweating.
4. Palpitations.
5. Blurring of vision.
6. Tremors.
7. Incoordination.
E. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another sub stance.
Diagnostic Criteria Other Hallucinogen Intoxication
Hallucinogen Persisting Perception Disorder
is a non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after using drugs,[1] including but not limited to psychedelics, dissociatives, entactogens, tetrahydrocannabinol (THC), and SSRIs.
The hallmark of — is the reexperiencing, when the individual is sober, of the perceptual disturbances that were experienced while the individ ual was intoxicated with the hallucinogen
A. Following cessation of use of a hallucinogen, the reexperiencing of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia and micropsia).
B. The symptoms in Criterion A cause clinically significant distress or impairment in so cial, occupational, or other important areas of functioning.
C. The symptoms are not attributable to another medical condition (e.g., anatomical le sions and infections of the brain, visual epilepsies) and are not better explained by an other mental disorder (e.g., delirium, major neurocognitive disorder, schizophrenia) or hypnopompic hallucinations.
Diagnostic Criteria for Hallucinogen Persisting Perception Disorder
Inhalant Use Disorder
is a mental health condition characterized by a problematic pattern of inhalant use that leads to clinically significant impairment or distress.
Individuals with — struggle to control their inhalant use, experience negative consequences due to inhalant use, and may continue to use inhalants despite harmful effects
A. A problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distress, as manifested by at least two of the follow ing, occurring within a 12-month period:
1. The inhalant substance is 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 use of the inhalant substance.
3. A great deal of time is spent in activities necessary to obtain the inhalant substance, use it, or recover from its effects.
4. Craving, or a strong desire or urge to use the inhalant substance.
5. Recurrent use of the inhalant substance resulting in a failure to fulfill major role ob ligations at work, school, or home.
6. Continued use of the inhalant substance despite having persistent or recurrent so cial or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced be cause of use of the inhalant substance.
8. Recurrent use of the inhalant substance in situations in which it is physically haz ardous.
9. Use of the inhalant substance is continued despite knowledge of having a persis tent or recurrent physical or psychological problem that is 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 the inhalant substance to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of the in halant substance.
Diagnostic Criteria for Inhalant Use Disorder
In early remission (IUD)
After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant 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 de sire or urge to use the inhalant substance,” may be met)
In sustained remission (IUD)
After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant 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 the inhalant substance,” may be met).
In a controlled environment (
This additional specifier is used if the individual is in an environment where access to inhalant substances is restricted
Inhalant Intoxication
is an inhalant-related, clinically significant mental disorder that de velops during, or immediately after, intended or unintended inhalation of a volatile hy drocarbon substance.
A. Recent intended or unintended short-term, high-dose exposure to inhalant sub stances, including volatile hydrocarbons such as toluene or gasoline.
B. Clinically significant problematic behavioral or psychological changes (e.g., belliger ence, assaultiveness, apathy, impaired judgment) that developed during, or shortly af ter, exposure to inhalants.
C. Two (or more) of the following signs or symptoms developing during, or shortly after, inhalant use or exposure:
1. Dizziness.
2. Nystagmus.
3. Incoordination.
4. Slurred speech.
5. Unsteady gait.
6. Lethargy.
7. Depressed reflexes.
8. Psychomotor retardation.
9. Tremor.
10. Generalized muscle weakness.
11. Blurred vision or diplopia.
12. Stupor or coma. 13. Euphoria.
D. The signs or symptoms are not attributable to another medical condition and are not bet ter explained by another mental disorder, including intoxication with another substance.
Diagnostic Criteria for Inhalant Intoxication
Opioid Use Disorder
includes signs and symptoms that reflect compulsive, prolonged self administration of opioid substances that are used for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, that are used in doses greatly in excess of the amount needed for that medical condition
(For example, an indi vidual prescribed analgesic opioids for pain relief at adequate dosing will use significantly more than prescribed and not only because of persistent pain.)
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 over a longer period than was in tended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the opi oid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a 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 be cause 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 physi cal or psychological problem that is 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 de sired effect.
b. A markedly diminished effect with continued use of the same amount of an opioid. Note:
This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.
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, pp. 547–548).
b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.
Diagnostic Criteria for Opioid Use Disorder
In early remission (OUD)
After full criteria for opioid 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 sustained remission (OUD)
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 de sire or urge to use opioids,” may be met).
On maintenance therapy (OUD)
This additional 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 tol erance to, or withdrawal from, the agonist). This category also applies to those individuals being maintained on a partial agonist, an agonist/antagonist, or a full antagonist such as oral naltrexone or depot naltrexone.
In a controlled environment (OUD)
This additional specifier is used if the individual is in an environment where access to opioids is restricted.
viral (e.g., HIV, hepatitis C virus) and bacterial infections, particularly among users of opioids by in jection.
The most common medical conditions associated with opioid use disorder are —
opioid intoxication
is the presence of clinically significant prob lematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that develop dur ing, or shortly after, opioid use
A. Recent use of an opioid.
B. Clinically significant problematic behavioral or psychological changes (e.g., initial eu phoria 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 sub stance.
Diagnostic Criteria for Opioid Intoxication
With perceptual disturbances (Opioid Intoxication)
(Opioid Intoxication) This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions oc cur in the absence of a delirium.
Opioid Withdrawal
The essential feature of — is the presence of a characteristic withdrawal syndrome that develops after the cessation of (or reduction in) opioid use that has been heavy and prolonged (Criterion A1).
The withdrawal syndrome can also be precipitated by administration of an opioid antagonist (e.g., naloxone or naltrexone) after a period of opioid use (Criterion A2).
This may also occur after administration of an opioid partial ag onist such as buprenorphine to a person currently using a full opioid agonist.
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.
Diagnostic Criteria for Opioid Withdrawal
Sedative, Hypnotic, or Anxiolytic Use Disorder
is a condition characterized by the misuse and dependence on substances like benzodiazepines, barbiturates, and other medications used to induce sleep or reduce anxiety. These substances, when used as prescribed, can be helpful in managing anxiety, insomnia, and seizures. However, when misused or abused, they can lead to significant health problems, including addiction.
A. A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically signif icant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a lon ger period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use.
3. A great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects.
4. Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic.
5. Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to sedative, hypnotic, or anxiolytic use; sedative-, hypnotic-, or anxiolytic-related absences, suspensions, or expulsions from school; neglect of children or household).
6. Continued sedative, hypnotic, or anxiolytic use despite having persistent or re current social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g., arguments with a spouse about conse quences of intoxication; physical fights).
7. Important social, occupational, or recreational activities are given up or reduced be cause of sedative, hypnotic, or anxiolytic use
8. Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use).
9. Sedative, hypnotic, or anxiolytic 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 sedative, hypnotic, or anxiolytic.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of the sed ative, hypnotic, or anxiolytic.
Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics (refer to Criteria A and B of the criteria set for sedative, hypnotic, or anxiolytic withdrawal, pp. 557–558).
b. Sedatives, hypnotics, or anxiolytics (or a closely related substance, such as al cohol) are taken to relieve or avoid withdrawal symptoms.
Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision
Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder
In early remission (SHAUD)
After full criteria for sedative, hypnotic, or anxiolytic use disorder were previously met, none of the criteria for sedative, hypnotic, or anxiolytic use disor der 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 the sedative, hypnotic, or anxiolytic,” may be met).
In sustained remission (SHAUD)
After full criteria for sedative, hypnotic, or anxiolytic use dis order were previously met, none of the criteria for sedative, hypnotic, or anxiolytic 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 the sedative, hypnotic, or anxiolytic,” may be met).
In a controlled environment (SHAUD)
This additional specifier is used if the individual is in an environment where access to sedatives, hypnotics, or anxiolytics is restricted.
antianxiety medications
Sedative, hypnotic, or anxiolytic substances include benzodiazepines, benzodiazepine like drugs (e.g., zolpidem, zaleplon), carbamates (e.g., glutethimide, meprobamate), barbiturates (e.g., secobarbital), and barbiturate-like hypnotics (e.g., glutethimide, meth aqualone). This class of substances includes all prescription sleeping medications and almost all prescription —- .
brain depressants
Like alcohol, these agents are — and can produce similar substance/ medication-induced and substance use disorders
alcohol use disorder, tobacco use disorder, and, generally, illicit drug use
Nonmedical use of sedative, hypnotic, or anxiolytic agents is associated with —
Sedative, Hypnotic, or Anxiolytic Intoxication
is a condition that occurs when someone takes too much of a sedative, hypnotic, or anxiolytic drug. These drugs, often prescribed for anxiety, insomnia, or seizures, can cause significant problems when misused or abused.
is the presence of clini cally significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develop during, or shortly after, use of a sedative, hypnotic, or anxiolytic
A. Recent use of a sedative, hypnotic, or anxiolytic.
B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappro priate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, sedative, hypnotic, or anxiolytic use.
C. One (or more) of the following signs or symptoms developing during, or shortly after, sedative, hypnotic, or anxiolytic use:
1. Slurred speech.
2. Incoordination.
3. Unsteady gait.
4. Nystagmus.
5. Impairment in cognition (e.g., attention, 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 sub stance.
Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication
Memory impairment
— is a prominent feature of sedative, hyp notic, or anxiolytic intoxication and is most often characterized by an anterograde amnesia that resembles “alcoholic blackouts,” which can be disturbing to the individual.
Sedative, Hypnotic, or Anxiolytic Withdrawal
occurs when someone abruptly stops using or significantly reduces their intake of sedative, hypnotic, or anxiolytic drugs after prolonged use. These drugs, commonly prescribed for anxiety, insomnia, or seizures, can cause physical and psychological dependence.
is characterized by two or more symptoms (similar to alcohol withdrawal) that include autonomic hyperactivity (e.g., increases in heart rate, respiratory rate, blood pressure, or body temperature, along with sweating); a tremor of the hands; insomnia; nausea, sometimes accompanied by vomiting; anxiety; and psychomotor agitation.
A. Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use that has been prolonged.
B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) sedative, hypnotic, or anxiolytic use described in Criterion A:
1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
2. Hand tremor.
3. Insomnia.
4. Nausea or vomiting.
5. Transient visual, tactile, or auditory hallucinations or illusions.
6. Psychomotor agitation.
7. Anxiety.
8. Grand mal 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
Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Withdrawal
Stimulant Use Disorder
is a condition characterized by the compulsive use of stimulant drugs, despite negative consequences. Stimulants are substances that increase alertness and energy levels. They can be legal, like prescription medications for ADHD (e.g., Adderall, Ritalin), or illegal, such as cocaine and methamphetamine.
A. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the follow ing, occurring within a 12-month period:
1. The stimulant is often taken in larger amounts or over a longer period than was in tended.
2. There is a persistent desire or 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 from 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 interper sonal problems caused or exacerbated by the effects of the stimulant.
7. Important social, occupational, or recreational activities are given up or reduced be cause 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 desired effect.
b. A markedly diminished effect with continued use of the same amount of the stimulant.
Note: This criterion is not considered to be met for those taking stimulant medica tions solely under appropriate medical supervision, such as medications for atten tion-deficit/hyperactivity disorder or narcolepsy.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal, p. 569).
b. The stimulant (or a closely related substance) is taken to relieve or avoid with drawal symptoms
Diagnostic Criteria for Stimulant Disorder
In early remission (Stimulant Use Disorder)
After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant 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 de sire or urge to use the stimulant,” may be met).
In sustained remission (Stimulant Use Disorder)
After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant 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 the stimulant,” may be met).
In controlled environment (Stimulant Use Disorder)
This additional specifier is used if the individual is in an environment where access to stimulants is restricted.
1 week
Individuals exposed to amphetamine-type stimulants or cocaine can develop stimu lant use disorder as rapidly as — , although the onset is not always this rapid
Stimulant Intoxication
, related to amphetamine-type stimulants and cocaine, is the presence of clinically significant behavioral or psychological changes that develop during, or shortly after, use of stimulants
. Auditory hallu cinations may be prominent, as may paranoid ideation, and these symptoms must be dis tinguished from an independent psychotic disorder such as schizophrenia
— refers to the state of being under the influence of a stimulant drug. This can lead to a range of physical and psychological effects, depending on the specific drug and the amount consumed
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 sub stance.
Diagnostic Criteria for Stimulant Intoxication
With perceptual disturbances (Stimulant Intoxication)
This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a de lirium.
Stimulant Withdrawal
is the presence of a characteristic with drawal syndrome that develops within a few hours to several days after the cessation of (or marked reduction in) stimulant use (generally high dose) that has been prolonged (Cri terion A).
The withdrawal syndrome is characterized by the development of dysphoric mood accompanied by two or more of the following physiological changes: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation
Bradycardia
is often present and is a reliable mea sure of 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.
Diagnostic Criteria for Stimulant Withdrawal
Tobacco Use Disorder
is a chronic condition characterized by compulsive tobacco use despite negative consequences. Nicotine, the addictive substance in tobacco products, stimulates the brain's reward center, leading to feelings of pleasure and reinforcement. Over time, this can lead to physical and psychological dependence.
is common among individuals who use cigarettes and smokeless tobacco daily and is uncommon among individuals who do not use tobacco daily or who use nicotine medications.
A. A problematic pattern of tobacco use leading to clinically significant impairment or dis tress, as manifested by at least two of the following, occurring within a 12-month period:
1. Tobacco is 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 tobacco use.
3. A great deal of time is spent in 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 interper sonal 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 be cause of tobacco use.
8. Recurrent tobacco use in situations in which it is physically hazardous (e.g., smok ing 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 either of the following:
a. A need for markedly increased amounts of 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.
Diagnostic Criteria for Tobacco Use Disorder
In early remission (TUD)
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 de sire or urge to use tobacco,” may be met).
In sustained remission (TUD)
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 (TUD)
The individual is taking a long-term maintenance medica tion, such as nicotine replacement medication, and no criteria for tobacco use disorder have been met for that class of medication (except tolerance to, or withdrawal from, the nicotine replacement medication).
In a controlled environment (TUD)
This additional specifier is used if the individual is in an environment where access to tobacco is restricted
Tobacco Withdrawal
The symptoms after abstinence from tobacco are in large part due to nicotine deprivation.
Symptoms are much more intense among individuals who smoke cigarettes or use smokeless tobacco than among those who use nicotine medications. This difference in symptom intensity is likely due to the more rapid onset and higher levels of nicotine with cigarette smoking.
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 four (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 bet ter explained by another mental disorder, including intoxication or withdrawal from an other substance.
Diagnostic Criteria for Tobacco Withdrawal
Other (or Unknown) Substance Use Disorder
refers to a condition where a person develops a compulsive pattern of substance use involving substances that are not specifically categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
comprises substance-related disorders unrelated to alcohol; caffeine; cannabis; hallucinogens (phen cyclidine and others); inhalants; opioids; sedative, hypnotics, or anxiolytics; stimulants (including amphetamine and cocaine); or tobacco
A. A problematic pattern of use of an intoxicating substance not able to be classified within the alcohol; caffeine; cannabis; hallucinogen (phencyclidine and others); inhal ant; opioid; sedative, hypnotic, or anxiolytic; stimulant; or tobacco categories and lead ing to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. The substance is 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 use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued use of the substance despite having persistent or recurrent social or in terpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced be cause of use of the substance.
8. Recurrent use of the substance in situations in which it is physically hazardous.
9. Use of the substance is continued despite knowledge of having a persistent or re current physical or psychological problem that is likely to have been caused or ex acerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of the sub stance.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for other (or unknown) substance (refer to Criteria A and B of the criteria sets for other [or unknown] substance withdrawal, p. 583).
b. The substance (or a closely related substance) is taken to relieve or avoid with drawal symptoms.
Diagnostic Criteria for Other (or Unknown) Substance Use Disorder
adolescent conduct disorder and adult antisocial personality disorder, and with suicidal ideation and suicide attempts.
Substance use disorders, including other (or unknown) substance use disorder, are com monly comorbid with one another, with
Other (or unknown) substance intoxication
is a clinically significant mental disorder that develops during, or immediately after, use of either a) a substance not elsewhere ad dressed in this chapter (i.e., alcohol; caffeine; cannabis; phencyclidine and other halluci nogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; or tobacco) or b) an unknown substance. If the substance is known, it should be reflected in the name of the disorder upon coding.
A. The development of a reversible substance-specific syndrome attributable to recent in gestion of (or exposure to) a substance that is not listed elsewhere or is unknown.
B. Clinically significant problematic behavioral or psychological changes that are attribut able to the effect of the substance on the central nervous system (e.g., impaired motor coordination, psychomotor agitation or retardation, euphoria, anxiety, belligerence, mood lability, cognitive impairment, impaired judgment, social withdrawal) and develop during, or shortly after, use of the substance.
C. The signs or symptoms are not attributable to another medical condition and are not bet ter explained by another mental disorder, including intoxication with another substance.
Diagnostic Criteria for Other (or Unknown) Substance Intoxication
Other (or Unknown) Substance Withdrawal
is a clinically significant mental disorder that develops during, or within a few hours to days after, reducing or terminating dosing with a substance (Criteria A and B).
Although recent dose reduction or termination usually is clear in the history, other diagnostic procedures are very challenging if the drug is un known. Criterion B requires development of a “substance-specific syndrome” (i.e., the in dividual’s signs and symptoms must correspond with the known withdrawal syndrome for the recently stopped drug)—a requirement that rarely can be met with an unknown substance.
A. Cessation of (or reduction in) use of a substance that has been heavy and prolonged.
B. The development of a substance-specific syndrome shortly after the cessation of (or reduction in) substance use.
C. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not attributable to another medical condition and are not better ex plained by another mental disorder, including withdrawal from another substance.
E. The substance involved cannot be classified under any of the other substance catego ries (alcohol; caffeine; cannabis; opioids; sedatives, hypnotics, or anxiolytics; stimu lants; or tobacco) or is unknown.
Diagnostic Criteria for Other (or Unknown) Substance Withdrawal
Gambling Disorder
s a mental health condition characterized by a persistent and recurrent urge to gamble, despite negative consequences. It's a behavioral addiction that can lead to significant financial, social, and emotional problems.
Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the fol lowing 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 of 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 distressed (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 op portunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.
B. The gambling behavior is not better explained by a manic episode.
Diagnostic Criteria for Gambling Disorder