Substance Use Disorders

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1. Criteria (Sub- A): A problematic pattern of substance use leading to

stance Use Dis- clinically significant distress, shown through a minimum
order) of TWO OR MORE of the following, occurring within a 12
MONTH PERIOD:
1. Impaired Control:
-Substance is often taken in larger amounts or over a
longer period of time than was intended
-There is a persistent desire or unsuccessful efforts to cut
down or control use
-Craving, or strong desire or urge to use
2. Social Impairment:
-A great deal of time is spent in activities necessary to
obtain, use or recover from the effects of (substance)
-Recurrent (substance) use resulting in a failure to fulfill
major role obligations at work, school, or home (e.g.,
interference with work)
-Continued (substance) use despite having persistent or
recurrent social or interpersonal problems caused or ex-
acerbated by the effects of (substance) (e.g., arguments
with others about (substance) use)
-Important social, occupational, or recreational activities
are given up or reduced because of (substance) use
3. Risky Use:
-Recurrent (substance) use in physically hazardous situa-
tions
-(Substance) use is continued despite knowledge of hav-
ing a persistent or recurrent physical or psychological
problem that is likely to have been caused or exacerbated
by (substance)
4. Pharmacological Criteria:
-Tolerance: as defined by the following:
o A need for markedly increased amounts of (substance)
to achieve the desired effect
o A markedly diminished effect with continued use of the
same amount of (substance)
-Withdrawal: as manifested by the either of the following:
o The characteristic withdrawal syndrome for (substance)
(refer to Criteria A and B of the criteria set for (substance)
withdrawal)
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o (Substance) (or a closely related substance) is taken to
relieve or avoid withdrawal symptoms

2. Duration of SXS Must last for 12 months!!

for DX (Sub-
stance Use Dis-
order)

3. Rule Out (Sub- •Other Medical Conditions

stance Use Dis- •Substance Intoxication
order)

4. Specifiers (Sub- Mild: 2-3 symptoms

stance Use Dis- Moderate: 4-5 symptoms
order) Severe: 6+ symptoms
Early Remission: 3-12 months no criteria (except craving)
Sustained Remission: 12+ months no criteria (except crav-
ing)
Maintenance Therapy: engaging in therapy to prevent
harmful substance use (methadone)
In Controlled Environment: remission due to circum-
stances (prison, hospital, etc.)

5. Criteria (Sub- 1. Cessation/reduction of (substance) use that has been

stance Withdraw- heavy/prolonged
al) 2. 2+ of the following signs or symptoms developing w/in
(time):
• Long list of physical symptoms associated w/(substance)
withdrawal
3. Symptoms cause sig. distress in social/occupational or
important areas of functioning
4. Symptoms not better explained by another mental disor-
der/AMC, including intoxication or withdrawal from another
substance

6. Criteria (Sub- 1. Recent ingestion of (substance)

stance Intoxica- 2. Clinically sig. problematic behavioral or psychological
tion) changes (e.g., inappropriate sexual or aggressive behav-
ior, mood lability, impaired judgment) that developed dur-
ing, or shortly after, (substance) ingestion
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3. 1+ of the following signs or symptoms developing dur-
ing/shortly after (substance) ingestion:
• Long list of physical symptoms associated w/(substance)
intoxication
4. Symptoms not better explained by another mental disor-
der/AMC, including intoxication or withdrawal from another
substance

7. Dual Diagnosis Associated with Increased:

(Substance Use o Symptom severity
Disorder) o Frequency of relapses
o Nonadherence to treatment (8x more)
o Suicidal ideation/risk
o Sexual/physical victimization
o Frequency and greater length of hospitalizations
o Utilization in service (ER visits)
o Number of hospital discharges AMA
o Physical health concerns
o Violence/aggression
o Risk for HIV/AIDS
o Legal encounters (4x)
o Homelessness

8. Prevalence (Al- 12 month: 7%

cohol Use) Men 2-4x > risk of "heavy drinkers"; (Abstainers = 38% of
population)
Native Americans, Hispanics > Other races

9. Gender Consid- M:F = M > F

erations (Alcohol Heavy Drinkers:
Use) • Men = 14+ per week
• Women = 7+ per week
Lifetime Pattern: tend to go through periods of binges and
socially healthy use/sobriety; not necessarily chronically
increasing use - sporadically progressive

10. Complications ¢Liver failure

(Alcohol Use) ¢ Malnutrition
¢ MDD (especially among women, high risk of SUI during
intoxication)
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¢ Motor Vehicle Accidents
¢ Effects on Unborn Fetus
¢ Withdrawal Effects

11. Other Notes (Al- No known neurotransmitters specific to alcohol

cohol Use) *Alcohol use impacts core symptoms of psychiatric disor-
ders*
AUDIT - assess quantity/freq. of alcohol use; score of 8+
(out of 40) = possible disorder

12. Important stats • Alcohol use disorder has 3x the risk of having comorbid
(Alcohol Use) mental illness
• Pre-existing mental illness has 2x risk of alcohol/pre-
scription drug use disorder
• 33% - 75% general psychiatric patients meet criteria for
comorbid SUD

13. Etiology Theo- • Operant conditioning - availability of nondrug alternative

ries of SUD reinforces (same location, group of people, etc.); body
used to stimulant in certain environments, stimuli - ODs
usually in different environment
• Social Learning - individuals modeling behaviors of sub-
stance use
• Neuroadaptation
o Chronic use gradually shifts dopaminergic reward sys-
tem and hypothalamic pituitary adrenal axis system - ef-
fects how we tolerate stress, drugs, drug withdrawal, basic
physiological pieces of drug use
o Some people with substance use disorder are born with
greater susceptibility to drugs due to weaker dopaminergic
system (impulsivity control)

14. Treatment Drop • About 8% (12 & older) have used in past month
Out rates for SUD • Treatment dropout rates about 50%
• Marijuana reportedly on the rise due to legalization/med-
ical marijuana
• Problems with more illicit substances thought to be more
heritable than alcohol
o Similar to heritability of more chronic medical issues,
mental health problems
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