Substance use disorder (for all substances except caffeine)

Problematic pattern of substance use, leading to impairment or distress+2 or more within 12months period
≠control Social ≠ Risky use Neuro-adaptive
 Use large amount or longer than  Role obligation failure.  Use in hazardous situation  Tolerance
intended.  Cont. use despite social  Cont. to use despite  Withdrawal
 Unsuccessful effort to cut down problem. physical/ psychological ≠
 Great deal of time using or recovering  Sacrificing activity to/ due to
 craving use.
Specify: In controlled environment
in early remission: >3m <12m no syx except craving On maintenance therapy >> for opioid only
in sustained remission: >12m no syx except craving Mild 2syx – moderate 4syx- sever 6syx or >
Intoxication Withdrawal
Alcohol & Sedative / hypnotic / anxiolytic
 Recent use  Recent cessation
 Abnormal behavior (inappropriate sexual or  2 or more within hours to days:
aggression- mood lability- poor judgment) ↑HR- sweating-tremor- nausea- vomiting- diarrhea- anxiety-
 1 or more of the following: (NB pupil constricted) hallucination- insomnia- agitation- grand mal seizure.
Slurred speech- Incoordination- Unsteady gait- nystagmus-  Significant function impairment.
Impaired attention and memory- Coma  Not due to AMC or mental – other substance
 Not due to AMC or other mental disorders  Specify: if with perceptual disturbances.
Marijuana/ cannabis/ hashish/ THC
 Recent use  Cessation of use that has been heavy &prolonged
 Abnormal behavior (≠motor coordination- euphoria- (almost daily for 2months)
anxiety- sensation of slowed time- impaired  3 or more within 1week of cessation
judgment- social withdrawal) Irritable, anger, aggression\anxiety- restlessness\ insomnia or
 2 or more within hours of use: (NB pupil constricted) disturbing dream\↓appetite or wt loss\ depressed mood-
Conjunctival injection- ↑appetite -↑HR- dry mouth (at least 1 of physical syx. Causing discomfort):
 Not due to AMC or other mental disorders abdominal pain- tremor- sweating- fever- headache.
 Specify: if with perceptual disturbances.  Significant function impairment.
 Not due to AMC or other mental disorders
Opioid morphine, methadone, heroin
 Recent use  Recent cessation or opioid antagonist after use
 Abnormal behavior (euphoria followed by apathy-  3 or more of the following:
Impaired judgment- psychomotor impairment) Dysphoric mood – nausea- vomiting-diarrhea- sweating -fever-
 Pupil constriction +1 or more lacrimation or rhinorrhea- pupil dilated- insomnia- yawning-
Drowsiness- slurred speech- Impaired attention or memory muscle pain- piloerection
 Not due to AMC or other mental disorders  Significant function impairment.
 Specify: if with perceptual disturbances.  Not due to AMC or other mental disorders
Stimulant (cocaine- crack- amphetamine- crystal meth) Ecstasy!!
 Recent use of cocaine or amphetamine  Recent cessation
 Abnormal behavior (affective blunting- euphoria-  Dysphoric mood +2 or more of the following:
sociability change- tension- anger- anxiety-≠ judge- Vivid unpleasant dream- fatigue- ↑appetite-
stereotyped behaviors ) ↑↓psychomotor/ sleep-
 2 or more of the following:  Significant function impairment.
Pupil dilated- ↑↓HR /BP/psychomotor- wt loss- nausea-  Not due to AMC or other mental disorders
vomiting- perspiration “sweating” – chills- chest pain- m.  Specify the substance that causes the withdrawal syx.
weakness- resp. depression- cardiac arrhythmia- confusion-
coma- seizure- dyskinesia- dystonia
 Not due to AMC or other mental disorders
 Specify: if with perceptual disturbances.
 Specify: the specific intoxicant
 Hallucinogen (LSD-PCP-DXM-Ketamine)
 Recent use
 Abnormal behavior (anxiety- depression- fear of loss of mind-
idea of reference- paranoid idea-≠ judge)
 Perceptual changes in clear wakefulness (depersonalization-
derealization- illusion- hallucination- synesthesia) production of
NO
sense by stimulation from another sence
 2 or more of the following:
Pupil dilated- blurred vision- ↑HR- sweating- tremor- incoordination.
 Not due to AMC or other mental disorders

For PCP
 Recent use
 Abnormal behavior (agitation- assaultiveness- impulsive- -≠
judge)
 2 or more within one hour NO
Nystagmus (vertical-horizontal)- ↑HR/BP- numbness or ↓response to
pain- ataxia- dysarthria- m. rigidity- seizure- coma- hyperacusis.
 Not due to AMC or other mental disorders
Hallucinogen Persisting Perception disorder (flashback)
 Following to cessation of hallucinogen use>> Re-experiencing of perceptual syx. That experienced during intoxicated
previously. (false perception- mico/macropsia- flash of color- trails)
 Cause distress and impairment of function.
 Not due to AMC.
Inhalant
 Recent use
 Abnormal behavior (apathy- assaultiveness- ≠ judge)
 2 or more:
Dizziness- unsteady gait- incoordination- generalized m. weakness- NO
lethargy- ↓reflexes/ psychomotor-tremor- slurred speech- stuper- coma-
euphoria- nystagmus- blurred vision or diplopia.
 Not due to AMC or other mental disorders.
Caffeine
 Recent consumption. (esp. 250mg)  Prolonged delay use of caffeine/ sudden
 5 or more of the following: cessation or ↓in caffeine use.
Restlessness- nervousness- excitement- ↑HR/ arrhythmia- psychomotor  3 or more within 24 hours:
agitation- inexhausted- insomnia- flushed face- diuresis- GI disturb.- m. Headache- fatigue- dysphoric mood- difficult
twitching- rambling of thought/speech concentration- flu-like syx.
 Significant distress or impairment.  Significant distress or impairment.
 Not due to AMC or other mental disorders.  Not due to AMC or other mental disorders.
Tobacco
 Daily use for at least several weeks.
 Abrupt cessation or ↓in amount +4 or more
Anger or irritable- anxiety- restlessness-
NO depressed mood- insomnia- ↑appetite- difficult
concentration.
 Significant distress or impairment.
 Not due to AMC or other mental disorders.