SUBSTANCE-RELATED and ADDICTIVE DISORDERS

DISORDER SIGNS AND SYMPTOMS DIAGNOSIS ONSET TREATMENT

1. Alcohol- Related Disorders
Mid- teens; Alcohol related
problems that do not meet full Three general steps are involved in treating
1. Alcohol Use Disorder See Substance Use Disorder Criteria
criteria may occur prior to age the alcoholic person after the disorder has
20 years been diagnosed:
1. Slurred speech
2. Incoordination 1. Intervention:
One or more signs and symptoms Average age onset:15 years
3. Unsteady gait - The goal is to break through feelings of
2. Alcohol Intoxication developing during, or shortly after, Highest prevalence: 18-25
4. Nystagmus denial and help the patient recognize the
caffeine use years
5. Impairment in attention/memory adverse consequences likely to occur if the
6. Stupor/ coma disorder is not treated
- Convincing patients that they are
responsible for their own actions while
reminding them of how alcohol has created
significant life impairments.
- Family can be a great help in the
intervention by learning not to protect the
patient from the problems caused by the
alcohol

2. Detoxification
1. Autonomic hyperactivity
- Mild/Moderate Withdrawal
2. Increased hand tremor
- Severe Withdrawal
3. Insomnia
- Protracted Withdrawal
4. Nausea/ vomiting Two or more signs and symptoms
Relatively rare in individuals
3. Alcohol Withdrawal 5. Transient visual, tactile, or auditory developing within several hours to a few
younger than 30 years 3. Rehabilitation
hallucinations/ illusions days
- continued efforts to increase and maintain
6. Psychomotor agitation
high levels of motivation for abstinence
7. Anxiety
- work to help the patient readjust to a lifestyle
8. Generalized tonic-clonic seizures
free of alcohol
- Relapse prevention: the counselor must help
the patient develop modes of coping to be
used when the craving for alcohol increases/
return
- Counselling (may be group/individual)
efforts in the first several months should focus
on day-to-day life issues to help patients
maintain a high level of motivation for
abstinence and to enhance their functioning

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- Medications
2. Caffeine- Related Disorders
1. Restlessness.
2. Nervousness.
3. Excitement.
4. Insomnia.
5. Flushed face.
Five or more of the following signs or
6. Diuresis. Pharmacotherapy
4. Caffeine Intoxication symptoms developing during, or shortly
7. Gastrointestinal disturbance.
after, caffeine use
8. Muscle twitching. The first step in reducing/eliminating caffeine
9. Rambling flow of thought and speech. use is to have patients determine their daily
10. Tachycardia or cardiac arrhythmia. All ages consumption of caffeine
11. Periods of inexhaustibility.
12. Psychomotor agitation. The patient and clinician should then decide
1. Headache. on a fading schedule for caffeine
2. Marked fatigue or drowsiness. consumption
3. Dysphoric mood, depressed mood, or
Followed within 24 hours by three or
5. Caffeine Withdrawal irritability.
more of the following signs or symptoms
4. Difficulty concentrating.
5. Flu-like symptoms (nausea, vomiting, or
muscle pain/stiffness).
3. Cannabis- Related Disorders

6. Cannabis Use Disorder See Substance Use Disorder Criteria Abstinence can be achieved through direct
intervention, such as hospitalization, or
1. Conjunctival injection. through careful monitoring on an outpatient
Two or more following of the signs or
2. Increased appetite. basis by the use of urine drug screens, which
7. Cannabis Intoxication symptoms developing within 2 hours of
3. Dry mouth. can detect cannabis for up to 4 weeks after use
cannabis use
4. Tachycardia.
Support can be achieved through the use of
1. Irritability, anger, or aggression. Adolescence or young
individual, family, and group psychotherapy
2. Nervousness or anxiety. adulthood
3. Sleep difficulty (e.g., insomnia, disturbing
Education should be a cornerstone for both
dreams). Three or more of the following signs and
abstinence and support programs
8. Cannabis Withdrawal 4. Decreased appetite or weight loss. symptoms develop within approximately
5. Restlessness. 1 week
A patient who does not understand the
6. Depressed mood.
intellectual reason for addressing a substance-
7. At least one of the following physical
abuse problem has little motivation to stop
symptoms causing significant discomfort:

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9. Phencyclidine Use Disorder
10. Phencyclidine Intoxication
11. Other Hallucinogen Use
Disorder
12. Other Hallucinogen
Intoxication
13. Hallucinogen Persisting
Perception Disorder
14. Inhalant Use Disorder
15. Inhalant Intoxication
walang withdrawal
SUBSTANCE-RELATED and ADDICTIVE DISORDERS
abdominal pain, shakiness/tremors, Pharmacotherapy, such as antianxiety drug,
sweating, fever, chills, or headache. for short- term relief
4. Hallucinogen- Related Disorders
See Substance Use Disorder Criteria
1. Vertical or horizontal nystagmus.
2. Hypertension or tachycardia.
3. Numbness or diminished responsiveness
to pain.
Within 1 hour, two or more of the
4. Ataxia. No drug is known to function as a direct PCP
following signs and symptoms
5. Dysarthria. antagonist
6. Muscle rigidity.
7. Seizures or coma. A basic principle in treatment is providing
Age onset is unknown
8. Hyperacusis. reassurance and supportive care.
See Substance Use Disorder Criteria Note: When the drug is
Can be helped by a quiet environment
smoked, “snorted”, or used
1. Pupillary dilation.
intravenously, the onset may be
2. Tachycardia. Pharmacotherapy
rapid
3. Sweating.
Two or more of the following signs
4. Palpitations.
developing during, or shortly after
5. Blurring of vision.
6. Tremors.
7. Incoordination.
1. Correct identification of the disorder
re-experiencing of one or more of the
perceptual symptoms that were experienced while intoxicated with the hallucinogen Pharmacological approaches and
antipsychotic agents
5. Inhalant- Related Disorder
Inhalant intoxication usually requires no
See Substance Use Disorder Criteria medical attention and resolves spontaneously.
However, the effects of the intoxication
1. Dizziness. (physical effects) need treatment
2. Nystagmus.
3. Incoordination. 12- 17 years Day treatment and Residential Programs,
Two (or more) of the following signs or
4. Slurred speech. especially for adolescent abusers with
symptoms developing during, or shortly
5. Unsteady gait. combined substance dependence and other
after
6. Lethargy. psychiatric disorders
7. Depressed reflexes.
8. Psychomotor retardation. Treatment usually lasts 3-12 months
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 SUBSTANCE-RELATED and ADDICTIVE DISORDERS

9. Tremor.
10. Generalized muscle weakness.
11. Blurred vision or diplopia.
12. Stupor or coma.
13. Euphoria.

6. Opioid- Related Disorders

Overdose treatment
16. Opioid Use Disorder See Substance Use Disorder Criteria
Medically Supervised Withdrawal and
Pupillary constriction (or pupillary Detoxification
dilation due to anoxia from severe - Opioid Agents such as Methadone
overdose) and - Opioid substitutes
1. Drowsiness or coma. one (or more) of the following signs or
17. Opioid Intoxication 2. Slurred speech. symptoms developing during, or shortly Pregnant Women with Opioid Dependence
3. Impairment in attention or memory. after - Neonatal addiction is a significant problem

Specify if: with/without perceptual Psychotherapy

disturbances - Individual psychotherapy, Behavioral
Can begin at any age, but are
psychotherapy, cognitive- behavioral
most common in the late teens
therapy, family therapy, support groups, and
or early 20s
1. Dysphoric mood. social skills training
2. Nausea or vomiting.
3. Muscle aches. Therapeutic Communities
4. Lacrimation or rhinorrhea. - Abstinence is the rule
5. Pupillary dilation, piloerection, or Three (or more) of the following - To be admitted, a person must show a high
18. Opioid Withdrawal
sweating. developing within minutes to several days level of motivation
6. Diarrhea. - Education and Needle Exchange
7. Yawning.
8. Fever. Narcotic Anonymous
9. Insomnia. - Self- help group of abstinent drug addicts
modelled on the 12-step principles of
Alcoholics Anonymous
7. Sedative, Hypnotic, or Anxiolytic Related Disorders
19. Sedative, Hypnotic, or Medications
See Substance Use Disorder Criteria
Anxiolytic Use Disorder
1. Slurred speech. One (or more) of the following signs or Teens or 20s Overdose
20. Sedative, Hypnotic, or
2. Incoordination. symptoms developing during, or shortly - The patients should be kept from slipping
Anxiolytic Intoxication
3. Unsteady gait. after into unconsciousness

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 SUBSTANCE-RELATED and ADDICTIVE DISORDERS

4. Nystagmus. - Hospitalization
5. Impairment in cognition
6. Stupor or coma. Expert Opinion
1. Autonomic hyperactivity (e.g., sweating
or pulse rate greater than 100 bpm).
2. Hand tremor.
3. Insomnia.
Two (or more) of the following,
21. Sedative, Hypnotic, or 4. Nausea or vomiting.
developing within several hours to a few
Anxiolytic Withdrawal 5. Transient visual, tactile, or auditory
days after the cessation
hallucinations or illusions.
6. Psychomotor agitation.
7. Anxiety.
8. Grand mal seizures.
8. Stimulant- Related Disorders
22. Stimulant Use Disorder See Substance Use Disorder Criteria Physicians should establish a therapeutic
1. Tachycardia or bradycardia. alliance with patients to deal with the
2. Pupillary dilation. underlying depression, personality disorders,
3. Elevated or lowered blood pressure. or both. Because many patients are heavily
4. Perspiration or chills. dependent on the drug, however
5. Nausea or vomiting. psychotherapy may be especially difficult
Two (or more) of the following signs or
6. Evidence of weight loss.
23. Stimulant Intoxication symptoms, developing during, or shortly
7. Psychomotor agitation or retardation. Detoxification
after
8. Muscular weakness, respiratory
depression, chest pain, or cardiac Psychosocial Therapy
arrhythmias. - Individual therapy focuses on the dynamics
9. Confusion, seizures, dyskinesias, leading to stimulant use, the perceived
dystonias, or coma. positive effects, and other ways to achieve
12- 25 years
these effects
- Group therapy and other support groups
focuses on discussions with other persons
who use stimulants and on sharing
1. Fatigue. experiences and effective coping methods
Dysphoric mood and two (or more) of the
2. Vivid, unpleasant dreams. - Family therapy is often an essential
following physiological changes,
24. Stimulant Withdrawal 3. Insomnia or hypersomnia. component of the treatment strategy.
developing
4. Increased appetite. Common issues discussed in family therapy
within a few hours to several days
5. Psychomotor retardation or agitation. are the ways the patient’s past behavior has
harmed the family and the responses of family
members to these behaviors. The therapy
should also focus on the future and on
changes in the family’s activities that may

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 SUBSTANCE-RELATED and ADDICTIVE DISORDERS

help the patient stay off the drug and direct

energies in different directions

Network Therapy
- Uses both psychodynamic and cognitive-
behavioral approaches to individual therapy,
while engaging the patient in a group support
(composed of family and peers) network

Pharmacological adjuncts
9. Tobacco- Related Disorders
walang Psychosocial Therapies
25. Tobacco Use Disorder withdrawal See Substance Use Disorder Criteria - Behavior therapy, skills training and relapse
prevention
1. Irritability, frustration, or anger. - Stimulus control
2. Anxiety. Abrupt cessation of tobacco use, or - Aversive Therapy make smokers smoke
18 years
3. Difficulty concentrating. reduction in the amount of tobacco used, repeatedly. (Requires a good therapeutic
26. Tobacco Withdrawal 4. Increased appetite. followed alliance)
5. Restlessness. within 24 hours by four (or more) of the - Psychopharmacological Therapies,
6. Depressed mood. following signs or symptoms Combined Psychosocial and Pharmacological
7. Insomnia. therapy
10. Other (or unknown) Substance Use Disorder
27. Other (or unknown) Psychosocial support systems
See Substance Use Disorder Criteria
Substance Use Disorder
28. Other (or unknown) No single pattern of 2 major treatments for substance abuse
See Substance Intoxication Criteria
Substance Intoxication development - Abstinence from substance
29. Other (or unknown) - Physical, psychiatric, and psychosocial
See Substance Withdrawal Criteria well- being of the patient
Substance Withdrawal
Non- Substance- Related Disorders
Gamblers seldom come forward voluntarily
1. Needs to gamble with increasing amounts
Persistent and recurrent problematic to be treated.
of money in order to achieve the desired
gambling behavior leading to clinically
excitement.
significant Legal difficulties, family pressures, or other
2. Is restless or irritable when attempting to
impairment or distress, as indicated by the Can occur during adolescence psychiatric complaints bring gamblers to
30. Gambling Disorder cut down or stop gambling.
individual exhibiting four (or more) of the or young adulthood treatment
3. Has made repeated unsuccessful efforts to
following
control, cut back, or stop gambling.
in a 12-month period: Gamblers Anonymous is a method of
4. Is often preoccupied with gambling
inspirational group therapy that involves
5. Often gambles when feeling distressed
public confessions, peer pressure, and the

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6. After losing money gambling, often returns presence of reformed gamblers available to
another day to get even help members resist the impulse to gamble.
7. Lies to conceal the extent of involvement
with gambling. Hospitalization may help by removing
8. Has jeopardized or lost a significant patients from their environments
relationship, job, or educational or career
opportunity because of gambling. Insight- oriented psychotherapy should not be
9. Relies on others to provide money to sought until patients have been away from
relieve desperate financial situations caused gambling for 3 months
by gambling.
Family therapy is often valuable

Cognitive- behavioral therapy (e.g. relaxation

techniques combined with visualization of
gambling avoidance) has had some success

Psychopharmacological treatment, once

largely unsuccessful, now plays a significant
role in the management of pathological
gamblers
1. preoccupation with Internet games
2. Withdrawal symptoms
3. Tolerance – the need to spend increasing
amounts of time
4. Unsuccessful attempts to control Persistent and recurrent use of the
5. Loss of interest in previous hobbies and Internet to engage in games, often with
entertainment other players, leading to clinically
31. Internet Gaming Disorder
6. continued use despite psychosocial significant impairment or distress as
problem indicated by five or more of the following
7. deception of people regarding the amount in a 12-month period
of Internet gaming
8. using to escape or relieve a negative mood
9. jeopardized or lost a significant major area
in life
A. more than minimal exposure to alcohol Criteria A, one in B, C, and two in D, one
32. Neurobehavioral Disorder
during gestation, including prior to pregnancy of which must be communication deficit
Associated with Prenatal
recognition or impairment in social communication
Alcohol Exposure
and interaction

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 SUBSTANCE-RELATED and ADDICTIVE DISORDERS

B. Impaired neurocognitive functioning as

manifested by one or more following
impairments
1. global intellectual performance
2. executive functioning
3. Learning
4. memory
5. Visual-spatial reasoning

C. Impaired self-regulation as manifested by

one or more:
1. impairment in mood or behavioral
regulation
2. attention deficit
3. impairment in impulse control

D. Impairment in adaptive functioning as

manifested by two or more, one of which
must be (1) or (2)
1. communication deficit
2. Impairment in social communication and
interaction
3. impairment in daily living skills
4. impairment in motor skills

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 SUBSTANCE-RELATED and ADDICTIVE DISORDERS

SUBSTANCE USE DISORDER

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period.

Impaired Control Social Impairment Risky Use of the Substance Pharmacological criteria

Criterion 1. The individual may take the
substance in larger amounts of over a longer
period than was originally intended
Criterion 2. The Individual may express a
persistent desire to cut down or regulate
substance use and may report multiple
unsuccessful efforts to decrease or discontinue
use
Criterion 3. The individual may spend a great
deal of time obtaining the substance, using the
substance, or recovering from its effects. In
some instances of more severe substance use
disorders, virtually all of the individual’s daily
activities revolve around the substance
Criterion 5. Recurrent substance use
may result in a failure to fulfil major
role obligation at work, school, or
home
Criterion 6. The individual may
continue substance use despite having
persistent or recurrent social or
interpersonal problems caused or
exacerbated by the effects of the
substance
Criterion 8. This may take the form of recurrent substance
use in situations in which it is physically hazardous
Criterion 9. The individual may continue substance use
despite knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been caused
or exacerbated by the substance. The key issue in evaluating
this criterion is not the existence of the problem, but rather
the individual’s failure to abstain from using the substance
despite the difficulty it is causing
Criterion 10. Tolerance is signalled by requiring a markedly
increased dose of the substance to achieve the desired effect or a
markedly reduced effect when the usual dose is consumed
Criterion 11. Withdrawal is a syndrome that occurs when blood or
tissue concentration of a substance decline in an individual who had
maintained prolonged heavy use of the substance. After developing
withdrawal symptoms, the individual is likely to consume the
substance to relieve the symptoms

Criterion 4. Craving is manifested by an

increase desire or urge for the drug that may
occur at any time but is more likely when in an
environment where the drug previously was
obtained or used

SUBSTANCE INTOXICATION SUBSTANCE WITHDRAWAL SEVERITY SPECIFIERS

Criterion A. The essential feature is the development of
a reversible substance- specific syndrome due to the
recent ingestion of a substance
Criterion B. The clinically significant problematic
behavioral or psychological changes associated with
intoxication 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 A. The essential feature is the development of a
substance- specific sections of behavioral change, with
physiological and cognitive concomitants, that is due to the
cessation or reduction in heavy and prolonged substance use
Mild: 2 or 3 symptoms Early Remission: >3 months, <12 months
Moderate: 4-5 symptoms
Severe: 6 or more symptoms Sustained Remission: after full criteria were
previously met, none of the criteria have been met
during a period of 12 months
Controlled Environment: substance is restricted
With/Without Perceptual Disturbances: Rare
instance when hallucinations occur with intact
reality testing, or auditory, visual or tactile
illusions occur in the absence of a delirium

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