Substance related and addictive disorders
The categories of substance-related disorders, as defined by the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), are divided into two main groups: Substance Use Disorders and Substance-Induced Disorders.
1. Substance Use Disorders (SUDs) 🥃💊
These are a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues to use a substance despite significant substance-related problems. The diagnosis of a Substance Use Disorder can be applied to 10 separate classes of drugs (all except caffeine).
A diagnosis requires a problematic pattern of substance use leading to clinically significant impairment or distress, manifested by at least two of 11 criteria occurring within a 12-month period. These 11 criteria are grouped into four major areas:
1- Impaired Control:
– Using the substance in larger amounts or for longer than intended.
– Persistent desire or failed attempts to cut down or control use.
– Spending a great deal of time in activities necessary to obtain, use, or recover from the effects of the substance.
– Experiencing craving, or a strong desire or urge to use the substance.
2- Social Impairment:
– Failure to fulfill major role obligations at work, school, or home due to substance use.
– Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the substance’s effects.
– Giving up or reducing important social, occupational, or recreational activities because of substance use.
3- Risky Use:
– Recurrent substance use in physically hazardous situations (e.g., driving while intoxicated).
– Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or worsened by the substance.
4- Pharmacological Criteria:
– Tolerance: Needing markedly increased amounts of the substance to achieve the desired effect, or a markedly diminished effect with continued use of the same amount.
– Withdrawal: The characteristic syndrome that occurs when blood or tissue concentrations of a substance decline, or using the substance (or a closely related substance) to relieve or avoid withdrawal symptoms.
The severity of a Substance Use Disorder is based on the number of criteria met:
Mild: 2–3 symptoms
Moderate: 4–5 symptoms
Severe: 6 or more symptoms
Substance Classes :
Substance Use Disorders are diagnosed for the following classes:
Alcohol
Cannabis
Hallucinogens (e.g., LSD, PCP)
Inhalants
Opioids (e.g., heroin, oxycodone)
Sedatives, Hypnotics, or Anxiolytics (e.g., benzodiazepines)
Stimulants (e.g., amphetamine, cocaine)
Tobacco
Caffeine (only as a Substance-Induced Disorder, not a Use Disorder)
2. Substance-Induced Disorders 🧠
These disorders involve mental and behavioral changes that are the direct result of the effects of a substance (intoxication, withdrawal, or other substance-related mechanisms). They are generally reversible.
Substance-Induced Disorders include:
A. Intoxication
This is a reversible substance-specific syndrome due to the recent ingestion of a substance. It involves clinically significant problematic behavioral or psychological changes (e.g., euphoria, impaired judgment, mood lability) that are due to the physiological effects of the substance on the central nervous system.
B. Withdrawal
This involves the development of a substance-specific problematic behavioral change with physiological and cognitive symptoms that is due to the cessation of, or reduction in, heavy and prolonged substance use. The symptoms cause clinically significant distress or impairment. Withdrawal is not defined for all substance classes (e.g., inhalants, PCP, or other hallucinogens).
C. Substance/Medication-Induced Mental Disorders
These are prominent symptoms of a mental disorder (like psychosis, depression, or anxiety) that are the direct physiological consequence of substance use or withdrawal. They are generally named after the substance and the resulting condition (e.g., Alcohol-Induced Depressive Disorder or Cannabis-Induced Psychotic Disorder). These include:
Substance-Induced Psychotic Disorder
Substance-Induced Bipolar and Related Disorder
Substance-Induced Depressive Disorder
Substance-Induced Anxiety Disorder
Substance-Induced Obsessive-Compulsive and Related Disorder
Substance-Induced Sleep Disorder
Substance-Induced Sexual Dysfunction
Substance-Induced Delirium
Substance-Induced Neurocognitive Disorder
What do you need to know for the exam ?