Substance Related and Addictive Disorder.pdf

Substance Related and Addictive Disorder according to DSM 5TR

1. Substance Related and
Addictive Disorder
Dr. Aisha Perveen
Assistant Professor
Department of Psychology
National University of Pakistan

2. The DSM-5-TR recognizes substance-related disorders
resulting from the use of 10 separate classes of drugs
1.Alcohol
2.Caffeine
3.Cannabis (https://nida.nih.gov/publications/drugfacts/cannabis-
marijuana#mjextracts)
4.Hallucinogens
5.Inhalants
6.Opioids
7.Sedatives
8.Hypnotics, or anxiolytics
9.Stimulants (including amphetamine-type substances, cocaine, and other
stimulants)
10.Tobacco

3. Cannabis (Marijuana)

5. •These 10 classes are not fully distinct.
•All drugs that are taken in excess have in common the
ability to directly activate the brain reward systems,
which are involved in the reinforcement of behaviors
and establishment of memories.
•Instead of achieving reward system activation through adaptive
behaviors, these substances produce such an intense activation of the
reward system that normal activities may be neglected.

6. • studies suggest that the neurobiological roots of substance use
disorders for some individuals can be seen in their behaviors long
before the onset of actual substance use (e.g., lower levels of self-
control may reflect impairments of brain inhibitory mechanisms);
•The DSM-5-TR recognizes that people are not all automatically or
equally vulnerable to developing substance-related disorders. Some
people have lower levels of self-control that predispose them to
develop problems if exposed to drugs.

7. Note about drug addiction
•Note that the phrase “drug addiction” is not applied as a diagnostic term
in this classification, although it is in common usage in many countries to
describe severe problems related to compulsive and habitual use of
substances.
•The more neutral term substance use disorder is used to describe the wide
range of the disorder, from a mild form to a severe state of chronically
relapsing, compulsive pattern of drug taking. Some clinicians will choose to
use the phrase “drug addiction” to describe more severe presentations, but
that wording is omitted from the official DSM-5 substance use disorder
diagnostic terminology because of its uncertain definition and its
potentially negative connotation.

8. Substance-Use vs. Substance-Induced Disorders
•There are two groups of substance-related disorders: substance-use
disorders and substance-induced disorders.
•Substance-use disorders are patterns of symptoms resulting from the
use of a substance that you continue to take, despite experiencing
problems as a result.
•Substance-induced disorders, including intoxication, withdrawal, and
other substance/medication-induced mental disorders, are caused by
the effects of substances

9. (The term substance/medication-induced mental disorder refers to
symptomatic presentations that are due to the physiological effects of
an exogenous substance on the central nervous system and includes
typical intoxicants (e.g., alcohol, inhalants, cocaine), psychotropic
medications (e.g., stimulants, sedative-hypnotics), other medications,
(e.g., steroids), and environmental toxins (e.g., organophosphate
insecticides).

11. Difference between Diagnostic Features and
Associated features
•Diagnostic features refer to the core symptoms and criteria that must
be present for a diagnosis of a particular mental disorder. These
features are essential for making an accurate diagnosis and are used
by clinicians to determine whether an individual meets the criteria for
a specific disorder.
•Associated features refer to additional characteristics that often
accompany the disorder but are not necessary for the diagnosis.
These features can provide a more complete picture of the disorder
and help in understanding the full scope of its impact on an
individual’s life. They may include related symptoms, comorbid
conditions, typical patterns of behavior, and other clinical
observations.

12. Substance Use Disorder
Diagnostic Feature
•The essential feature of a substance use disorder is a cluster of
cognitive, behavioral, and physiological symptoms indicating that the
individual continues using the substance despite significant
substance-related problems.
•the diagnosis of a substance use disorder can be applied to all 10
substance classes included in this chapter except caffeine.

13. Substance Use Disorders
Substance use disorders span a wide variety of problems arising from
substance use, and cover 11 different criteria:
•Overall, the diagnosis of a substance use disorder is based on a
pathological pattern of behaviors related to use of the substance. To
assist with organization, the diagnostic items making up Criterion A
can be considered to fit within overall groupings of impaired control,
social impairment, risky use, and pharmacological criteria.

14. Category 1: Impaired control
1.Taking the substance in larger amounts or for longer than you're meant to
2.Wanting to cut down or stop using the substance but not managing to. and
may report multiple unsuccessful efforts to decrease or discontinue use
3.Spending a lot of time getting, using, or recovering from use of the
substance
4.Cravings and urges to use the substance. may occur at any time but is more
likely when in an environment where the drug previously was obtained or
used. Current craving is often used as a treatment outcome measure
because it may be a signal of impending relapse.

15. Category 2: Social impairment
5. Not managing to do what you should at work, home, or school because of
substance use
6.Continuing to use, even when it causes problems in relationships
7.Giving up important social, occupational, or recreational activities because
of substance use

16. Category 3: Risky Use of the substance
8. Using substances again and again, even when it puts you in danger
9. Continuing to use, even when you know you have a physical or psychological
problem that could have been caused or made worse by the substance
Category 4: Pharmacological
10. Needing more of the substance to get the effect you want (tolerance). Tolerance
may be difficult to determine by history alone, and laboratory tests may be helpful (e.g.,
high blood levels of the substance coupled with little evidence of intoxication suggest
that tolerance is likely).
11. Development of withdrawal symptoms, which can be relieved by taking more of
the substance
•Withdrawal (is a syndrome that occurs when blood or tissue concentrations of a
substance decline in an individual who had maintained prolonged, heavy use of the
substance.

17. •Severity of Substance Use Disorders
•The DSM-5-TR allows clinicians to specify how severe or how much of
a problem the substance use disorder is, depending on how many
symptoms are identified.
•Mild: Two or three symptoms indicate a mild substance use disorder.
5
•Moderate: Four or five symptoms indicate a moderate substance use
disorder.
•Severe: Six or more symptoms indicate a severe substance use
disorder.

18. •Clinicians can also add "in early remission," "in sustained remission,"
"on maintenance therapy" for certain substances, and "in a controlled
environment." These further describe the current state of the
substance use disorder.
•Understanding the severity of a substance use disorder can help
doctors and therapists better determine which treatments to
recommend. Choosing the appropriate level of care may improve a
person's chances of recovery.

19. Remission
In Early Remission
•What it means: The person had a substance use disorder but has not had any symptoms (except maybe
cravings) for at least 3 months but less than 12 months.
•Example: If someone stopped abusing alcohol 6 months ago and hasn't had any symptoms since then, they
are "in early remission."
•They have maintained sobriety but are still within the critical period where the risk of relapse is relatively
high.
In Sustained Remission
•What it means: The person had a substance use disorder but has not had any symptoms (except maybe
cravings) for 12 months or more.
•Example: If someone stopped abusing alcohol 14 months ago and hasn't had any symptoms since then, they
are "in sustained remission."
•The individual is considered to have a lower risk of relapse, but continued monitoring and support may still
be necessary to maintain remission.
•These terms help doctors understand how long a person has been free from the symptoms of their disorder.

20. •In the DSM-5 and ICD-10 coding systems, F10.120 is a specific
diagnostic code used to describe a particular type of mental and
behavioral disorder related to alcohol use. Here's a breakdown of the
code:
•F10.120
•F10: This part of the code indicates that the disorder is related to
alcohol use.
•.1: Indicates the presence of an alcohol-induced disorder.
•20: Provides further specificity to the diagnosis. In this case:

21. •Complete Code: F10.120
•F10: Mental and behavioral disorders due to the use of alcohol.
•.1: Alcohol-induced disorders.
•20: Alcohol use disorder, moderate (presence of 5 6 symptoms)
•Interpretation:
•F10.120: Alcohol use disorder, moderate, with symptoms
•This code is used by healthcare providers to document cases where
an individual has a moderate alcohol use disorder with significant
symptoms present

22. Substance-Induced Disorders
•The overall category of substance-induced disorders includes
substance intoxication, substance withdrawal, and
substance/medication-induced mental disorders (e.g., substance-
induced psychotic disorder, substance-induced depressive disorder).
While substance intoxication and substance withdrawal are
recognized as mental disorders, for purposes of clarity of reference in
discussions across this chapter, the term substance/medication-
induced mental disorder (e.g., alcohol-induced depressive disorder,
methamphetamine-induced anxiety disorder) is used to distinguish
these disorders from substance intoxication and substance
withdrawal.

23. Diagnostic features
(Criterion A)
The essential feature is the development of a reversible substance-
specific syndrome due to the recent ingestion of a substance
(A reversible substance-specific syndrome" refers to a set of symptoms
and behaviors that occur in response to the recent use or withdrawal
from a particular substance and that typically resolve once the
substance is metabolized and eliminated from the body or once the
withdrawal process is complete)

24. (Criterion B)
The clinically significant problematic behavioral or psychological
changes associated with intoxication (e.g., belligerence, mood lability,
impaired judgment) are attributable to the physiological effects of the
substance on the central nervous system (CNS) and develop during or
shortly after use of the substance
(Criterion C).
and are accompanied by substance-specific signs and symptoms

25. (Criterion D)
The symptoms are not attributable to another medical condition and
are not better explained by another mental disorder
•Substance intoxication is common among individuals with a substance
use disorder but also occurs frequently in persons who use
substances but do not have a substance use disorder. This category
does not apply to tobacco.

26. Gambling disorder (nonsubstance related
disorder)
•In addition to the substance-related disorders, this chapter also
includes gambling disorder, reflecting evidence that gambling
behaviors activate reward systems similar to those activated by drugs
of abuse and that produce some behavioral symptoms that appear
comparable to those produced by the substance use disorders. Other
excessive behavioral patterns, such as Internet gaming (see
“Conditions for Further Study”), have also been described, but the
research on these and other behavioral syndromes is less clear.

27. Gambling disorder (nonsubstance related
disorder)
•Recently, scientists and mental health professionals decided to
classify problem gambling as a behavioral addiction, the first of its
kind, putting it in a category of disorders that also includes substance
abuse. The reason for this change comes from neuroscience research,
which has shown that gambling addicts have a lot in common with
drug and alcohol addicts, including changes in behavior and brain
activity.
•The decision to move gambling disorder alongside substance use
disorders reflects a new understanding of the underlying
commonalities between gambling and other addictions.

28. •There is a growing body of neuroscience and psychology research
suggesting problem gambling is similar to drug addiction.
•The evidence indicates that gambling activates the brain's reward
system in much the same way that a drug does.

29. Islamic Perspective
“They ask you about intoxicants and games
of chances. Say: in both of them there is a
great sin...” (Surah al-Baqarah 2:219).