Biopsychosocial and Diagnosis

GrayChapter14B-1.pptx

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Susan W. Gray

Psychopathology: A Competency-Based Assessment Model for Social Workers

Chapter 14 Substance-Related and Addictive Disorders (continued)

The substance-related disorders are seen as a cluster of cognitive, behavioral, and physical symptoms indicating that the individual continues using the substance despite significant substance-related problems

The DSM-5 presents 10 classes of substances

This section continues the prior Power Point slide series by picking up with the sedative, hypnotic, or anxiolytic use disorders

We conclude this sequence with the non-substance related disorder of gambling

Sedative, Hypnotic, or Anxiolytic Use Disorder

Sedative, hypnotic, or anxiolytic use - the individual must meet 2 (or more) of the 11 overall criteria for substance use within a 12 month period

Intoxication – after recent use, significant behavioral or psychological changes (such as sexual or aggressive behavior, mood changes, or impaired judgment) emerge and the person shows 1 (or more) of: slurred speech; incoordination; unsteady gait; nystagmus; impairment in attention or memory; and stupor or coma

Withdrawal - after the person stops or reduces prolonged use, 2 (or more) symptoms develop within hours to days of: autonomic hyperactivity (such as sweating or a pulse rate greater than 100); increased hand tremor; insomnia; nausea that is sometimes accompanied by vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety (or panic attacks); or grand mal seizures

Stimulant-related Disorders

Stimulant use - the individual must meet 2 (or more) of the 11 overall criteria for substance use within a 12 month period

Intoxication – with recent use and significant problematic behavioral or psychological changes (such as euphoria with enhanced energy or affective blunting, changes in sociability such as becoming extremely gregarious, hypervigilance, sensitivity to others, anxiety, tension, anger, stereotypical and repetitive behaviors, and impaired judgment) 2 (or more) are present: tachycardia (fast heart beat) or bradycardia (slow heart rate); dilated pupils; elevated or lowered blood pressure; perspiration or chills; nausea or vomiting; weight loss; psychomotor agitation or retardation; muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias; confusion, seizures, dyskinesias, dystonias or coma

Withdrawal – after stopping (or reducing) prolonged use with dysphoric mood, 2 (or more) of the following symptoms develop within hours to days: fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation

Tobacco-related Disorders

Tobacco use - the individual must meet 2 (or more) of the 11 overall criteria for substance use within a 12 month period

Withdrawal – symptoms emerge within 24 hours after the person stops or reduces daily use for at least several weeks showing 4 (or more) symptoms of: irritability, frustration or anger; anxiety; difficulty concentrating; increased appetite (or weight gain); restlessness; a depressed mood; and insomnia

Janet Sellar’s Story Illustrates the Use of Multiple Substances

Other (or Unknown) Substance-related Disorders

Other (or unknown) substance-related use - symptoms are unable to be classified but the individual meets 2 (or more) of the 11 overall criteria for substance use within a 12 month period

Other (or unknown) substance-related intoxication – symptoms develop during (or within a few hours to days) after a person ingests (or exposed to) an unknown substance or is not listed elsewhere along with problematic behavioral or psychological changes (such as impaired motor coordination, psychomotor agitation or retardation, euphoria, anxiety, belligerence, mood lability, cognitive impairment, impaired judgment, social withdrawal)

Other (or unknown) substance-related withdrawal – applies after stopping or reducing heavy prolonged use of a substance but it cannot be classified or is unknown at the time

Unspecified other (or unknown) substance-related - the person shows symptoms causing significant distress or impairment but does not meet full criteria for any of the other (or unknown) substance-related disorders

Non-substance--related Disorders

Gambling Disorder – persistent and recurrent gambling behavior over a 12 month period with 4 (or more) symptoms of: needing to gamble with more money to get the same excitement from gambling as before; feeling restless or irritable when trying to reduce or stop gambling; continuing to try to reduce or stop gambling without success; gambling is frequently on the person’s mind, both in reliving past gambling experiences and planning future gambling events; gambling when feeling depressed, guilty or anxious; trying to win back gambling losses; lying to cover up how much the person is gambling; losing not only money, but also relationships, the job, or a significant career opportunity as a result of gambling; becoming dependent on other people to give the person money to deal with financial problems that have been caused by gambling

Larry Dalton’s story illustrates gambling disorder

Comparing the DSM-IV-TR Multiaxial System and the DSM-5

Substance abuse and substance dependence from the DSM-IV have been combined into single substance use disorders specific to each substance of abuse within a new “addictions and related disorders” category

Within the substance use disorder criteria:

Presence of recurrent legal problems was deleted

Craving or a strong desire or urge to use a substance was added

The threshold of the number of criteria that must be met was changed

Coding for severity from mild to severe was added and is based on the number of criteria endorsed

Comparing the DSM-IV-TR Multiaxial System and the DSM-5

Criteria for cannabis and caffeine withdrawal were added

New specifiers were added for early and sustained remission along with specifiers for “in a controlled environment” and “on maintenance therapy”

Gambling disorder and tobacco use disorder are new disorders