Transcript Management of TASC Services in North Carolina

North Carolina TASC
Clinical Series Training
Module Eight: DSM -IV
DSM-IV System
Axis I: Clinical disorders
Axis II: Personality disorders and mental
retardation
Axis III: General medical conditions relevant to
the understanding or management of the
mental disorder
Axis IV: Psychosocial and environmental
problems
Axis V: Global Assessment of Functioning
(GAF)
Diagnosis of Substance Abuse
• Determination of substance dependence
or abuse based on DSM-IV definitions
• A determination of the presence or
absence of physiological dependence as
indicated by withdrawal tolerance
• The present course of dependence
Criteria for Dependence
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A maladaptive pattern of substance use, leading to
clinically significant impairment or distress.
Manifested by three or more of the following:
Tolerance
Withdrawal
Using increasing amounts
Craving or desire to cut down
Significant time devoted to using/seeking
substances
Salience of drug use
Use despite harm or consequences
Tolerance
• What effects have you received from
the substance?
• Do you usually get intoxicated and
how intoxicated?
• Has the occurrence changed in the
last year or two?
• What do these drugs cost you per
week?
• How much do you think you spend on
drugs per week?
Increasing Amounts and Time Devoted
• How many days per week do you use
drugs?
• What time of day do you usually begin
use?
• Has your pattern of use changed over
the last year or two?
• How often do you use more drugs
than “average”?
Salience
• When and why do you think that you
use drugs?
• What situations make you use drugs?
• Who do you usually use drug with?
• Have things changed in your life due
to your use?
Withdrawal/Craving – Desire to Cut Down
• Have you ever overdosed or
experience a blackout?
• Have you ever had the shakes or
DTs?
• Have you ever had to seek medical
treatment in these situations?
• How has your drug use changed in the
past year?
• Why do you think this happened?
Withdrawal/Craving – Desire to Cut Down
• Have you ever tried to quit or cut
down?
• Have you ever experienced physical
or emotional problems?
• How long did these problems last?
• How hard was it dealing with these
problems?
• Why do you think you began using
again?
Use Despite Harm or Consequences
• Have you ever used drugs knowing
that your use was causing you
physical or psychological problems?
• Has anyone complained to you about
your drug use?
• Has your use caused problems with
relationships? Home? Work/School?
Socially? Legally?
Use Despite Harm or Consequences
• Do you use despite failure to fulfill
obligations?
• Do you use despite recurrent legal
problems?
• Do you use despite recurrent
employment, social, or interpersonal
problems?
Criteria for Abuse
A maladaptive pattern of substance use, leading to
clinically significant impairment or distress.
Manifested by one or more of the following:
• Recurrent use resulting in failure to fulfill obligations at
work, home, or school
• Recurrent use in situations in which it is physically
hazardous
• Recurrent substance related legal problems
• Continued use despite persistent or recurrent social or
interpersonal problems
AND
• Symptoms have never met the substance dependence
criteria
Drug Classifications
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Alcohol
Caffeine
Cocaine
Inhalants
Opioids
Sedatives
•Amphetamines
•Cannabis
•Hallucinogens
•Nicotine
•Phencyclidine
Drug Classifications
Drug
Classes
Dependence DI
Abuse DI
Alcohol
303.90
305.00
Cocaine
304.20
305.60
Inhalants
304.60
305.90
Opioids
304.00
305.50
Course Specifiers
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Early Full Remission
Early Partial Remission
Sustained Full Remission
Sustained Partial Remission
On Agonist Therapy
In a Controlled Environment
Actively Using
Never Met Criteria
Congratulations!
You now understand DSM-IV