Transcript Assessment of Substance Use Disorders

Assessment of Substance Use Disorders
• Methods vary, but generally fall into 3
categories:
1. Physiological or biochemical
2. Interview by clinician
3. Self-report screening tools or
measures/intruments
SUBSTANCE CLASSES
 Major Stimulants
 Minor Stimulants (tobacco; caffeine)
 Depressants
 Alcohol
 Inhalants
 Benzodiazepines, barbiturates,
sedatives, dissociative anesthetics
 Hallucinogens
 Cannabinoids
 Opioids
DSM-V SUBSTANCE CLASSES
(p. 482 in DSM-5)
Diagnoses Associated with Substance Class
Psychotic Bipolar Depressive Anxiety
Alcohol
Caffeine
Cannabis
Hallucinogens
Phencylidine
Other
Hallucinogens
Inhalants
Opiods
Sedatives, hypnotics,
or anxiolytics
Stimulants**
Tobacco
Other
I/W
I/W
I/W
I
OCD &
NeuroSleep Sexual Delirium
Sbst. use Intoxication Withdrawal
related
cognitive
I/W
I
I
I/W
I/W
I/W
I/W
I/W
I
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
I
I
I
I
I
I*
I
I
I
I
I/W
I
I
W
I/W
I
I/W
I/W
I/W
I/W
W
I/W
I/W
I/W
I/W
I/W
I/W
I/W
X=category is recognized in DSM-5
I=specifier "with onset during intoxication" may be noted for the category
W=specifier "with onset during withdrawal" may be noted for the category
I/W=either of the above specifiers may be noted
P=the disorder is persisting
*also hallucinogen persisting perception disorder (flashbacks)
**includes amphetamine-type substances, cocaine, & other or unspecified stimulants
I/W/P
I/W
I/W
I
I
I/W
I/W
I/W
W
I/W
I/W
I/W
I/W
I
I/W/P
I/W
I/W
I/W/P
I/P
X
X
X
X
X
X
X
X
X
X
SUBSTANCE RELATED DISORDERS
DSM-IV CRITERIA FOR SUBSTANCE DEPENDENCE
- need at least 3 of the following within 12-month period
- symptoms present at least 1 month or occur
repeatedly over time
 Tolerance
(physical dependence present)
 Withdrawal
 Substance taken in larger amounts or over a
longer period than intended (loss of control)
 Persistent desire, or unsuccessful efforts, to cut
down or control substance use
SUBSTANCE RELATED DISORDERS
CRITERIA FOR SUBSTANCE DEPENDENCE
 Much time spent in activities needed to
obtain, use, and recover from the
substance
 Important social, family, school, work, or
recreational activities are given up or
reduced because of the substance use
 Substance use is continued despite
knowing that physical or psychological
problems are likely to be caused or
exacerbated by the substance
SUBSTANCE RELATED DISORDERS
SUBSTANCE DEPENDENCE – Course Specifiers
 Early full remission: > 1 month < 12 months
 Early partial remission: > 1 month < 12
months; one or more criteria for
dependence or abuse met, but full criteria
not met
 Sustained full remission: > 12 months
 Sustained partial remission: > 12 months,
but 1 or more criteria met
 On agonist therapy
 In controlled environment
SUBSTANCE RELATED DISORDERS
DSM-IV CRITERIA FOR SUBSTANCE ABUSE
- need at least 1 of the following within 12-month period
- symptoms have never met criteria for Dependence for
this class of substance
 Failure to fulfill role obligations at school, work,
or home (e.g., many absences or poor work
performance; neglect of kids)
 Recurrent use in physically hazardous
situations (e.g., driving)
 Recurrent legal problems (e.g., disorderly conduct)
 Continued use despite persistent social,
interpersonal problems (e.g., verbal or physical
aggression directed at spouse)
DSM-V SUBSTANCE USE DISORDER
11 GENERAL CRITERIA (etoh as ex.)
A. Alcohol Use Disorder – a problematic pattern of alcohol
use leading to clinically significant impairment or
distress, as manifested by at least two of the following,
occurring within a 12-month period:
1. Alcohol is often taken in larger amounts or over a
longer period than was intended.
2. There is a persistent desire or unsuccessful efforts
to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary
to obtain alcohol, use alcohol, or recover from its
effects.
4. Craving, or a strong desire or urge to use
alcohol. (new to DSM-5)
DSM-V SUBSTANCE USE DISORDER
GENERAL CRITERIA, cont’d.
5. Recurrent alcohol use resulting in a failure to fulfill
major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational
activities are given up or reduced because of
alcohol use.
8. Recurrent alcohol use in situations in which it is
physically hazardous.
9. Alcohol use is continued despite knowledge of
having a persistent or recurrent physical or
psychological problem that is likely to have been
caused or exacerbated by alcohol.
DSM-V SUBSTANCE USE DISORDER
GENERAL CRITERIA, cont’d.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of
alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use
of the same amount of alcohol.
11. Withdrawal, as manifested by either of the
following:
a. The characteristic withdrawal syndrome for
alcohol (refer to Criteria A & B of the criteria set
for alcohol withdrawal, pp. 499-500)
b. Alcohol (or a closely related substance, such as
a benzodiazepine) is taken to relieve or avoid
withdrawal symptoms.
DSM-V SUBSTANCE USE DISORDER
• SPECIFIERS
• In early remission: After full criteria for alcohol use
disorder previously met, none of the criteria for alcohol use
disorder have been met for at least 3 months but for less
than 12 months (with exception that Criterion A4,
“Craving…” may be met).
• In sustained remission: After full criteria for alcohol use
disorder previously met, none of the criteria for alcohol use
disorder have been met at any time during a period of 12
months or longer (with the exception that “Craving” may be
met).
• In a controlled environment: This additional specifier is
used if the individual is in an environment where access to
alcohol is restricted
DSM-V SUBSTANCE USE DISORDER
• SEVERITY
•
Specify current severity:
• 305.00 Mild:
Presence of 2-3 symptoms.
• 303.90 Moderate: Presence of 4-5 symptoms.
• 303.90 Severe:
Presence of 6 or more symptoms.
SUBSTANCE RELATED DISORDERS
 Assessment Tools
 Semi-structured interviews / intakes
 Structured Clinical Interviews for the DSM (SCID)
 Survey instruments (e.g., AUI; Addiction Severity
Index; DRINC-2R – Drinker Inventory of
Consequences)
 Brief Screens (e.g., MAST; DAST; CAGE)
SUBSTANCE RELATED DISORDERS
 Assessment Tools
 Alcohol Use Inventory (AUI)
 AUDIT
 Drug Use Profile (just descriptive)
 MAST; DAST
 CAGE