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Substance Related Disorders DSM

Criteria for Substance Dependence
Criteria for Substance Abuse
Criteria for Substance Intoxication
Criteria for Substance Withdrawal
Diagnostic Criteria for Alcohol Intoxication
Diagnostic Criteria for Alcohol Withdrawal
Drug-Related Criteria
DSM-IV Resources

The definitions for substance-related disorders are adapted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR™) -an official manual of mental health problems developed by the American Psychiatric Association. This reference book is used by psychiatrists, psychologists, social workers, and other health and mental health care providers to understand and diagnose a mental health problem. Insurance companies and health care providers also use the terms and explanations in this book when they discuss mental health problems.

Caution: These materials are for educational purposes only and are not a substitute for a diagnosis made by a qualified mental health professional.

The Criteria

Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

  1. tolerance, as defined by either of the following:
    1. a need for markedly increased amounts of the substance to achieve intoxication or desired effect
    2. markedly diminished effect with continued use of the same amount of the substance

  2. withdrawal, as manifested by either of the following:
    1. the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of The Criteria sets for Withdrawal from the specific substances)
    2. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

  3. the substance is often taken in larger amounts or over a longer period than was intended

  4. there is a persistent desire or unsuccessful efforts to cut down or control substance use

  5. a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

  6. important social, occupational, or recreational activities are given up or reduced because of substance use

  7. the substance 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 the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Criteria for Substance Abuse

  1. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
    1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
    2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
    3. recurrent substance-related legal problems (e.g., arrests for substance- related disorderly conduct)
    4. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

  2. The symptoms have never met The Criteria for Substance Dependence for this class of substance.

Criteria for Substance Intoxication

  1. The development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance. Note: Different substances may produce similar or identical syndromes.

  2. Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system (e.g., belligerence, mood lability, cognitive impairment, impaired judgment, impaired social or occupational functioning) and develop during or shortly after use of the substance.

  3. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Criteria for Substance Withdrawal

  1. The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged.

  2. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  3. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

305.00 Alcohol Abuse
(See linked section)-see substance abuse and put in alcohol #305.00 and same for alcohol dependence 303.90

Diagnostic Criteria for Alcohol Intoxication

  1. Recent ingestion of alcohol.

  2. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion.

  3. One (or more) of the following signs, developing during, or shortly after, alcohol use:
    1. slurred speech
    2. incoordination
    3. unsteady gait
    4. nystagmus
    5. impairment in attention or memory
    6. stupor or coma

  4. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Diagnostic Criteria for Alcohol Withdrawal

  1. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

  2. Two (or more) of the following, developing within several hours to a few days after Criterion A:
    1. autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)
    2. increased hand tremor
    3. insomnia
    4. nausea or vomiting
    5. transient visual, tactile, or auditory hallucinations or illusions
    6. psychomotor agitation
    7. anxiety
    8. grand mal seizures

  3. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  4. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Drug-Related Criteria

DSM-IV criteria have also been developed for a variety of other substance-related disorders. These criteria are similar to the alcohol criteria and include criteria for dependence, abuse, intoxication, and withdrawal. The Criteria have been developed for the following substances:

Amphetamines
Caffeine
Cannabis (marijuana)
Cocaine
Hallucinogens
Inhalants
Nicotine
Opioids
Phencyclidine
Sedatives and Hypnotics

DSM-IV Resources

The information presented comes from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, published by the American Psychiatric Association. These materials are for educational purposes only and are not a substitute for a diagnosis made by a qualified mental health professional.

The information about The Criteria used to diagnosis anxiety disorders may contain words or ideas that are not familiar. A member of your mental health team may help explain to you the words and ideas that you do not understand.

If you are interested in learning more about these diagnostic criteria, visit your local library. Many libraries in the United States have copies of the manual. You can also visit the website of the American Psychiatric Association at www.psych.org, or purchase the manual online at www.amazon.com.

Last modified on: 30 June 2015

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