Substance Use Disorders Overview
511 Questions
0 Views

Substance Use Disorders Overview

Created by
@QuickerDatePalm

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What term is preferred over 'drug addiction' in clinical settings?

  • Chronic substance dependency
  • Substance use disorder (correct)
  • Habitual drug abuse
  • Compulsive substance use

    • Which of the following is NOT classified as a substance-related disorder?

  • Counseling abuse (correct)
  • Caffeine
  • Hallucinogens
  • Sedatives

    • What is a significant behavioral indicator of substance use disorders seen before actual substance use?

  • Increased social isolation
  • Compulsive shopping habits
  • Negative self-image
  • Reinforcement of reward systems (correct)

    • Substance-related disorders are primarily categorized into two groups. What are they?

    <p>Substance use disorders and substance-induced disorders</p> Signup and view all the answers

    What potential consequence does substance use have on brain function?

    <p>Negative impact on inhibitory mechanisms</p> Signup and view all the answers

    Which of the following substances is included in the category of 'other substances' in substance-related disorders?

    <p>Steroids</p> Signup and view all the answers

    What does the term 'substance/medication-induced mental disorder' refer to?

    <p>Symptomatic presentations due to exogenous substances' effects</p> Signup and view all the answers

    Which class of drugs includes substances like amphetamines and cocaine?

    <p>Stimulants</p> Signup and view all the answers

    Which symptom is NOT part of the impaired control criteria for substance use disorders?

    <p>Relapsing after a successful treatment</p> Signup and view all the answers

    What characterizes the social impairment grouping of criteria in substance use disorders?

    <p>Failure to fulfill major role obligations</p> Signup and view all the answers

    Which of the following substances has NOT been documented to cause significant withdrawal symptoms in humans?

    <p>Phencyclidine</p> Signup and view all the answers

    How is the severity of a substance use disorder primarily assessed?

    <p>By the number of symptoms endorsed</p> Signup and view all the answers

    Which factor does NOT typically affect the diagnosis of substance use disorders?

    <p>Individual's income level</p> Signup and view all the answers

    Which of the following symptoms may indicate a significant physiological sign of withdrawal?

    <p>Marked physiological changes</p> Signup and view all the answers

    Which grouping includes experiencing withdrawal symptoms related to recurrent substance use?

    <p>Pharmacological criteria</p> Signup and view all the answers

    Under what condition are tolerance and withdrawal symptoms NOT considered in diagnosing a substance use disorder?

    <p>If the individual is using prescribed medications correctly</p> Signup and view all the answers

    What indicates a moderate level of severity in a substance use disorder?

    <p>Four to five symptoms endorsed</p> Signup and view all the answers

    What distinguishes a substance/medication-induced mental disorder from substance intoxication?

    <p>It relates to behavioral changes</p> Signup and view all the answers

    What is indicated by recurrent substance use in physically hazardous situations?

    <p>Risky use criteria</p> Signup and view all the answers

    Which criterion addresses taking a substance in larger amounts than intended?

    <p>Impaired control</p> Signup and view all the answers

    What role does biological testing play in diagnosing substance use disorders?

    <p>It can complement other assessments</p> Signup and view all the answers

    Which substance class is excluded from the diagnosis of substance use disorders?

    <p>Caffeine</p> Signup and view all the answers

    What should be recorded when a substance/medication-induced mental disorder occurs alongside a substance use disorder?

    <p>Only the substance/medication-induced mental disorder.</p> Signup and view all the answers

    Which of the following is NOT a symptom included in the diagnostic criteria for alcohol-related disorders?

    <p>Physical cravings for non-alcohol substances.</p> Signup and view all the answers

    What is a common consequence of heavy alcohol ingestion on physical health?

    <p>Gastrointestinal disorders.</p> Signup and view all the answers

    How is the severity of alcohol use disorder assessed?

    <p>By the number of diagnostic criteria endorsed.</p> Signup and view all the answers

    Which form of alcohol-related consequence can lead to problems such as depression and insomnia?

    <p>Repeated high doses of alcohol.</p> Signup and view all the answers

    What indicates craving in the context of alcohol use disorder?

    <p>A strong desire to drink that disrupts daily activities.</p> Signup and view all the answers

    Which of these conditions is linked with prolonged alcohol use?

    <p>Gastrointestinal issues.</p> Signup and view all the answers

    Which substance-induced disorder is an exception to typical diagnostic protocols regarding duration and treatment?

    <p>Substance-associated neurocognitive disorders.</p> Signup and view all the answers

    What is a central characteristic of alcohol use disorder regarding consumption patterns?

    <p>Prolonged or intense patterns of alcohol ingestion.</p> Signup and view all the answers

    Why might withdrawal symptoms like sleep problems contribute to relapse in individuals with alcohol use disorder?

    <p>They persist at lower intensities for months.</p> Signup and view all the answers

    When diagnosing a substance-induced mental disorder, which aspect should be emphasized?

    <p>The specific substance and type of mental disorder produced.</p> Signup and view all the answers

    What role does frequency and quantity of substance consumption play in substance/medication-induced mental disorders?

    <p>Increased use is correlated with a higher risk of developing disorders.</p> Signup and view all the answers

    If someone has a documented history of alcohol use disorder, what might they experience during withdrawal?

    <p>Intense cravings and withdrawal symptoms.</p> Signup and view all the answers

    What term describes symptoms initiated by a decline in blood or tissue concentrations of a substance?

    <p>Withdrawal</p> Signup and view all the answers

    Which of the following factors is most likely to increase the risk of withdrawal symptoms?

    <p>Rapid routes of administration</p> Signup and view all the answers

    Which statement about half-life and withdrawal symptoms is correct?

    <p>Longer acting substances lead to longer time between cessation and withdrawal onset.</p> Signup and view all the answers

    What is a characteristic of substance/medication-induced mental disorders?

    <p>Symptoms must not occur during delirium.</p> Signup and view all the answers

    Which age group is identified as having a high prevalence rate for substance use disorders?

    <p>Young adults aged 18-24</p> Signup and view all the answers

    In cases of substance withdrawal, what is most commonly observed in individuals?

    <p>A strong urge to re-administer the substance</p> Signup and view all the answers

    Which general classification of substances is known to produce significant depressive symptoms during intoxication?

    <p>Sedative drugs</p> Signup and view all the answers

    What is the primary purpose of laboratory analyses during substance use assessments?

    <p>To help diagnose substance withdrawal and recent substance use</p> Signup and view all the answers

    What ICD-10-CM code should be used if the specific substance taken by an individual is unknown?

    <p>Other (or unknown) substance intoxication code</p> Signup and view all the answers

    Patients undergoing treatment with medications may have withdrawal symptoms that do not apply to which condition?

    <p>Substance use disorder diagnosis</p> Signup and view all the answers

    Which factor is likely to distinguish substance/medication-induced disorders from independent mental disorders?

    <p>Association with a specific substance or medication</p> Signup and view all the answers

    Which statement reflects the relationship between the intensity of withdrawal symptoms and the acute withdrawal period?

    <p>Shorter acute withdrawal periods lead to less intense symptoms.</p> Signup and view all the answers

    What effect do sedating and stimulating drugs both tend to produce?

    <p>Temporary mood disturbances</p> Signup and view all the answers

    What is the likely outcome if the symptoms of a substance show an overlap with an independent mental disorder?

    <p>They may not be classified as substance-induced disorders.</p> Signup and view all the answers

    What is a potential consequence of heavy alcohol consumption related to peripheral neuropathy?

    <p>Paresthesias</p> Signup and view all the answers

    Which demographic has the highest twelve-month prevalence of alcohol use disorders?

    <p>Individuals aged 18-29 years</p> Signup and view all the answers

    How does alcohol use disorder often affect individuals during severe intoxication?

    <p>It increases risk of suicidal behavior.</p> Signup and view all the answers

    In which group is alcohol use disorder prevalence lower compared to the general population?

    <p>American Indian and Alaska Native communities</p> Signup and view all the answers

    What factor is NOT commonly associated with alcohol use disorder in adolescents?

    <p>High academic performance</p> Signup and view all the answers

    What characterizes the typical course of alcohol use disorder?

    <p>Periodical remission and relapse</p> Signup and view all the answers

    What factor is NOT mentioned as a risk factor for developing alcohol-related problems?

    <p>Access to mental health resources</p> Signup and view all the answers

    Which genetic factor is associated with alcohol use disorder risk?

    <p>Variations in alcohol dehydrogenase enzymes</p> Signup and view all the answers

    Why are older individuals more susceptible to alcohol's effects?

    <p>Age-related physical changes</p> Signup and view all the answers

    What key component can influence the development of alcohol problems in certain individuals?

    <p>Higher peer substance use</p> Signup and view all the answers

    What is often a misconception regarding individuals with alcohol use disorder?

    <p>They all have severe alcohol-related problems.</p> Signup and view all the answers

    What physiological difference increases women's vulnerability to alcohol-related effects compared to men?

    <p>Higher fat and lower water concentration</p> Signup and view all the answers

    What is a characteristic symptom of cognitive deficits related to alcohol use disorder?

    <p>Severe memory impairment</p> Signup and view all the answers

    What is the estimated rate of alcohol use disorder among close relatives of affected individuals?

    <p>Three to four times higher than the general population</p> Signup and view all the answers

    At what blood alcohol level is an individual likely to fall asleep and enter the first stage of anesthesia?

    <p>200-300 mg/dL</p> Signup and view all the answers

    What percentage of 12th-grade students in the U.S. reported having been drunk at least once in their lifetime in 2018?

    <p>43%</p> Signup and view all the answers

    Which of the following is NOT a symptom of alcohol withdrawal?

    <p>Respiratory depression</p> Signup and view all the answers

    Which ICD-10-CM code is assigned for alcohol withdrawal with perceptual disturbances?

    <p>F10.132</p> Signup and view all the answers

    What is a common predictor of severe alcohol withdrawal?

    <p>Previous low potassium levels</p> Signup and view all the answers

    Which demographic group has the highest 12-month prevalence of high-risk drinking in the U.S. as mentioned?

    <p>Native Americans</p> Signup and view all the answers

    Which is considered a key diagnostic feature of alcohol withdrawal?

    <p>Characteristic withdrawal syndrome</p> Signup and view all the answers

    Which risk factor is directly associated with increased alcohol intoxication?

    <p>Peer influence of heavy drinkers</p> Signup and view all the answers

    What effect does acute alcohol intoxication typically have on cognitive function?

    <p>Causes cognitive impairment</p> Signup and view all the answers

    What does alcohol intoxication contribute to annually in the United States?

    <p>95,000 deaths</p> Signup and view all the answers

    What symptom would NOT commonly be associated with acute alcohol intoxication?

    <p>Generalized tonic-clonic seizures</p> Signup and view all the answers

    How long does acute alcohol withdrawal typically last?

    <p>4–5 days</p> Signup and view all the answers

    In which situation is alcohol withdrawal most likely to be severe?

    <p>With a history of prior severe withdrawal</p> Signup and view all the answers

    What environmental factors significantly influence alcohol risk during adolescence?

    <p>Peer pressure and social environment</p> Signup and view all the answers

    Which blood test finding might indicate excessive alcohol consumption?

    <p>Elevated carbohydrate-deficient transferrin (CDT)</p> Signup and view all the answers

    What is a key difference between alcohol use disorder and alcohol intoxication?

    <p>Alcohol use disorder is characterized by problematic behavior patterns</p> Signup and view all the answers

    What symptom can be indicative of chronic heavy drinking related to gastrointestinal effects?

    <p>Dyspepsia</p> Signup and view all the answers

    Which psychiatric factor has been linked to increased suicide risk in individuals with alcohol use disorder?

    <p>Aggression</p> Signup and view all the answers

    What impact does severe alcohol use disorder have on behavior according to studies?

    <p>Leads to disinhibition and irritability</p> Signup and view all the answers

    What association is commonly observed between alcohol use and suicide methods?

    <p>Heavy drinkers are more likely to use firearms</p> Signup and view all the answers

    What bodily change is generally not associated with regular heavy alcohol consumption?

    <p>Normal uric acid levels</p> Signup and view all the answers

    Which of the following behaviors is indicative of risky alcohol use?

    <p>Driving while intoxicated</p> Signup and view all the answers

    What is the primary element used to diagnose alcohol use disorder?

    <p>Heavy doses of alcohol leading to distress or impaired functioning</p> Signup and view all the answers

    What is a common misbelief among individuals regarding alcohol consumption and its risks?

    <p>Low alcohol consumption is completely risk-free</p> Signup and view all the answers

    Which of the following is NOT a consequence of alcohol use disorder?

    <p>Improved workplace productivity</p> Signup and view all the answers

    What is a potential risk of alcohol withdrawal in hospitalized patients?

    <p>Added risks and costs of hospitalization</p> Signup and view all the answers

    What is indicated by elevated levels of mean corpuscular volume (MCV) in the context of alcohol use?

    <p>Potential risk for alcohol use disorder</p> Signup and view all the answers

    What is a common cause of absenteeism in the workplace related to alcohol consumption?

    <p>Alcohol-related job loss</p> Signup and view all the answers

    What can exacerbate alcohol use behaviors and contribute to relapse?

    <p>Symptoms of withdrawal</p> Signup and view all the answers

    Which medical conditions can mimic the symptoms of alcohol withdrawal?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the lifetime risk for major depressive episodes among individuals with alcohol use disorder?

    <p>40%</p> Signup and view all the answers

    When are alcohol-induced mental disorders diagnosed instead of alcohol intoxication or withdrawal?

    <p>When they cause significant distress</p> Signup and view all the answers

    How does the duration of alcohol-induced mental disorders compare to independent mental disorders?

    <p>They are shorter in duration</p> Signup and view all the answers

    What percentage of individuals with alcohol use disorder experience alcohol-induced psychotic episodes?

    <p>Less than 5%</p> Signup and view all the answers

    What is a common symptom of caffeine intoxication?

    <p>Nervousness</p> Signup and view all the answers

    Which group is more likely to experience symptoms of caffeine intoxication?

    <p>Children and the elderly</p> Signup and view all the answers

    What percentage of individuals in the U.S. may experience functional impairment consistent with caffeine intoxication?

    <p>7%</p> Signup and view all the answers

    Which factor is important in differentiating between alcohol-induced mental disorders and independent mental disorders?

    <p>Temporal relationship between symptoms and alcohol use</p> Signup and view all the answers

    What is a symptom of caffeine withdrawal?

    <p>Gastrointestinal distress</p> Signup and view all the answers

    What may happen to coffee drinkers who suddenly stop consumption?

    <p>Experience withdrawal symptoms</p> Signup and view all the answers

    What is the recommended clinical approach when identifying possible alcohol-induced mental disorders?

    <p>Consider endocrine conditions first</p> Signup and view all the answers

    What is the implication of alcohol withdrawal contributing to functional impairment?

    <p>Persistent occupational challenges</p> Signup and view all the answers

    What is a hallmark feature of caffeine withdrawal?

    <p>Severe headache</p> Signup and view all the answers

    Which factor is known to significantly decrease the elimination of caffeine, increasing the risk of intoxication?

    <p>Oral contraceptive use</p> Signup and view all the answers

    Which of the following does NOT differentiate caffeine intoxication from caffeine-induced anxiety disorder?

    <p>Presence of withdrawal symptoms</p> Signup and view all the answers

    What common factor may increase vulnerability to caffeine withdrawal?

    <p>Mental disorders</p> Signup and view all the answers

    Which caffeine-related risk factor is associated with pregnant individuals?

    <p>Slower caffeine clearance in later trimesters</p> Signup and view all the answers

    What effect does caffeine withdrawal typically have on sleep?

    <p>Increased slow-wave sleep</p> Signup and view all the answers

    Which characteristic symptom is NOT typically associated with caffeine withdrawal?

    <p>Irregular heart rate</p> Signup and view all the answers

    What is characterized by impairment in social, occupational, or other important areas after caffeine cessation?

    <p>Caffeine withdrawal</p> Signup and view all the answers

    What role do genetic factors play in caffeine intoxication?

    <p>They may increase the risk of intoxication</p> Signup and view all the answers

    Which demographic is particularly documented for caffeine withdrawal symptoms?

    <p>Children and adolescents</p> Signup and view all the answers

    What is a significant indicator of functional impairment during caffeine withdrawal?

    <p>Decreased motivation at work</p> Signup and view all the answers

    What diagnostic feature assists in determining caffeine withdrawal?

    <p>Approximate caffeine amount consumed</p> Signup and view all the answers

    What potential side effect can occur from extremely high doses of caffeine?

    <p>Fatal outcomes</p> Signup and view all the answers

    What is a common misconception about caffeine consumption’s effects?

    <p>It is beneficial for all ages</p> Signup and view all the answers

    What distinguishes caffeine withdrawal from caffeine-induced sleep disorder?

    <p>Severity of sleep symptoms requiring clinical attention.</p> Signup and view all the answers

    Which disorder is NOT associated with caffeine withdrawal symptoms?

    <p>Substance use disorder</p> Signup and view all the answers

    What defines Unspecified Caffeine-Related Disorder?

    <p>Symptoms causing significant distress but not fitting specific criteria.</p> Signup and view all the answers

    Which symptom is NOT part of the diagnostic criteria for cannabis use disorder?

    <p>Frequent use of cannabis solely for relaxation.</p> Signup and view all the answers

    During which remission period is no criteria for cannabis use disorder met?

    <p>Sustained remission.</p> Signup and view all the answers

    Which cannabinoid primarily affects the brain's CB1 and CB2 receptors?

    <p>Delta-9-tetrahydrocannabinol (THC)</p> Signup and view all the answers

    What is a common method of cannabis consumption that typically provides rapid effects?

    <p>Vaping</p> Signup and view all the answers

    What is a common demographic with the highest prevalence of cannabis use disorder?

    <p>Youth aged 12-17 years</p> Signup and view all the answers

    Which statement about cannabis withdrawal symptoms is true?

    <p>They can lead to a desire to continue using cannabis to relieve symptoms.</p> Signup and view all the answers

    What defines the severity of cannabis use disorder?

    <p>The presence of withdrawal, tolerance, and other behavioral criteria.</p> Signup and view all the answers

    What is one of the main medical uses for cannabis?

    <p>Chronic pain management</p> Signup and view all the answers

    Which form of cannabis typically has the highest potency?

    <p>Hashish or hash oil</p> Signup and view all the answers

    What description correctly matches the term 'cannabis intoxication'?

    <p>Presence of euphoric effects and altered states of consciousness.</p> Signup and view all the answers

    What can indicate harmful use of cannabis according to the diagnostic criteria?

    <p>Reduced interest in social activities.</p> Signup and view all the answers

    What is the primary percentage of adolescents in treatment who report cannabis as their primary substance of abuse?

    <p>76%</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with cannabis intoxication?

    <p>Euphoria with appropriate laughter</p> Signup and view all the answers

    What percentage of adults with DSM-5 cannabis use disorder also had a past-year tobacco use disorder?

    <p>64%</p> Signup and view all the answers

    What common withdrawal symptom is experienced by individuals with cannabis withdrawal?

    <p>Irritability</p> Signup and view all the answers

    Which of the following best describes the onset timeline for cannabis withdrawal symptoms after cessation of use?

    <p>24-48 hours</p> Signup and view all the answers

    How is cannabis use classified among adults seeking treatment for substance use disorders?

    <p>Secondary or tertiary problem</p> Signup and view all the answers

    What is the potential consequence of high-potency cannabis use observed in a study across European sites?

    <p>Higher incidence of psychotic disorders</p> Signup and view all the answers

    Which condition is also considered a common co-occurring mental disorder in those with cannabis use disorder?

    <p>Bipolar disorder</p> Signup and view all the answers

    What is the ICD-10-CM code for cannabis withdrawal occurring without a cannabis use disorder?

    <p>F12.93</p> Signup and view all the answers

    What factor significantly influences the severity of withdrawal symptoms when quitting cannabis?

    <p>Amount and frequency of cannabis use</p> Signup and view all the answers

    Which symptom is indicative of acute cannabis intoxication?

    <p>Sedation and lethargy</p> Signup and view all the answers

    In a study, what percentage of African American cannabis users reported experiencing withdrawal symptoms?

    <p>15.3%</p> Signup and view all the answers

    Which statement accurately reflects cannabis use's relationship with psychotic disorders?

    <p>Increased risk when used in critical periods</p> Signup and view all the answers

    What best describes the psychological changes during cannabis intoxication?

    <p>Euphoric feelings accompanied by impaired memory</p> Signup and view all the answers

    What factor is most strongly correlated with the development of cannabis use disorder among young adults?

    <p>Early onset of cannabis use</p> Signup and view all the answers

    Which of the following demographics has a higher reported risk for developing cannabis use disorder?

    <p>Native American and Hispanic adults</p> Signup and view all the answers

    What role do genetic factors play in the risk of developing cannabis use disorders?

    <p>They account for 30% to 80% of the risk</p> Signup and view all the answers

    What behavioral characteristics are commonly associated with youth who develop cannabis use disorder?

    <p>Preferences for novelty-seeking and risk-taking</p> Signup and view all the answers

    How has the perception of cannabis use changed among adolescents in recent years?

    <p>Many perceive it as less harmful than alcohol or tobacco</p> Signup and view all the answers

    What is a major diagnostic marker used to identify cannabis use disorder?

    <p>Detection of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THCCOOH) in urine</p> Signup and view all the answers

    What psychological impact is associated with cannabis use disorder?

    <p>Decreased life satisfaction</p> Signup and view all the answers

    Which factor is NOT associated with an increased risk for developing cannabis use disorder?

    <p>Stable family environment</p> Signup and view all the answers

    How does cannabis use disorder typically manifest in adults?

    <p>Daily use despite psychosocial or medical issues</p> Signup and view all the answers

    What is the relationship between cannabis use and motivation, according to studies?

    <p>Cannabis use is linked to a motivational syndrome characterized by reduced goal-directed activity</p> Signup and view all the answers

    Which state-specific factor can elevate the risk of cannabis use disorder among adults?

    <p>Legalization of recreational marijuana use</p> Signup and view all the answers

    Which demographic is most likely to experience negative withdrawal symptoms associated with cannabis use?

    <p>Women of all age groups</p> Signup and view all the answers

    What is one consequence of increasing cannabis use among middle-aged and older adults?

    <p>Increased cases of cannabis use disorder</p> Signup and view all the answers

    Which of the following best defines 'telescoping' in the context of cannabis use?

    <p>The rapid transition from initial use to cannabis use disorder</p> Signup and view all the answers

    What is a common misperception among regular cannabis users experiencing withdrawal symptoms?

    <p>They may not realize that cannabis is the cause of their symptoms.</p> Signup and view all the answers

    Which of the following symptoms would most likely NOT warrant a diagnosis of cannabis-induced mental disorders?

    <p>Severe anxiety disorders unrelated to cannabis use.</p> Signup and view all the answers

    Which characteristic is NOT part of the diagnostic criteria for phencyclidine use disorder?

    <p>Withdrawal symptoms indicating medical distress.</p> Signup and view all the answers

    What functional consequence is related to both cannabis and phencyclidine use disorders?

    <p>Increased risk of relapse into substance use.</p> Signup and view all the answers

    What does unspecified cannabis-related disorder specifically account for?

    <p>Clinically significant distress without fulfilling specific disorder criteria.</p> Signup and view all the answers

    What primary factor differentiates phencyclidine-induced mental disorders from phencyclidine intoxication?

    <p>The severity and persistence of cognitive impairments.</p> Signup and view all the answers

    Which symptom is characteristic of both cannabis withdrawal and phencyclidine use disorder?

    <p>Persistent craving for the substance.</p> Signup and view all the answers

    What approach is essential in the differential diagnosis of cannabis withdrawal symptoms?

    <p>Eliminating other substance-related withdrawal symptoms.</p> Signup and view all the answers

    What potential long-term effect can result from chronic phencyclidine usage?

    <p>Persistent alterations in mental processes resembling psychosis.</p> Signup and view all the answers

    In what type of environments is the assessment for phencyclidine use disorder particularly assessed?

    <p>Therapeutic communities and locked hospital units.</p> Signup and view all the answers

    How might cannabis withdrawal influence treatment-seeking behaviors in users?

    <p>Increase awareness of mental health impacts.</p> Signup and view all the answers

    Which of the following describes a characteristic symptom of phencyclidine intoxication?

    <p>Diminished pain perception.</p> Signup and view all the answers

    Which mental health issue is commonly associated with frequent cannabis users?

    <p>Antisocial personality disorder.</p> Signup and view all the answers

    Which of the following factors does NOT typically influence the severity assessment of a substance use disorder?

    <p>Duration of abstinence.</p> Signup and view all the answers

    What psychological disorder can phencyclidine use mimic?

    <p>Major depressive disorder</p> Signup and view all the answers

    What is an example of a hallucinogen that is often consumed in a manner distinct from oral ingestion?

    <p>DMT</p> Signup and view all the answers

    Which criteria suggest a diagnosis of Other Hallucinogen Use Disorder?

    <p>Use resulting in failure to fulfill major role obligations</p> Signup and view all the answers

    Which factor is NOT associated with increased risk for other hallucinogen use disorder?

    <p>Higher age of onset of hallucinogen use</p> Signup and view all the answers

    How is remission from Other Hallucinogen Use Disorder defined?

    <p>Meeting none of the diagnostic criteria for 3 to 12 months</p> Signup and view all the answers

    Which characteristic is typical for hallucinogen users, particularly with LSD?

    <p>Visual hallucinations</p> Signup and view all the answers

    What distinguishes MDMA/ecstasy from other hallucinogens?

    <p>Distinctive effects due to both hallucinogenic and stimulant properties</p> Signup and view all the answers

    Which symptom is NOT part of the diagnostic criteria for hallucinogen use disorders?

    <p>Psychotic episodes</p> Signup and view all the answers

    What percentage of individuals aged 12 or older endorsed symptoms of past 12-month hallucinogen use disorder in 2018?

    <p>0.1%</p> Signup and view all the answers

    What is a primary consequence of hallucinogen intoxication?

    <p>Hyperthermia</p> Signup and view all the answers

    Which substance is excluded from the hallucinogen category due to differing psychological effects?

    <p>Cannabis</p> Signup and view all the answers

    What is a common feature of hallucinogens that can aid in diagnosis?

    <p>Distinctive behavioral changes after use</p> Signup and view all the answers

    Which age group shows higher prevalence rates of other hallucinogen use disorders?

    <p>18-29 years old</p> Signup and view all the answers

    What is the significance of laboratory testing in diagnosing hallucinogen use disorder?

    <p>It distinguishes between different hallucinogens</p> Signup and view all the answers

    Which term refers to the classification of hallucinogens based on their origins or chemical structure?

    <p>Chemical taxonomy</p> Signup and view all the answers

    What is a significant characteristic of hallucinogen use disorder?

    <p>Social and occupational impairment due to substance use</p> Signup and view all the answers

    Which of the following is NOT a common consequence of hallucinogen intoxication?

    <p>Heightened reality testing</p> Signup and view all the answers

    What distinguishes phencyclidine intoxication from other substance intoxications?

    <p>Presence of nystagmus</p> Signup and view all the answers

    Which condition can be a part of comorbidity with hallucinogen use disorder?

    <p>Post-traumatic stress disorder</p> Signup and view all the answers

    What is the role of laboratory testing in diagnosing phencyclidine intoxication?

    <p>To detect phencyclidine in urine, but with limited clinical relevance</p> Signup and view all the answers

    What is a potential severe consequence of ongoing hallucinogen use, especially with MDMA?

    <p>Neurotoxic effects</p> Signup and view all the answers

    Which behavioral change is commonly observed in phencyclidine intoxication?

    <p>Extreme agitation</p> Signup and view all the answers

    What characteristic differentiates hallucinogen intoxication from substance-induced psychotic disorders?

    <p>Functional decline and social skills preservation</p> Signup and view all the answers

    What is a common diagnostic criterion for phencyclidine intoxication?

    <p>Recent use accompanied by adverse physical changes</p> Signup and view all the answers

    Which of the following can increase the risk of serious adverse effects when using hallucinogens?

    <p>Combining with other stimulating substances</p> Signup and view all the answers

    What is a common misunderstanding regarding the prevalence of hallucinogen use in the U.S. population?

    <p>It is notably low at less than 1% for most age groups</p> Signup and view all the answers

    Which of the following is a known physiological effect of hallucinogen use?

    <p>Increased alertness and hyperthermia</p> Signup and view all the answers

    What is a significant risk factor associated with the use of hallucinogens in young adults?

    <p>Increased likelihood of psychological dependencies</p> Signup and view all the answers

    What factor is a significant predictor of inhalant use disorder?

    <p>Sensation seeking and impulsivity</p> Signup and view all the answers

    Which of the following is NOT a consequence of long-term inhalant use?

    <p>Enhanced social skills</p> Signup and view all the answers

    Inhalant use disorder is differentiated from which condition?

    <p>Inhalant intoxication and inhalant-induced mental disorders</p> Signup and view all the answers

    What is a diagnostic marker for inhalant use disorder?

    <p>Urine, breath, or saliva tests</p> Signup and view all the answers

    What characterizes inhalant intoxication?

    <p>Clinically significant behavioral or psychological changes</p> Signup and view all the answers

    What significant risk factor is associated with childhood factors in the progression to inhalant use disorder?

    <p>Childhood maltreatment or trauma</p> Signup and view all the answers

    Which population is reported to experience a high prevalence of inhalant problems internationally?

    <p>Isolated Indigenous communities</p> Signup and view all the answers

    What common behavior may be observed among individuals who experience inhalant intoxication?

    <p>Reckless behaviors and accidents</p> Signup and view all the answers

    Which disorder commonly co-occurs with inhalant use disorder?

    <p>Anxiety disorders</p> Signup and view all the answers

    What is indicated by the intentional exposure to inhalants for a diagnosis of inhalant use disorder?

    <p>Intentional inhalant exposure</p> Signup and view all the answers

    What is the primary age group that reports the highest prevalence of inhalant use in the United States?

    <p>Ages 12-17 years</p> Signup and view all the answers

    Inhalant use disorder can lead to which severe health consequence?

    <p>Central nervous system depression</p> Signup and view all the answers

    What might be a typical long-term health risk associated with inhalant use disorder?

    <p>Increased risk for HIV/AIDS</p> Signup and view all the answers

    What distinguishes hallucinogen persisting perception disorder from other hallucinogen intoxications?

    <p>Symptoms continue episodically for weeks or longer.</p> Signup and view all the answers

    Which factor is suggested to potentially contribute to the susceptibility of hallucinogen persisting perception disorder?

    <p>Genetic predisposition.</p> Signup and view all the answers

    What is a diagnostic feature for inhalant use disorder?

    <p>Repeated reliance on inhalants despite known problems.</p> Signup and view all the answers

    What percentage of individuals using inhalants report tolerance symptoms?

    <p>10%</p> Signup and view all the answers

    What comorbid mental disorder is most commonly associated with hallucinogen persisting perception disorder?

    <p>Schizophrenia spectrum disorders.</p> Signup and view all the answers

    What is the demographic with the highest reported prevalence of inhalant use disorder in the United States?

    <p>Non-Hispanic Whites.</p> Signup and view all the answers

    What condition may develop as a result of repeated inhalant use?

    <p>Major neurocognitive disorder.</p> Signup and view all the answers

    Which of the following is NOT considered a characteristic medical complication of inhalant use disorder?

    <p>Chronic obstructive pulmonary disease.</p> Signup and view all the answers

    What feature is necessary for the diagnosis of unspecified phencyclidine-related disorder?

    <p>Disturbances causing clinically significant distress.</p> Signup and view all the answers

    Which of the following is a key feature of the symptoms associated with hallucinogen persisting perception disorder?

    <p>A continuity of abnormal perceptions.</p> Signup and view all the answers

    What common condition may be a trigger for hallucinogen persisting perception disorder symptoms?

    <p>Exercise.</p> Signup and view all the answers

    What is the proposed relationship between hallucinogen use and the onset of persistent perception disorder?

    <p>There is no clear correlation.</p> Signup and view all the answers

    What defines the severity of inhalant use disorder?

    <p>The number of diagnostic criteria endorsed.</p> Signup and view all the answers

    What kind of assessments are involved in evaluating inhalant use disorder?

    <p>Clinical observations and biological testing.</p> Signup and view all the answers

    Which factor does NOT contribute to the increasing risk of sedative, hypnotic, or anxiolytic use disorder with age?

    <p>More social engagements</p> Signup and view all the answers

    What behavior is commonly observed in individuals who justify their increased use of sedatives based on original symptoms of anxiety or insomnia?

    <p>Seeking multiple prescriptions from various physicians</p> Signup and view all the answers

    What is one significant factor that contributes to higher prevalence rates of opioid use disorder among ethnoracial groups?

    <p>Widespread availability of opioids</p> Signup and view all the answers

    Which age group has the highest rates of nonmedical prescription opioid use?

    <p>Adults ages 18-25</p> Signup and view all the answers

    What symptom is NOT typically associated with sedative, hypnotic, or anxiolytic intoxication?

    <p>Rapid heartbeat</p> Signup and view all the answers

    In which way are the functional consequences of sedative use disorder similar to alcohol use disorder?

    <p>Potential for disinhibited behavior</p> Signup and view all the answers

    Which condition is not directly associated with opioid use disorder?

    <p>Osteoporosis</p> Signup and view all the answers

    What is a potential risk associated with intravenous use of sedative, hypnotic, or anxiolytic substances?

    <p>Medical complications from contaminated needles</p> Signup and view all the answers

    What is a primary reason why women may progress to opioid use disorder more quickly than men?

    <p>Responses to sexual abuse and violence</p> Signup and view all the answers

    Which demographic is reported to have a higher frequency of benzodiazepine use in the United States?

    <p>Non-Latinx Whites</p> Signup and view all the answers

    What genetic factor has been indicated to influence the risk for opioid use disorders?

    <p>Familial history of addiction</p> Signup and view all the answers

    What is the main risk associated with repeated opioid intoxication?

    <p>Heightened risk for suicide attempts</p> Signup and view all the answers

    Which condition is usually NOT associated with sedative, hypnotic, or anxiolytic use disorder?

    <p>Obesity</p> Signup and view all the answers

    Which condition is frequently experienced alongside opioid use disorder, complicating treatment outcomes?

    <p>Post-traumatic stress disorder</p> Signup and view all the answers

    What diagnostic marker remains effective for detecting long-acting sedatives after use?

    <p>Urine test results</p> Signup and view all the answers

    What pattern of drug use can lead to planning daily activities around obtaining and using opioids?

    <p>Regular patterns of compulsive drug use</p> Signup and view all the answers

    How does the onset of sedative, hypnotic, or anxiolytic use disorder typically present?

    <p>Beginning with social recreational use</p> Signup and view all the answers

    Which outcome is commonly found in individuals who inject opioids?

    <p>High rates of hepatitis B infections</p> Signup and view all the answers

    Which of the following outcomes is commonly observed due to the cognitive side effects of sedative, hypnotic, or anxiolytic use?

    <p>Interference with work or school performance</p> Signup and view all the answers

    What behavioral trait is highly associated with opioid use disorder?

    <p>Impulsivity</p> Signup and view all the answers

    What is the distinguishing characteristic of opioid use disorder compared to opioid intoxication?

    <p>Impaired control over opioid use</p> Signup and view all the answers

    In diagnosing sedative, hypnotic, or anxiolytic withdrawal, which criteria is essential?

    <p>Manifestation of physiological withdrawal signs</p> Signup and view all the answers

    Which group has a lower prevalence of prescription opioid use disorder among adolescents?

    <p>Younger adolescents (12-14 years)</p> Signup and view all the answers

    Which ICD-10-CM code is applied when moderate or severe opioid use disorder is present alongside opioid withdrawal?

    <p>F11.23</p> Signup and view all the answers

    What is a defining feature of unspecified opioid-related disorders?

    <p>Symptoms cause significant distress without specific disorder classification</p> Signup and view all the answers

    What is the relationship between sedative, hypnotic, or anxiolytic use disorder and major neurocognitive disorder?

    <p>Uncertain relationship regarding increased risk</p> Signup and view all the answers

    What is a common misconception about the effects of sedative, hypnotic, or anxiolytic drugs?

    <p>They always cause cognitive improvement</p> Signup and view all the answers

    Which of the following is NOT a criterion for sedative-, hypnotic-, or anxiolytic-related disorders?

    <p>Increased tolerance to stimulant effects</p> Signup and view all the answers

    What crucial diagnostic marker can remain positive for most opioids after use?

    <p>Urine toxicology test results</p> Signup and view all the answers

    What symptom is NOT typically associated with both opioid withdrawal and sedative-hypnotic withdrawal?

    <p>Rhinorrhea</p> Signup and view all the answers

    What is the probable duration for the emergence of withdrawal symptoms following the cessation of short-acting opioids like heroin?

    <p>6-12 hours</p> Signup and view all the answers

    What common behavior may complicate the diagnostic process of opioid use disorder?

    <p>Overlapping symptoms with independent mental disorders</p> Signup and view all the answers

    How is the severity of a sedative, hypnotic, or anxiolytic use disorder determined?

    <p>By the number of endorsed criteria</p> Signup and view all the answers

    What should be monitored in regular users of opioids due to the risk associated with substance use?

    <p>Risk of suicide attempts</p> Signup and view all the answers

    Which of the following may indicate a more severe opioid withdrawal syndrome?

    <p>Piloerection</p> Signup and view all the answers

    What pattern of use is most commonly observed in individuals developing sedative-, hypnotic-, or anxiolytic use disorders?

    <p>Initial occasional use escalating to problematic use</p> Signup and view all the answers

    Which substance is NOT typically included in the classification of sedative, hypnotic, or anxiolytic substances?

    <p>Stimulants</p> Signup and view all the answers

    What psychiatric syndrome can develop as a complication in individuals with opioid use disorder?

    <p>Persistent Depressive Disorder</p> Signup and view all the answers

    Which symptom would NOT typically be seen during opioid withdrawal?

    <p>Euphoria</p> Signup and view all the answers

    What is a common consequence of increased sedative, hypnotic, or anxiolytic use among individuals with other substance use disorders?

    <p>Increased respiratory depression and hypotension</p> Signup and view all the answers

    What is a potential effect of opioids resembling an independent mental disorder?

    <p>Anxiety Disorder</p> Signup and view all the answers

    What demographic group has the highest prevalence of DSM-IV sedative, hypnotic, or anxiolytic use disorder?

    <p>Young adults aged 18-29 years</p> Signup and view all the answers

    Which of the following correctly describes a potential risk when sedatives are misused to counteract certain stimulants?

    <p>Rapid development of tolerance to both substances</p> Signup and view all the answers

    How does the severity of withdrawal symptoms usually correlate with the type of opioid used?

    <p>Short-acting opioids generally cause more severe withdrawal</p> Signup and view all the answers

    What factor primarily influences whether an individual experiences withdrawal symptoms?

    <p>Duration of use</p> Signup and view all the answers

    What distinguishes mild from moderate sedative, hypnotic, or anxiolytic use disorders?

    <p>The severity based on number of criteria met</p> Signup and view all the answers

    What is a common withdrawal symptom for individuals dependent on opioids?

    <p>Aches and pains</p> Signup and view all the answers

    Which behavior indicates a strong desire or urge to use sedatives, hypnotics, or anxiolytics?

    <p>Planning activities around substance availability</p> Signup and view all the answers

    When is opioid withdrawal considered a distinct condition?

    <p>When it occurs without drug-seeking behavior</p> Signup and view all the answers

    What is a significant challenge in diagnosing sedative, hypnotic, or anxiolytic use disorder in individuals prescribed these substances?

    <p>Need to ascertain inappropriate use of prescribed drugs</p> Signup and view all the answers

    What is a common trend in the prevalence of sedative, hypnotic, or anxiolytic use disorder across different age groups?

    <p>Decreasing prevalence as age increases</p> Signup and view all the answers

    What treatment consideration is crucial when managing opioid withdrawal in a clinical context?

    <p>Gradual tapering of opioid dosage</p> Signup and view all the answers

    What is a notable risk linked to continued use of sedatives despite knowledge of related problems?

    <p>Escalation of mental health conditions</p> Signup and view all the answers

    Which of the following withdrawal symptoms is typically NOT a clinical observation seen in opioid withdrawal?

    <p>Lethargy</p> Signup and view all the answers

    What characterizes anterograde amnesia in the context of sedative, hypnotic, or anxiolytic intoxication?

    <p>Loss of the ability to form new memories.</p> Signup and view all the answers

    Which of the following is NOT typically seen as a consequence of prolonged use of sedatives, hypnotics, or anxiolytics?

    <p>Significant paranoia.</p> Signup and view all the answers

    What distinguishes withdrawal symptoms in individuals who have been using benzodiazepines for an extended period?

    <p>They may include life-threatening delirium and seizures.</p> Signup and view all the answers

    How can one differentiate between sedative, hypnotic, or anxiolytic intoxication and alcohol use disorder?

    <p>Self-report of substance use.</p> Signup and view all the answers

    What ICD-10-CM code corresponds to mild sedative, hypnotic, or anxiolytic withdrawal?

    <p>F13.130</p> Signup and view all the answers

    What is a significant feature that could indicate severe withdrawal from sedative, hypnotic, or anxiolytic substances?

    <p>Visual hallucinations.</p> Signup and view all the answers

    What could be considered a diagnostic marker for sedative, hypnotic, or anxiolytic withdrawal?

    <p>Autonomic instability.</p> Signup and view all the answers

    Which factor likely affects the onset and intensity of withdrawal symptoms when discontinuing sedatives?

    <p>Duration and dosage of substance use.</p> Signup and view all the answers

    What should be noted if an individual experiences illusions amidst intact reality testing during withdrawal?

    <p>Withdrawal delirium with perceptual disturbances.</p> Signup and view all the answers

    In cases of cognitive impairment or delirium, how can sedative, hypnotic, or anxiolytic intoxication manifest?

    <p>At very low doses.</p> Signup and view all the answers

    What is a common physiological symptom associated with moderate to severe withdrawal from sedatives?

    <p>Hand tremor.</p> Signup and view all the answers

    Which of the following can trigger sedative, hypnotic, or anxiolytic intoxication in individuals?

    <p>Using substances without a prescription.</p> Signup and view all the answers

    How does the pharmacokinetics of a substance influence withdrawal symptoms?

    <p>Shorter-acting substances may show withdrawal symptoms within hours.</p> Signup and view all the answers

    What are characteristic features of sedative, hypnotic, or anxiolytic withdrawal syndrome?

    <p>Hallucinations and psychomotor agitation.</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with sedative, hypnotic, or anxiolytic withdrawal?

    <p>Anxiety disorder</p> Signup and view all the answers

    What is required for a diagnosis of Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorders?

    <p>Symptoms cause clinically significant distress</p> Signup and view all the answers

    Which criterion indicates that stimulant use disorder is present?

    <p>Daily use despite knowing risks</p> Signup and view all the answers

    What is a common withdrawal symptom associated with stimulant use disorder?

    <p>Hyperomnia</p> Signup and view all the answers

    Which of the following substances is primarily consumed in a form that leads to rapid onset of effects?

    <p>Cocaine hydrochloride</p> Signup and view all the answers

    In what timeframe can an individual develop stimulant use disorder from amphetamine-type substances?

    <p>One week</p> Signup and view all the answers

    Which type of substances are included in stimulant-related disorders?

    <p>Psychoactive substances that increase brain activity</p> Signup and view all the answers

    When diagnosing stimulant use disorder, which of the following is a significant behavioral indicator?

    <p>Giving up recreational activities</p> Signup and view all the answers

    Which criterion is used to assess withdrawal in stimulant-related disorders?

    <p>Craving for stimulants</p> Signup and view all the answers

    What defines 'sustained remission' in the context of stimulant use disorder?

    <p>No disorder criteria met for at least 12 months</p> Signup and view all the answers

    What symptom might indicate a significant psychological issue associated with stimulant use?

    <p>Tolerance development</p> Signup and view all the answers

    What type of environments are classified as 'controlled' for assessing substance use disorder?

    <p>Therapeutic environments</p> Signup and view all the answers

    Which aspect is critical in the diagnosis of stimulant-related disorders?

    <p>Pattern of use resulting in impairment</p> Signup and view all the answers

    What common effect do amphetamine-type substances and cocaine share?

    <p>Increased brain activity</p> Signup and view all the answers

    What behavioral change is most commonly associated with stimulant use disorder?

    <p>Chaotic behavior and social isolation</p> Signup and view all the answers

    Which of the following is a potential predictor of cocaine use among teenagers?

    <p>Prenatal cocaine exposure</p> Signup and view all the answers

    What is a common physiological risk associated with intravenous use of stimulants?

    <p>Skin infections from improper care</p> Signup and view all the answers

    What characterizes stimulant use disorder?

    <p>Risky stimulant use with continued usage despite health issues</p> Signup and view all the answers

    What type of behavior might develop due to conditioned responses in individuals with stimulant use disorder?

    <p>Positive reactions to drug-related stimuli</p> Signup and view all the answers

    Which condition indicates stimulant intoxication?

    <p>Euphoria coupled with impaired judgment</p> Signup and view all the answers

    What is NOT considered a diagnostic criterion for stimulant use disorder?

    <p>The presence of euphoria during use</p> Signup and view all the answers

    Which psychological condition is specifically identified as a risk factor for stimulant use disorder?

    <p>Antisocial personality disorder</p> Signup and view all the answers

    What is a characteristic associated with withdrawal symptoms from stimulants?

    <p>Intense depressive symptoms</p> Signup and view all the answers

    How does stimulant withdrawal manifest?

    <p>Possible mood disturbances and fatigue</p> Signup and view all the answers

    Which demographic is statistically more likely to develop stimulant use disorders?

    <p>Men who have sex with men</p> Signup and view all the answers

    Which of the following is a common co-occurring disorder with stimulant use disorder?

    <p>Antisocial personality disorder</p> Signup and view all the answers

    What effect does tolerance have on the experience of stimulant use?

    <p>Decreased pleasurable effects and increased dysphoria</p> Signup and view all the answers

    What is a defining factor of stimulant-induced mental disorders?

    <p>Presence of psychosis not present during intoxication</p> Signup and view all the answers

    Which ICD-10-CM code corresponds to moderate stimulant use disorder?

    <p>F15.220</p> Signup and view all the answers

    What physical health issue is commonly related to the smoking of stimulants?

    <p>Respiratory problems, such as bronchitis</p> Signup and view all the answers

    What can be a contributing factor to increases in stimulant use among specific demographic groups?

    <p>Exposure to community violence during childhood</p> Signup and view all the answers

    What does stimulant intoxication NOT typically lead to?

    <p>Consistent engagement in responsible behaviors</p> Signup and view all the answers

    Which of the following symptoms is associated with severe stimulant intoxication?

    <p>Convulsions</p> Signup and view all the answers

    What common condition affects neurocognitive functioning in stimulant users?

    <p>Impaired memory and attention deficits</p> Signup and view all the answers

    What distinguishes mild cocaine use disorder in terms of ICD-10-CM coding?

    <p>F14.120</p> Signup and view all the answers

    Which of these conditions is linked to higher suicide mortality rates associated with stimulant use?

    <p>Schizophrenia</p> Signup and view all the answers

    During stimulant intoxication, which symptom is least likely to occur?

    <p>Affective blunting</p> Signup and view all the answers

    What timeframe is noted for the rapid progression to severe stimulant use disorder?

    <p>Weeks to months</p> Signup and view all the answers

    What is often a common physical complication in cocaine-related treatment admissions?

    <p>Chest pain</p> Signup and view all the answers

    Which group is NOT prone to stimulant-related disorders?

    <p>People with diabetes</p> Signup and view all the answers

    Which aspect is considered when diagnosing stimulant-induced mental disorders?

    <p>Onset during or shortly after stimulant use</p> Signup and view all the answers

    Which demographic group is reported to have the highest 12-month prevalence of tobacco use disorder?

    <p>Native Americans</p> Signup and view all the answers

    What factor is NOT significantly associated with higher prevalence rates of tobacco use disorder?

    <p>High income</p> Signup and view all the answers

    What is the approximate percentage of current daily smokers that exhibit tobacco use disorder?

    <p>50%</p> Signup and view all the answers

    Which of the following factors does NOT influence nicotine metabolism and smoking behavior?

    <p>Age-standardized prevalence rates</p> Signup and view all the answers

    Which psychiatric disorder is NOT mentioned as being comorbid with tobacco use disorder?

    <p>Schizophrenia</p> Signup and view all the answers

    What is the approximate male to female ratio among U.S. smokers?

    <p>1.4:1</p> Signup and view all the answers

    What is a common mental health consequence faced by individuals with smoking habits?

    <p>Elevated risks of suicidal thoughts</p> Signup and view all the answers

    Which phase of the menstrual cycle is associated with more intense tobacco withdrawal symptoms?

    <p>Luteal phase</p> Signup and view all the answers

    What is NOT a commonly endorsed withdrawal symptom from tobacco use?

    <p>Depression</p> Signup and view all the answers

    When do tobacco withdrawal symptoms typically peak after cessation?

    <p>2-3 days</p> Signup and view all the answers

    Which condition is associated with increased severity of tobacco withdrawal symptoms?

    <p>Depressive disorders</p> Signup and view all the answers

    What diagnostic code is used for tobacco withdrawal when a moderate or severe tobacco use disorder is present?

    <p>F17.203</p> Signup and view all the answers

    Which factor does NOT typically complicate the diagnosis of tobacco withdrawal?

    <p>Medical history of sociocultural acceptance</p> Signup and view all the answers

    Which is NOT a common functional consequence of tobacco withdrawal?

    <p>Low rates of functional impairment</p> Signup and view all the answers

    What is a key physiological change associated with stimulant withdrawal?

    <p>Bradycardia</p> Signup and view all the answers

    Which symptom is NOT classified as part of the characteristic withdrawal syndrome for stimulants?

    <p>Hyperactivity</p> Signup and view all the answers

    In distinguishing stimulant withdrawal from stimulant-induced mental disorders, which characteristic is essential?

    <p>Severity of symptoms in excess of withdrawal</p> Signup and view all the answers

    Which withdrawal symptom is specifically associated with a high-dose use of stimulants?

    <p>Crashing</p> Signup and view all the answers

    What role does environmental cue exposure have in tobacco use disorder?

    <p>It can trigger cravings and withdrawal symptoms.</p> Signup and view all the answers

    Which feature is a diagnostic criterion for tobacco use disorder?

    <p>Significant time spent obtaining or using tobacco</p> Signup and view all the answers

    What ICD-10-CM code applies to unspecified stimulant-related disorders?

    <p>F15.99</p> Signup and view all the answers

    What defines the concept of tobacco withdrawal syndrome?

    <p>A collection of symptoms resulting from cessation of use</p> Signup and view all the answers

    Which statement accurately reflects the distinction between tobacco use disorder and tobacco-induced disorders?

    <p>Tobacco use disorder leads to significant impairment or distress.</p> Signup and view all the answers

    In the context of stimulant withdrawal, which psychological symptom is often considered serious?

    <p>Suicidal thoughts or behavior</p> Signup and view all the answers

    What is NOT a common physiological symptom during tobacco withdrawal?

    <p>Enhanced focus</p> Signup and view all the answers

    What does the term 'anhedonia' refer to in the context of stimulant withdrawal?

    <p>Inability to feel pleasure</p> Signup and view all the answers

    Which of the following increases the likelihood of developing a medically serious condition due to tobacco use disorder?

    <p>Long-term and heavy tobacco use</p> Signup and view all the answers

    What must occur for a diagnosis of unspecified stimulant-related disorder?

    <p>Clinical significance of distress or impairment is evident</p> Signup and view all the answers

    What characterizes opioid tolerance in individuals?

    <p>Developing a need for higher amounts to achieve the same effect</p> Signup and view all the answers

    When is opioid withdrawal considered to be present?

    <p>When opioids are taken to alleviate withdrawal symptoms</p> Signup and view all the answers

    What additional specification applies to an individual in remission from opioid use disorder?

    <p>They are receiving maintenance therapy</p> Signup and view all the answers

    What distinguishes the Preparation phase in the process of behavior change from the other stages?

    <p>The formulation of specific and actionable plans for change</p> Signup and view all the answers

    Which statement correctly describes the relationship between stressors and substance addiction relapse?

    <p>Stressors can serve as triggers for relapse in individuals with addiction disorders.</p> Signup and view all the answers

    How is the severity of opioid use disorder categorized?

    <p>As mild, moderate, or severe</p> Signup and view all the answers

    Which routes are commonly associated with the nonmedical use of heroin?

    <p>Injection, smoking, or nasal snorting</p> Signup and view all the answers

    What is the impact of addiction disorders on pregnant women and their newborns during the perinatal period?

    <p>It may alter neurobehavioral outcomes in newborns and affect pregnancy outcomes.</p> Signup and view all the answers

    Which symptom is not typically associated with Fetal Alcohol Spectrum Disorders (FASD)?

    <p>Enhanced cognitive performance</p> Signup and view all the answers

    What is true about fentanyl regarding its use and administration?

    <p>It can be administered in both medical and nonmedical situations</p> Signup and view all the answers

    Which of the following accurately describes a criterion for classifying opioid use disorder?

    <p>Ongoing use despite significant interpersonal issues</p> Signup and view all the answers

    In which phase of change is a person most likely to actively weigh the pros and cons of their addictive behavior?

    <p>Contemplation</p> Signup and view all the answers

    What role do coping strategies play in substance addiction recovery?

    <p>They are critical for managing urges and negative emotions associated with substance withdrawal.</p> Signup and view all the answers

    What environments qualify for the 'in a controlled environment' specification in remission?

    <p>Closely supervised and substance-free settings like jails or therapeutic communities</p> Signup and view all the answers

    Which of the following factors tends to increase the likelihood of relapse in substance abuse?

    <p>Low mood and stressful events</p> Signup and view all the answers

    What is the primary consequence of maternal alcohol consumption during pregnancy?

    <p>Damage to the emotional, cognitive, and social behaviors of the developing infant</p> Signup and view all the answers

    What characterizes the crucial feature of other (or unknown) substance intoxication?

    <p>Clinically significant behavioral or psychological changes during or after use</p> Signup and view all the answers

    Which aspect is critical when diagnosing other (or unknown) substance use disorder?

    <p>Impaired control over substance use</p> Signup and view all the answers

    Under what circumstance might a diagnosis of other (or unknown) substance withdrawal be made?

    <p>When symptoms arise after discontinuing familiar substances</p> Signup and view all the answers

    What is essential in determining the prevalence of other (or unknown) substance withdrawal?

    <p>Comorbidity with other substance use disorders</p> Signup and view all the answers

    Which ICD-10-CM code applies when other (or unknown) substance withdrawal occurs without perceptual disturbances?

    <p>F19.130</p> Signup and view all the answers

    What is typically the result of the differential diagnosis process in substance-related disorders?

    <p>Distinguishing withdrawal from intoxication symptoms</p> Signup and view all the answers

    Which statement best describes the challenges faced in diagnosing unknown substance intoxication?

    <p>Clinical judgment must adapt to a broad range of symptoms</p> Signup and view all the answers

    What is a likely functional consequence of other (or unknown) substance intoxication?

    <p>Engagement in high-risk behaviors</p> Signup and view all the answers

    What factor is crucial for distinguishing other (or unknown) substance-induced mental disorders from substance withdrawal?

    <p>Severity of symptoms presented</p> Signup and view all the answers

    What does the development of a reversible substance-specific syndrome entail?

    <p>Symptoms resolving after cessation of use</p> Signup and view all the answers

    What might be the onset and duration of withdrawal symptoms after substance use is terminated?

    <p>Varies greatly, depending on previous use</p> Signup and view all the answers

    What indicates a problematic pattern of other (or unknown) substance use?

    <p>Recurrent use despite evident health risks</p> Signup and view all the answers

    How are the codes for other (or unknown) substance use disorders determined?

    <p>By considering the substance used and any comorbid disorders</p> Signup and view all the answers

    What is the primary aim of the biopsychosocial model in addressing addiction?

    <p>To identify genetic, environmental, and psychological factors that influence substance use</p> Signup and view all the answers

    Which neurotransmitter systems are considered the most dominant in addiction disorders?

    <p>Cholinergic, serotonergic, noradrenergic, and glutamatergic systems</p> Signup and view all the answers

    What aspect of addiction does the unconscious prioritization of brain reward pathways negatively affect?

    <p>Social relationships and pro-social engagements</p> Signup and view all the answers

    What is one challenge of applying psychological theories to addiction treatment?

    <p>Psychological models often lack practical clinical implications</p> Signup and view all the answers

    Which factors do pharmacological interventions in addiction treatment primarily target?

    <p>Unique receptor types in neurotransmitter systems</p> Signup and view all the answers

    How do temporary life stressors relate to substance-seeking behaviors in cognitive-behavioral theory?

    <p>They can trigger substance use as a coping mechanism</p> Signup and view all the answers

    How does the interaction between individual vulnerabilities and environmental factors influence addiction?

    <p>It results in brain abnormalities and substance use disorders</p> Signup and view all the answers

    What is a potential benefit of understanding the anatomy and physiology of the brain in addiction?

    <p>It allows for the development of better behavioral treatments</p> Signup and view all the answers

    What common characteristic of substance-related disorders does the biopsychosocial model highlight?

    <p>They are influenced by a combination of genetic, psychological, and social factors</p> Signup and view all the answers

    Which factor is most likely to contribute to ineffective substance use treatment?

    <p>A lack of understanding of addiction's complex nature</p> Signup and view all the answers

    Which psychological aspect is significantly influenced by stressors in cognitive–behavioral models of addiction?

    <p>Substance-seeking behaviors and coping mechanisms</p> Signup and view all the answers

    What is one challenge in assessing and diagnosing substance addiction disorders?

    <p>Diagnostics can struggle to encapsulate the multifaceted nature of addiction</p> Signup and view all the answers

    What does a cognitive-behavioral approach suggest regarding coping behaviors for those with substance use issues?

    <p>Preemptive teaching of functional coping behaviors is essential</p> Signup and view all the answers

    What does the CAGE Questionnaire specifically assess in individuals?

    <p>Problematic patterns of substance use</p> Signup and view all the answers

    Which of the following components is NOT part of the primary treatment phase for substance addiction?

    <p>Long-term maintenance interventions</p> Signup and view all the answers

    What is a key indicator of substance addiction as defined in the context provided?

    <p>Difficulty in discontinuing the substance despite awareness of adverse consequences</p> Signup and view all the answers

    Which therapeutic approach is primarily focused on altering maladaptive coping mechanisms in substance addiction?

    <p>Cognitive-behavioral therapy</p> Signup and view all the answers

    In terms of treatment, which factor is emphasized as critical for ensuring successful recovery beyond initial therapy?

    <p>Post-treatment social support and long-term engagement</p> Signup and view all the answers

    What role does pharmacological intervention play in the treatment of substance use disorders?

    <p>It is crucial but should be combined with psychosocial interventions</p> Signup and view all the answers

    What aspect of substance use is primarily addressed by the Stages of Change Model?

    <p>The process of behavior change in individuals</p> Signup and view all the answers

    What does the withdrawal response signify in the context of substance use?

    <p>The body’s adaptation to the absence of the substance</p> Signup and view all the answers

    Which factor is considered in understanding the addiction process regardless of an individual’s background?

    <p>Availability and accessibility of the substance</p> Signup and view all the answers

    Which approach has shown greater effectiveness in substance addiction treatment according to evaluations?

    <p>Social interactions and support systems</p> Signup and view all the answers

    What characteristic underscores the importance of recovery in the context of substance addiction treatment?

    <p>Recovery requires confronting various obstacles and challenges</p> Signup and view all the answers

    What is a common psychological focus of psychosocial interventions in substance use disorder treatment?

    <p>Changing cognitions and behaviors related to substance use</p> Signup and view all the answers

    Which of the following represents a critical challenge faced by individuals after leaving treatment for substance use?

    <p>Handling cravings and high-risk situations</p> Signup and view all the answers

    What is a significant risk factor associated with the development of gambling disorder?

    <p>Increased rates of gambling in family relatives</p> Signup and view all the answers

    Which demographic group is most likely to develop early-life gambling disorder?

    <p>Young men aged 18-21</p> Signup and view all the answers

    Which substance-related disorder is particularly linked with gambling behavior?

    <p>Alcohol use disorder</p> Signup and view all the answers

    How does the prevalence of gambling disorder vary across genders?

    <p>The gender gap in gambling disorder rates is narrowing</p> Signup and view all the answers

    Which psychological condition has been linked to the persistence of gambling disorder symptoms?

    <p>Anxiety disorder</p> Signup and view all the answers

    What trend is observed relating to the gambling preferences of younger versus older adults?

    <p>Older adults are more inclined towards slot machines and bingo</p> Signup and view all the answers

    What major consequence can stem from gambling disorder?

    <p>Jeopardizing important relationships</p> Signup and view all the answers

    How is the concept of addiction perceived differently across ethnoracial groups?

    <p>Asian Americans are less likely to feel preoccupied with gambling</p> Signup and view all the answers

    What characteristic of video gaming may influence gambling behavior?

    <p>Overlapping characteristics with gambling</p> Signup and view all the answers

    How does gambling disorder prevalence differ between U.S.-born individuals and first-generation immigrants?

    <p>U.S.-born individuals have higher rates</p> Signup and view all the answers

    What phenomenon is observed with impulsivity and gambling disorder?

    <p>Impulsivity is linked to early-life onset of gambling disorder</p> Signup and view all the answers

    What is a common behavior among women with gambling disorder compared to men?

    <p>More shame related to gambling activities</p> Signup and view all the answers

    Which factor is likely to influence the prognostic outcome of gambling issues?

    <p>The presence of past gambling problems</p> Signup and view all the answers

    What is required to classify a substance as having an 'other (or unknown) substance use disorder'?

    <p>The substance must lead to clinically significant impairment or distress.</p> Signup and view all the answers

    Which condition must NOT be present for a diagnosis of other (or unknown) substance use disorder?

    <p>Clearly identifiable symptoms related to specific substance classes.</p> Signup and view all the answers

    What consequence is associated with nitrous oxide misuse in adolescents and young adults?

    <p>Mental conditions such as psychosis and severe neuropathy.</p> Signup and view all the answers

    Which of the following is a common risk factor for developing other (or unknown) substance use disorders?

    <p>An early onset of substance-related problems.</p> Signup and view all the answers

    What diagnostic marker is commonly ineffective at identifying unusual or new substances?

    <p>Routine clinical tests.</p> Signup and view all the answers

    What sets apart sustained remission from early remission in substance use disorders?

    <p>In sustained remission, no criteria for disorder have been met for over 12 months.</p> Signup and view all the answers

    Which symptom is NOT typically associated with other (or unknown) substance use disorders?

    <p>Use of substance strictly for recreational purposes without harm.</p> Signup and view all the answers

    Which statement reflects the nature of withdrawal symptoms in substance use disorders?

    <p>Symptoms can manifest both physically and psychologically.</p> Signup and view all the answers

    What type of substances are commonly classified under the 'other (or unknown) substance' category?

    <p>New illicit drugs or those sold under false names.</p> Signup and view all the answers

    Which of the following represents a common theme in the risk factors for other (or unknown) substance use disorders?

    <p>Presence of other substance use disorders.</p> Signup and view all the answers

    Which diagnostic criteria address the consequences of substance use in social situations?

    <p>Continued use despite social problems caused by use.</p> Signup and view all the answers

    How do other (or unknown) substance-related disorders compare to known substance use disorders in terms of prevalence?

    <p>They are less prevalent.</p> Signup and view all the answers

    What primarily influences the identification of substance-related disorders in clinical settings?

    <p>Reports of negative consequences related to daily functioning.</p> Signup and view all the answers

    Which aspect is crucial in differentiating other (or unknown) substance use disorders from classified substance use disorders?

    <p>The clear categorization within established substance classes.</p> Signup and view all the answers

    What factor primarily influences the duration of withdrawal symptoms after substance use?

    <p>The particular drug and the doses the individual became tolerant to</p> Signup and view all the answers

    Which of the following is least likely to occur as a functional consequence of withdrawal from substances?

    <p>Increased athletic performance</p> Signup and view all the answers

    What is a potential outcome if symptoms indicative of a substance-induced mental disorder are present?

    <p>They can be diagnosed separately from substance withdrawal only if severe</p> Signup and view all the answers

    Which aspect is crucial for the differential diagnosis of unknown substance withdrawal?

    <p>Identifying the specific substance and its effects</p> Signup and view all the answers

    Which statement about gambling disorder reflects its complexity as a mental health condition?

    <p>It can result from a physiological response to medication.</p> Signup and view all the answers

    What can be inferred about the prevalence of gambling disorder among different ethnoracial groups in the United States?

    <p>African Americans show higher prevalence rates compared to other groups.</p> Signup and view all the answers

    What may indicate a severe gambling disorder based on the number of criteria endorsed?

    <p>All or most criteria being met within the same year</p> Signup and view all the answers

    How might gambling patterns inform the diagnosis of gambling disorder?

    <p>They can be either regular or episodic and still indicate a disorder.</p> Signup and view all the answers

    Why is the concept of 'chasing losses' significant in gambling disorder?

    <p>It reflects a need to recover losses, indicating severity.</p> Signup and view all the answers

    Which behavioral aspect is often linked to higher severity within gambling disorder?

    <p>Endorsing preoccupation and lying about gambling involvement</p> Signup and view all the answers

    What common trait distinguishes the initial experience of gambling disorder among different genders?

    <p>Women tend to progress more rapidly than men.</p> Signup and view all the answers

    What is the classification for symptoms that lead to significant distress but do not meet criteria for specific substance disorders?

    <p>Unspecified Other (or Unknown) Substance-Related Disorder</p> Signup and view all the answers

    In which situation may an individual with gambling disorder exhibit multiple forms of gambling?

    <p>In times of stress or depression</p> Signup and view all the answers

    Which symptom is typically among the least endorsed criteria in individuals with severe gambling disorder?

    <p>Jeopardizing personal relationships</p> Signup and view all the answers

    What is the primary reason for the frequent occurrence of ethical dilemmas in addiction treatment settings?

    <p>The complex nature of public health concerns</p> Signup and view all the answers

    How do perinatal substance use issues primarily affect the developing fetus?

    <p>By causing early toxic influences</p> Signup and view all the answers

    What role do psychologists serve when addressing substance use disorders in pregnant women?

    <p>They advocate for health and social service needs</p> Signup and view all the answers

    What factor is more critical in diagnosing adolescents with substance use issues than bio-behavioral features?

    <p>The degree of problems identified</p> Signup and view all the answers

    Which aspect of addiction treatment does confidentiality pertain to most directly?

    <p>Professional responsibility to the client</p> Signup and view all the answers

    What is the potential impact of alcohol consumption during pregnancy on cognitive development?

    <p>High risk for incomplete cognitive development</p> Signup and view all the answers

    What distinguishes the Discovery Interview in the context of addiction treatment?

    <p>It is exclusive to female AD patients in Europe</p> Signup and view all the answers

    What significant consequence can arise from uncontrolled alcohol addiction in pregnant women?

    <p>It creates a likelihood of maternal-infant bonding disconnection</p> Signup and view all the answers

    What must mental health professionals verify to obtain informed consent from clients?

    <p>Clients can understand and retain information presented</p> Signup and view all the answers

    Which of the following is NOT a legal situation where confidentiality laws protect data?

    <p>Divorce proceedings</p> Signup and view all the answers

    What is a primary focus of Cognitive-Behavioral Therapy in the context of addiction treatment?

    <p>Developing general problem-solving skills</p> Signup and view all the answers

    In the dual diagnosis treatment model, what is essential for effective treatment planning?

    <p>Integrating drug, biological, and psychosocial aspects</p> Signup and view all the answers

    What is a primary goal of Motivational Interviewing (MI) in substance misuse treatment?

    <p>To resolve ambivalence about substance use behavior</p> Signup and view all the answers

    Which factor is NOT considered a crucial aspect when assessing the effectiveness of substance abuse treatments?

    <p>Presence of a support group</p> Signup and view all the answers

    What are mental health professionals advised to do in public oversight issues relating to informed consent?

    <p>Maximize understanding and absorption of information</p> Signup and view all the answers

    What is an important consideration when providing treatment to dual diagnosis clients?

    <p>Collaborating with multiple care providers across different systems</p> Signup and view all the answers

    Which option best describes the role of the trainer in mental health interventions?

    <p>To address and clarify client misunderstandings</p> Signup and view all the answers

    What characterizes the integration of mental health and addiction treatment?

    <p>Coordinated treatment protocols that address both areas</p> Signup and view all the answers

    What is the significance of cue specificity in Cognitive-Behavioral Therapy?

    <p>It helps to recognize addictive triggers effectively</p> Signup and view all the answers

    What factor can enhance the clinical attention required during addiction treatment?

    <p>Addressing lifestyle factors like nutrition and physical fitness</p> Signup and view all the answers

    Which aspect of pharmaceutical substances can trigger mental health symptoms during addiction treatment?

    <p>Brain chemical imbalances</p> Signup and view all the answers

    What is a characteristic feature of family systems that may facilitate substance use development?

    <p>Rigid and overcontrolled family dynamics</p> Signup and view all the answers

    Which aspect of family therapy primarily targets improving emotional bonds among members?

    <p>Changing emotional relationships</p> Signup and view all the answers

    What common goal do community resources for recovering individuals strive to achieve?

    <p>Stakeholder ownership</p> Signup and view all the answers

    Which strategy is essential for preventing burnout among clinicians in health professions?

    <p>Balancing work demands with personal life</p> Signup and view all the answers

    What does the dual diagnosis approach focus on in mental health and addiction treatment?

    <p>Funding mental health constituents for substance abuse treatment</p> Signup and view all the answers

    Which factor is considered crucial in addressing professional ethics in treatment planning?

    <p>Balancing autonomy with informed consent</p> Signup and view all the answers

    What is meant by the term 'pre-vocational programs' within community resources?

    <p>Employment readiness training</p> Signup and view all the answers

    Which innovation in treatment approaches aims to integrate client community knowledge with clinical practices?

    <p>Unorthodox treatment approaches</p> Signup and view all the answers

    What role do peer counselors play in recovery programs for substance use?

    <p>Encouraging and supporting their peers</p> Signup and view all the answers

    How do behavioral health strategies contribute to organizational change in healthcare settings?

    <p>By enriching jobs through empowerment</p> Signup and view all the answers

    What is a critical component of professional development for clinicians dealing with substance use?

    <p>Engaging in supervision and consultation</p> Signup and view all the answers

    What is the objective of psychoeducation groups within community mental health resources?

    <p>To enhance clients' understanding of their issues</p> Signup and view all the answers

    What future direction in addiction treatment research emphasizes the integration of individual and community strengths?

    <p>Understanding vulnerabilities of individuals and communities</p> Signup and view all the answers

    What is the role of cultural competence in addiction treatment?

    <p>To ensure respect for diverse cultural backgrounds in treatment</p> Signup and view all the answers

    Which of the following best describes the concept of intersectionality in addiction treatment?

    <p>Considering social identities that create structured inequalities</p> Signup and view all the answers

    What primary prevention strategy is highlighted in combating substance use disorders?

    <p>Enhancing self-esteem and social skills among at-risk youth</p> Signup and view all the answers

    What is a key component of the integrated system for clinical practice and cultural expertise?

    <p>Cultural awareness of the psychosocial patterns of drug use</p> Signup and view all the answers

    What misconception may arise when addressing addiction in American-Asian communities?

    <p>All American-Asians share the same cultural beliefs</p> Signup and view all the answers

    What should treatment providers prioritize to enhance the therapeutic alliance?

    <p>Understanding their personal biases and professional limitations</p> Signup and view all the answers

    Which characteristic distinguishes harm reduction strategies in substance use treatment?

    <p>They aim to minimize the negative consequences of substance use</p> Signup and view all the answers

    Which approach is often ineffective in delaying adolescent substance use?

    <p>Information-based school prevention programs</p> Signup and view all the answers

    What element is critical in exploring substance use risk factors among adolescents?

    <p>Assessing individual characteristics and social environments</p> Signup and view all the answers

    What principle is often reconciled with therapeutic models of addiction?

    <p>The importance of understanding individual spirituality</p> Signup and view all the answers

    Which misconception about prevention strategies might hinder their effectiveness?

    <p>Assuming that educational curriculums will automatically lead to behavior change</p> Signup and view all the answers

    In what way should explanatory models in addiction treatment be approached?

    <p>With a culture-specific and nuanced perspective</p> Signup and view all the answers

    What consequence can arise from not incorporating cultural insights in addiction treatment?

    <p>Potential alienation and misunderstanding of clients</p> Signup and view all the answers

    What is the focus of primary prevention regarding substance use disorders?

    <p>Minimizing environmental changes that increase substance accessibility</p> Signup and view all the answers

    Study Notes

    Substance Use Disorders

    • Substance use disorders can occur in 10 distinct classes of drugs including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, or anxiolytics, stimulants (amphetamine-type substances, cocaine, and other stimulants), tobacco, and other (or unknown) substances.
    • The term "drug addiction" is not used in the DSM-5 diagnostic criteria, but the more neutral term "substance use disorder" is used to indicate a wide range of disorder severity, from mild to a severe state of chronically relapsing, compulsive drug use.
    • Substance use disorders are a cluster of cognitive, behavioral, and physiological symptoms that indicate an individual continues using the substance despite significant problems, including impaired control, social impairment, risky use, and pharmacological criteria.
    • The severity of a substance use disorder is based on the number of criteria endorsed:
      • Mild: 2-3 symptoms
      • Moderate: 4-5 symptoms
      • Severe: 6 or more symptoms
    • Substance use disorders can be diagnosed for all 10 substance classes except caffeine, and may vary based on culture, availability, and regulations.
    • Changes in severity over time are reflected by variations in the frequency and/or dose of substance use.
    • Alcohol-related disorders involve problematic alcohol use patterns leading to clinically significant impairment or distress.
    • At least two of the following criteria must be met:
      • alcohol is often taken in larger amounts or over a longer period than intended
      • there is a persistent desire or unsuccessful efforts to cut down or control alcohol use
      • a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
      • craving
      • recurrent alcohol use resulting in failure to fulfill major role obligations
      • continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol
      • important social, occupational, or recreational activities are given up or reduced because of alcohol use
      • recurrent alcohol use in situations in which it is physically hazardous
      • 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
      • tolerance
      • withdrawal
    • Alcohol use disorder can lead to issues with conduct problems, depression, anxiety, and insomnia.
    • Heavy drinking can affect nearly every organ system including the gastrointestinal tract, cardiovascular system, and central and peripheral nervous systems.

    Gastrointestinal Effects

    • Alcohol use can lead to conditions like gastritis, stomach ulcers, liver cirrhosis, pancreatitis, and an increased risk of cancer.
    • Heavy drinking can also result in cardiomyopathy and other myopathies.

    Cardiovascular Effects

    • Increased levels of triglycerides and low-density lipoprotein cholesterol contribute to an elevated risk of heart disease.

    Nervous System Effects

    • Peripheral neuropathy can occur, causing muscular weakness, paresthesias, and decreased peripheral sensation.
    • More persistent central nervous system effects include cognitive deficits like memory impairment and cerebellar degeneration.
    • These effects are linked to direct alcohol effects, trauma, or vitamin deficiencies, particularly B vitamins like thiamine.

    Mental Health Effects

    • Alcohol use disorder is associated with increased suicide risk, particularly during severe intoxication and in the context of alcohol-induced depression or bipolar disorder.
    • The prevalence of alcohol use disorder varies, with significantly higher rates among men than women.

    Alcohol Use Disorder Prevalence and Onset

    • The prevalence of alcohol use disorder shows age-related trends, being higher among younger adults and lower among older adults.
    • While alcohol use disorder can develop in various ways, the first episode of intoxication typically occurs in the mid-teens.
    • Most individuals develop alcohol-related disorders by their late 30s, with withdrawal symptoms often appearing after other aspects of the disorder have developed.
    • Earlier onset of alcohol use disorder is linked to preexisting conduct problems and earlier intoxication.

    Alcohol Use Disorder Course

    • The course of alcohol use disorder is variable, characterized by periods of remission and relapse.
    • Individuals often attempt to stop drinking due to crises but often relapse, leading to rapid escalation of consumption and worsening problems.
    • While some cases of alcohol use disorder are severe, the majority of individuals have a more promising prognosis.

    Risk Factors for Alcohol Use Disorder

    • Environmental factors playing a role in alcohol use disorder include poverty, discrimination, unemployment, low education, cultural attitudes towards drinking, alcohol availability, personal experiences with alcohol, and stress levels.
    • Individual factors like heavier peer substance use, exaggerated positive expectations from alcohol, and poor stress coping mechanisms also contribute to the development of alcohol problems.
    • Alcohol use disorder has a significant genetic component, with 40%–60% of risk variance attributed to genetics.
    • Close relatives of individuals with alcohol use disorder have a three to four times higher risk, with the risk increasing with the number of affected relatives, closeness of genetic relationship, and severity of alcohol-related problems in relatives.
    • Environmental factors can modulate genetic influences, with genetic effects being more pronounced when social constraint is low or alcohol is readily available.

    Alcohol Use Disorder in Specific Populations

    • Alcohol is the most commonly used intoxicating substance in most cultures and contributes significantly to morbidity and mortality.
    • Genetic polymorphisms in alcohol metabolizing enzymes can affect individual responses to alcohol, leading to reactions like flushed faces and palpitations.
    • Men have historically had higher rates of alcohol use disorder than women, but the gender gap is narrowing as women initiate alcohol use at younger ages.
    • Women are more likely to develop higher blood alcohol levels per drink due to their lower body weight, higher body fat, and less water content.
    • They are also more vulnerable to specific physical consequences of alcohol, including blackouts and liver disease.

    Diagnostic Markers for Alcohol Use Disorder

    • Standardized questionnaires and blood tests can reveal diagnostic markers for alcohol use disorder.
    • Blood alcohol concentration is the most direct measure of alcohol consumption.
    • Elevated levels of gamma-glutamyltransferase (GGT) may indicate regular heavy drinking.
    • Laboratory tests like carbohydrate-deficient transferrin (CDT) and mean corpuscular volume (MCV) can help identify individuals at risk for alcohol use disorder.
    • Elevated blood lipid levels, such as triglycerides and high-density lipoprotein cholesterol, and high normal levels of uric acid can also suggest alcohol use.
    • Physical signs like dyspepsia, nausea, bloating, hepatomegaly, esophageal varices, hemorrhoids, tremor, unsteady gait, insomnia, and erectile dysfunction can be suggestive of alcohol use.

    Alcohol Use Disorder and Suicide Risk

    • Most studies on suicidality and alcohol focus on alcohol consumption rather than alcohol use disorder.
    • A psychological autopsy study highlighted aggression, psychiatric comorbidity, and recent interpersonal conflicts as suicide risk factors in individuals with alcohol use disorder.
    • A meta-analysis found a nearly 560-sevenfold increase in the risk of suicide attempt among alcohol users compared to non-drinkers.
    • Co-use of alcohol and sedatives is associated with an even higher risk of attempted suicide.
    • A systematic review found alcohol use linked to firearm possession and increased risk of suicide by firearm.

    Social and Occupational Implications of Alcohol Use Disorder

    • Alcohol use disorder significantly impacts various aspects of life, including driving, work, relationships, and health.
    • It is associated with increased accident, violence, and suicide risks.
    • Alcohol-related disorders contribute to absenteeism, accidents, and low productivity at work.
    • Prevalence is elevated among homeless individuals, reflecting a downward spiral in social and occupational functioning.

    Alcohol Use Disorder and Hospitalization

    • Alcohol use disorder is a significant contributor to hospital admissions, with alcohol-related events affecting a significant percentage of the US population.
    • Severe alcohol use disorder can lead to criminal acts, including homicide.
    • Unanticipated alcohol withdrawal in hospitalized individuals can increase hospitalization time and costs.

    Definition and Differentiation of Alcohol Use Disorder

    • The core feature of alcohol use disorder is heavy alcohol use resulting in repeated and significant distress or impaired functioning.
    • It's distinguished from alcohol intoxication, withdrawal, and alcohol-induced mental disorders by its pattern of alcohol use involving impaired control, social impairment due to alcohol use, risky alcohol use, and pharmacological symptoms like tolerance or withdrawal.

    Alcohol Intoxication

    • Alcohol intoxication is characterized by problematic behavioral or psychological changes following alcohol ingestion.
    • It's a serious health issue that can lead to violence, suicidal behavior, and suicide.
    • The duration of intoxication depends on the amount of alcohol consumed, with the body metabolizing approximately one drink per hour.
    • Mild intoxication can occur after two drinks, with symptoms often reflecting stimulation during the drinking period.
    • As blood alcohol levels fall, individuals become more depressed, withdrawn, and cognitively impaired.
    • Alcohol intoxication can lead to amnesia for events during intoxication ("blackouts").
    • Acute alcohol intoxication can cause metabolic alterations and severe cardiovascular, respiratory, and gastrointestinal effects.
    • High blood alcohol levels can cause respiratory and pulse inhibition and even death in non-tolerant individuals.
    • The prevalence of alcohol intoxication is high, with most alcohol consumers experiencing intoxication at some point.

    Risk Factors for Alcohol Intoxication

    • Risk factors for alcohol intoxication include individual factors like personality characteristics of sensation seeking and impulsivity.
    • Environmental factors like heavy-drinking peers, beliefs about heavy drinking, and using alcohol to cope with stress also contribute.
    • Cultural differences regarding alcohol use and gender differences can also play a role.

    Diagnostic Markers for Alcohol Intoxication

    • Observing an individual's behavior and smelling alcohol on their breath can help diagnose alcohol intoxication.
    • Blood or breath alcohol levels are crucial in determining the degree of intoxication.

    Mortality and Morbidity Associated with Alcohol Intoxication

    • Alcohol intoxication contributes to a significant number of deaths and years of potential life lost in the United States.

    Alcohol Withdrawal

    • Alcohol withdrawal is a condition characterized by autonomic hyperactivity, tremor, insomnia, nausea, vomiting, hallucinations, agitation, anxiety, and seizures upon cessation of heavy and prolonged alcohol use.
    • The ICD-10-CM code varies based on the presence of a comorbid alcohol use disorder and perceptual disturbances.
    • The withdrawal syndrome includes autonomic hyperactivity, anxiety, and gastrointestinal symptoms.
    • Symptoms can be relieved by alcohol or benzodiazepines.
    • Alcohol withdrawal delirium, characterized by hallucinations, can occur and may be a sign of underlying medical conditions.

    Prevalence and Risk Factors for Alcohol Withdrawal

    • The prevalence of alcohol withdrawal does not seem to vary across racial groups.
    • Acute withdrawal typically lasts 4-5 days and occurs after extended periods of heavy drinking.
    • The risk and severity increase with age, being rare in individuals younger than 30 years.
    • Heavier alcohol intake, conduct disorders, and antisocial personality disorder increase the likelihood of withdrawal.
    • Dependence on other depressants and past withdrawal experiences also contribute to the severity of alcohol withdrawal.
    • Predictors of severe withdrawal include delirium, history of severe withdrawal syndromes, low blood potassium levels, decreased platelet counts, and systolic hypertension.

    Diagnostic Markers for Alcohol Withdrawal

    • Diagnostic markers include autonomous hyperactivity in the context of falling blood alcohol levels and a history of prolonged heavy drinking.

    Consequences of Alcohol Withdrawal

    • Withdrawal symptoms can perpetuate drinking behaviors and contribute to relapse.
    • Symptoms requiring medical supervision can lead to hospital utilization and work loss.
    • The presence of withdrawal is associated with greater functional impairment and poorer prognosis in individuals with alcohol use disorder.

    Differential Diagnosis of Alcohol Withdrawal

    • Symptoms of alcohol withdrawal can be mimicked by medical conditions like hypoglycemia and diabetic ketoacidosis.
    • Alcohol withdrawal must be differentiated from sedative, hypnotic, or anxiolytic withdrawal due to severity and clinical presentation.

    Alcohol-Induced Mental Disorders

    • Alcohol-induced mental disorders are diagnosed when symptoms warrant independent clinical attention.
    • They are similar to independent mental disorders but can have severe consequences and improve without formal treatment after intoxication or withdrawal cessation.
    • They must develop in the context of severe alcohol intoxication or withdrawal.
    • Differentiation is based on temporal relationship between alcohol use and psychiatric symptoms.
    • It must be determined that the observed disorder is not better explained by an independent, pre-existing mental disorder.
    • Symptoms occurring only during delirium should be considered part of the delirium, not a separate diagnosis.
    • The alcohol-induced disorder must be clinically relevant, causing significant distress or functional impairment.

    Alcohol-Induced Mental Disorders

    • Alcohol use disorder (AUD) can lead to a range of mental health conditions
    • The lifetime risk of experiencing a major depressive episode in individuals with AUD is approximately 40%
    • Alcohol-induced psychotic episodes are infrequent, affecting less than 5% of individuals with AUD
    • Alcohol-induced mental disorders are distinguished from independent mental health conditions by their shorter duration, typically resolving within a few days to a month after cessation of intoxication or withdrawal.
    • Caffeine intoxication occurs after consuming caffeine and experiencing five or more symptoms, including restlessness, nervousness, insomnia, flushed face, and gastrointestinal discomfort.
    • Symptoms can vary in severity depending on the dose and individual factors like age and prior caffeine exposure.
    • The prevalence of caffeine intoxication in the general population is unclear, but approximately 7% of individuals in the United States may experience five or more symptoms along with functional impairment.
    • Caffeine intoxication can resemble independent mental disorders, such as anxiety or panic attacks.

    Caffeine Withdrawal

    • Caffeine withdrawal is characterized by a withdrawal syndrome that develops after the abrupt cessation of prolonged daily caffeine ingestion.
    • The hallmark symptom is headache, which can be severe and sensitive to movement.
    • Other symptoms include fatigue , irritability, and difficulty concentrating.
    • The severity of withdrawal symptoms is generally related to the usual daily caffeine dose.
    • Caffeine withdrawal may be overlooked or misattributed to other causes due to the widespread use of caffeine.
    • Functional consequences of caffeine withdrawal range from mild to extreme, at times causing impairment in daily activities.
    • Cannabis-related disorders encompass cannabis use disorder, intoxication, withdrawal, and cannabis-induced mental disorders.
    • The primary psychoactive component of cannabis is delta-9-tetrahydrocannabinol (THC), which acts on cannabinoid receptors in the central nervous system.
    • Cannabis use disorder is characterized by a problematic pattern of cannabis use leading to significant impairment or distress.
    • The severity of cannabis use disorder is determined by the presence of 11 criteria, including withdrawal, tolerance, craving, and spending a great deal of time in activities related to the substance.
    • Regular cannabis users often develop tolerance to the effects of cannabis, making cessation of use challenging due to withdrawal symptoms.
    • Cannabis withdrawal can cause significant distress, leading to continued use to relieve symptoms and difficulty quitting use or relapse.
    • The prevalence of cannabis use disorder varies by demographic, with the highest rates among youth and young adults.
    • Increased availability of medical and recreational marijuana may impact the development and course of cannabis use disorder.
    • Early onset of cannabis use (before age 15) is a strong predictor of the development of cannabis use disorder and other substance use disorders.
    • Risk factors for developing cannabis use disorder include a history of conduct disorder, unstable family situations, and family history of substance use disorders.
    • Cultural context significantly influences cannabis use patterns and perceptions.
    • Women may experience more severe cannabis withdrawal symptoms, particularly mood and gastrointestinal symptoms.
    • The detection of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THCCOOH) in urine can assist in diagnosis, especially when individuals deny cannabis use.

    Cannabis Use Disorder

    • Cannabis use disorder is characterized by problematic cannabis use leading to clinically significant impairment or distress.
    • It is often considered a "gateway" drug, with cannabis users having a higher lifetime probability of using other risky substances.
    • Cannabis use disorder is highly comorbid with other substance use disorders, including alcohol, cocaine, and opioids.
    • Cognitive functions, particularly higher executive function, may become compromised in cannabis users with a cumulative dose-dependent relationship.
    • Cannabis withdrawal is characterized by a withdrawal syndrome that develops after the cessation of regular cannabis use.
    • Common symptoms include irritability, depressed mood, anxiety, restlessness, sleep difficulty, decreased appetite, and physical symptoms like abdominal pain, tremors, sweating, fever, chills, or headache.
    • Prevalence estimates of cannabis withdrawal symptoms vary widely, with substantial differences among racial and ethnic groups.
    • Onset typically occurs within 24-48 hours after cessation of use, peaking within 2-5 days and resolving within 1-2 weeks.
    • Cannabis withdrawal can occur in adults and adolescents, and women may experience more severe symptoms than men.
    • Hallucinogen-Related Disorders include disorders related to phencyclidine (PCP) and other hallucinogens.
    • Phencyclidine (PCP) is a dissociative anesthetic that became a street drug in the 1960s.
    • It produces feelings of separation from mind and body, with hallucinogenic effects lasting for weeks and potentially leading to a persistent psychotic episode resembling schizophrenia.
    • Ketamine, another dissociative anesthetic, has been used in the treatment of major depressive disorder.
    • PCP use disorder is characterized by a problematic pattern of use leading to clinically significant impairment or distress, manifesting in various symptoms related to compulsive use, social impairment, and physical health consequences.
    • PCP may be detected in urine for up to 8 days or even longer at very high doses.
    • The prevalence of PCP use disorder is not readily available, but rates appear to be low.
    • Other Hallucinogen Use Disorder (OHMUD) is characterized by a problematic pattern of hallucinogen use leading to clinically significant impairment or distress.
    • It includes symptoms related to impaired control over drug use, social impairment, risky use, and pharmacological symptoms like tolerance.
    • Hallucinogens are substances that produce similar alterations in perception, mood, and cognition, including phenylalkylamines (ecstasy), indoleamines (psilocybin, DMT), and other ethnobotanical compounds like Salvia divinorum.
    • Most OHMUD cases occur among young adults aged 18-29.
    • Risk factors for OHMUD include high sensation-seeking behavior, environmental risk factors, early onset of hallucinogen use, peer use of other drugs, and genetics
    • While hallucinogens have been used in various religious and spiritual practices throughout history, they are also associated with adverse effects, both acute and long-term, including those related to physical health, psychological health, and cognitive functions.

    Phencyclidine Intoxication

    • Highly associated with other hallucinogen use disorders, such as cocaine use disorder, stimulant use disorder, other substance use disorder, tobacco use disorder, personality disorders, PTSD, and panic attacks.
    • Characterized by clinically significant behavioral changes shortly after ingestion of phencyclidine or related substances.
    • Common presentations include disorientation, confusion without hallucinations, nystagmus, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, hyperacusis, and coma of varying severity.
    • Other associated behavioral changes include violent behavior, extreme agitation, persecutory delusions, euphoria, retrograde amnesia, and hypertension.
    • Prevalence of use is rare, with <0.1% of the U.S. population age 12 and older reporting past 12-month use in 2018.
    • Phencyclidine is detectable in urine for up to 8 days following use, although levels are only weakly associated with an individual’s clinical presentation.
    • Creatine phosphokinase and aspartate aminotransferase levels may be elevated.
    • Produces extensive cardiovascular and neurological toxicity.
    • Should be differentiated from intoxication due to other substances, including other hallucinogens, amphetamine, cocaine, or other stimulants; anticholinergics; and benzodiazepine withdrawal.
    • Nystagmus and bizarre and violent behavior may distinguish intoxication due to phencyclidine from that due to other substances.

    Other Hallucinogen Intoxication

    • Reflects clinically significant behavioral or psychological changes that occur shortly after ingestion of a hallucinogen.
    • Duration varies depending on the specific hallucinogen, from minutes (e.g., salvia) to several hours or longer (e.g., LSD or MDMA).
    • Prevalence estimates are not fully known but may be approximated based on the prevalence of use of the substances.
    • In 2018, 1.5% of individuals ages 12-17 years in the United States reported use of hallucinogens in the past year. Rates were consistently higher for boys and men than for girls and women in every age group.
    • A study of more than 135,000 U.S. adults, including more than 19,000 individuals who use psychedelics, did not find evidence that lifetime psychedelic use is an independent risk factor for mental health problems, suicidal thoughts, or suicide attempts.
    • One large U.S. population survey found that a lifetime history of hallucinogen use was associated with lower odds of mental distress and suicidal thoughts or behavior, although a causal relationship cannot be inferred from this study.
    • Can have serious consequences, including perceptual disturbances and impaired judgment, resulting in injuries or fatalities from accidents, physical fights, or unintentional self-injury.
    • When consumed in combination with other drugs, coma can occur, with the duration and profundity of coma greater than when other hallucinogens are taken alone.
    • Continued use of hallucinogens, particularly MDMA, has been linked with neurotoxic effects.
    • Adverse effects include hyperthermia, cardiac tachyarrhythmias, pneumothorax hypernatremia, motor incoordination, nystagmus, restlessness, hallucinations/delusions, mydriasis, increased alertness, and high blood pressure.
    • More serious reactions include renal failure, hepatic failure, seizures, cerebral infarction, rhabdomyolysis, cardiac complications, and hepatotoxicity.
    • Should be differentiated from intoxication with amphetamine-type substances, cocaine, or other stimulants; anticholinergics, inhalants, and phencyclidine.
    • Toxicological tests are useful in making this distinction, and determining the route of administration may also be useful.
    • Other disorders and conditions to be considered include schizophrenia, depression, withdrawal from other drugs (e.g., sedatives, alcohol), certain metabolic disorders (e.g., hypoglycemia), seizure disorders, tumors of the central nervous system, and vascular insults.
    • Distinguished from hallucinogen-induced mental disorders, such as hallucinogen persisting perception disorder, because the symptoms in the latter continue episodically or continuously for weeks or longer after the most recent intoxication.

    Hallucinogen Persisting Perception Disorder

    • Primarily occurs after LSD use, but not exclusively.
    • There does not appear to be a strong correlation between the disorder and the number of occasions of hallucinogen use, with some instances occurring in individuals with minimal exposure to hallucinogens.
    • Some instances may be triggered by use of other substances (e.g., cannabis or alcohol), adaptation to dark environments, exercise, and exposure to noise and photophobia.
    • Associated features include reality testing remaining intact in individuals with the disorder (i.e., the individual is aware that the disturbance is linked to the drug's effect).
    • Prevalence estimates are unknown, with initial prevalence estimates of the disorder among individuals who use hallucinogens being approximately 4.2%.
    • Although there is little evidence regarding risk factors, genetic factors have been suggested as a possible explanation underlying the susceptibility to LSD effects in this condition.
    • Comorbid mental disorders include panic disorder, alcohol use disorder, major depressive disorder, bipolar I disorder, and schizophrenia spectrum disorders.

    Phencyclidine-Induced Mental Disorders

    • Described in other chapters of the manual with disorders with which they share phenomenology, such as phencyclidine-induced psychotic disorder, phencyclidine-induced bipolar and related disorder, phencyclidine-induced depressive disorder, and phencyclidine-induced anxiety disorder.
    • These disorders are diagnosed instead of phencyclidine intoxication only when the symptoms are sufficiently severe to warrant independent clinical attention.
    • Unspecified Phencyclidine-Related Disorder (F16.99) is a category that applies to presentations where symptoms characteristic of a hallucinogen-related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific phencyclidine-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

    Inhalant Use Disorder

    • A condition where an individual is in remission and in a controlled environment, such as closely supervised and substance-free jails, therapeutic communities, and locked hospital units.
    • Severity is assessed by the number of diagnostic criteria endorsed.
    • The changing severity across time is reflected by reductions in the frequency and/or dose used, as assessed by the individual's self-report, report of others, clinician's observations, and biological testing (when practical).
    • Diagnostic features include repeated use of an inhalant substance despite the individual's knowing that the substance is causing serious problems.
    • This can result in missed work or school, continued use even though it causes arguments with family or friends, fights, and other social or interpersonal problems.
    • Limiting family contact, work or school obligations, or recreational activities may also occur.
    • Use of inhalants when driving or operating dangerous equipment is also seen.
    • Tolerance is reported by about 10% of individuals who use inhalants.
    • A diagnosis is supported by recurring episodes of intoxication with negative results in standard drug screens, possession or lingering odors of inhalant substances, peri-oral or peri-nasal "glue-sniffer's rash," association with other individuals known to use inhalants, membership in groups with prevalent inhalant use, easy access to certain inhalant substances, paraphernalia possession, presence of the disorder's characteristic medical complications, and the presence of multiple other substance use disorders.
    • Individuals may present with symptoms of pernicious anemia, subacute combined degeneration of the spinal cord, major or mild neurocognitive disorder, brain atrophy, leukoencephalopathy, and many other nervous system disorders.
    • Prevalence in the United States is highest among non-Hispanic Whites and individuals reporting more than one racialized identity, and lowest among American Indians/Alaska Natives.
    • The declining prevalence after adolescence indicates that the disorder usually remits in early adulthood.
    • Is a serious health issue that can lead to various complications, including addiction, depression, and other health issues.
    • Predictors include sensation seeking and impulsivity, as well as the widespread availability of inhalant gases.
    • Childhood maltreatment or trauma can also contribute to the progression from inhalant non-use to inhalant use disorder.
    • Behavioral disinhibition, a highly heritable propensity to not constrain behavior in socially acceptable ways, breaks social norms and rules, and takes dangerous risks, is a risk factor for youths with strong behavioral disinhibition.
    • Culture-related diagnostic issues exist, with certain isolated Indigenous communities experiencing a high prevalence of inhalant problems internationally.
    • In some low- and middle-income countries, homeless children living on the streets have extensive inhalant use problems due to poverty and the availability and affordability of substances.
    • The disorder is very rare among adult women.
    • Diagnostic markers include urine, breath, or saliva tests, but technical problems and the considerable expense of analyses make frequent biological testing for inhalants impractical.
    • Can be associated with suicidal thoughts and behavior, especially among individuals reporting symptoms of anxiety and depression and histories of trauma.
    • Can result in fatal consequences such as anoxia, cardiac dysfunction, extreme allergic reaction, severe injury to the lungs, vomiting, accidents or injury, or central nervous system depression.
    • Long-term inhalant users are at increased risk for tuberculosis, HIV/AIDS, sexually transmitted diseases, depression, anxiety, bronchitis, asthma, and sinusitis.
    • A diagnosis of inhalant use disorder only applies if the inhalant exposure is intentional.

    Inhalant Intoxication

    • Occurs frequently during inhalant use disorder but may occur among individuals whose use does not meet criteria for inhalant use disorder.
    • Is differentiated from inhalant use disorder and inhalant-induced mental disorders, which describe psychiatric syndromes that develop in the context of heavy use.
    • Inhalant use disorder commonly co-occurs with other substance use disorders, and symptoms may be similar and overlapping.
    • Comorbidity is another significant factor, individuals often have other substance use, mood, anxiety, and personality disorders, and may have comorbid symptoms of hepatic or renal damage, rhabdomyolysis, methemoglobinemia, or symptoms of other gastrointestinal, cardiovascular, or pulmonary diseases.
    • The ICD-10-CM code depends on whether there is a comorbid inhalant use disorder.
    • Is a condition characterized by clinically significant behavioral or psychological changes that develop during or immediately after inhalation of a volatile hydrocarbon substance.
    • The specific substance involved should be named when possible, and intoxication usually occurs in brief episodes that may recur with further inhalant use.
    • Associated features include evidence of possession or lingering odors of inhalant substances, such as glue, paint thinner, gasoline, butane lighters.
    • Other symptoms may include euphoria, relaxation, headache, rapid heartbeat, confusion, talkativeness, blurred vision, amnesia, slurred speech, irritability, nausea, fatigue, burning in eyes or throat, grandiosity, chest pain, auditory or visual hallucinations, and dissociation.
    • Prevalence of actual episodes of inhalant intoxication in the general population is unknown, but it is probable that a majority of inhalant users would at some time exhibit behavioral or psychological changes and symptoms that would meet criteria for inhalant intoxication.
    • In 2017, inhalant use in the past year was reported by 0.6% of all Americans older than 12 years, with the highest prevalence in younger age groups (2.3% for individuals ages 12-17 years, 1.6% for individuals ages 18-25 years, and 0.3% for individuals age 26 and older).
    • Gender differences in the prevalence of inhalant intoxication in the general population are unknown.
    • Regarding gender differences in the prevalence of inhalant use in the United States, 0.8% of boys/men older than 12 years and 0.5% of girls/women older than 12 years have used inhalants in the previous year, but in the younger age groups differences are minimal or girls may have slightly higher prevalence.
    • Functional consequences include unconsciousness, anoxia, death, sudden sniffing death, enhanced toxicity of certain volatile inhalants, and persistent medical and neurological problems.
    • Clinically significant correlates include reckless behaviors, antisocial behaviors, and serious accidents.
    • Inhalant intoxication is distinguished from inhalant-induced mental disorders (e.g., inhalant-induced anxiety disorder, with onset during intoxication) because the symptoms in these latter disorders are in excess of those usually associated with inhalant intoxication, predominate in the clinical presentation, and are severe enough to warrant independent clinical attention.
    • Numerous neurological and other medical conditions may produce the clinically significant behavioral or psychological changes that also characterize inhalant intoxication.
    • Opioids are a class of drugs that are prescribed as analgesics, anesthetics, antidiarrheal agents, or cough suppressants.
    • Often taken in larger amounts or over a longer period than intended, with persistent desire or unsuccessful efforts to cut down or control opioid use.
    • A great deal of time is spent in activities necessary to obtain the opioid, use it, or recover from its effects.
    • Recurrent opioid use resulting in failure to fulfill major role obligations at work, school, or home, continued opioid use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids, and continued opioid use in situations where it is physically hazardous.

    Opioid Use Disorder

    • Tolerance: A need for more opioids to achieve the desired effect or a diminished effect with continued use of the same amount. This criterion does not apply to individuals taking opioids under medical supervision.
    • Withdrawal: Manifested by opioid withdrawal syndrome or using opioids to relieve withdrawal symptoms.
    • Severity: Mild, moderate, or severe.
    • Opioids: Include natural opioids like morphine and codeine, semisynthetics like heroin and oxycodone, and synthetics with morphine-like action.
    • Heroin: Commonly misused, typically injected, but can be smoked or snorted.
    • Fentanyl: Typically injected, both medically and nonmedically, and used in transdermal and transmucosal formulations.
    • Prescription Opioids: Can result in opioid use disorder alongside illicit opioids like heroin and fentanyl.
    • Compulsive Use: Characterized by prolonged self-administration of opioids for non-medical purposes.
    • Conditioned Responses to Drug-Related Stimuli: Contribute to relapse and are difficult to extinguish.
    • Patterns of Compulsive Use: Lead to daily activities being planned around obtaining and administering opioids.
    • Opioid Overdoses: Increased exponentially in the United States since 1999.
    • Heroin Overdoses: Becoming more prevalent since 2010.
    • Prevalence: 4.1%–4.7% in adults ages 18 and older, higher in 18-25 than in 26 and older.
    • Prevalence in Adolescents: 2.8%–3.9% nonmedical prescription opioid use in ages 12-17, higher in older adolescents than in younger adolescents.
    • Heroin Use in Adolescents: Low (< 0.05%–0.1%).
    • Opioid Use Disorder Prevalence: 0.6%–0.9% in adults 18 and older.
    • Heroin Use Disorder Prevalence: 0.1%–0.3% in adults 18 and older.
    • Opioid Use Disorder Prevalence in Adolescents: 0.4% for prescription opioids, rare for heroin.
    • Prevalence by Ethnoracial Group: Rates vary – Native Americans (1.42%), African Americans (1.04%), non-Latinx Whites (0.96%), Latinx (0.70%), Asian Americans or Pacific Islanders (0.16%).
    • Association with Other Substance Use Disorders: Highly associated with other substance use disorders, especially tobacco, alcohol, cannabis, stimulants, and benzodiazepines.
    • Externalizing Traits: Opioid use disorder highly associated with externalizing traits like novelty-seeking, impulsivity, and disinhibition.
    • Risk Factors: Family, peer, and social environmental factors increase the risk for opioid use disorder.
    • Genetic Contribution: Strong genetic contribution to the risk for opioid use disorders.
    • Culture-Related Issues: Individuals from socially oppressed ethnoracial groups have historically been overrepresented, but the prevalence has become more common among White individuals due to widespread opioid availability and other social factors.
    • Gender Differences: Women are more likely to initiate opioid use in response to sexual abuse and violence, introduced by a partner, and progress to use disorder more quickly than men.
    • Diagnostic Markers: Urine toxicology tests remain positive for most opioids for 12–36 hours after administration. Some opioids like fentanyl and oxycodone are not detected by standard tests but can be identified by specialized procedures.
    • Lab Evidence: Presence of other substances like cocaine, marijuana, alcohol, amphetamines, and benzodiazepines is common in heroin users.
    • Hepatitis A, B, and C: Often positive in injection opioid users.
    • Elevated Liver Function Tests: Common due to resolving hepatitis or toxic injury.
    • HIV: Prevalent in injection opioid users.
    • Suicide Risk: Opioid use disorder associated with a heightened risk for suicide attempts and suicide.
    • Suicide Attempts and Suicide: May be associated with severe depressions, either temporary or intense enough to lead to suicide attempts.
    • Differentiation of Overdose and Attempted Suicide: Can be difficult but should not be mistaken for each other.
    • Suicide as a Cause of Death: Common among regular opioid users, possibly undercounted or misclassified in opioid-poisoning data.
    • Suicide Mortality Risk: Elevated risk for suicide mortality among individuals with opioid use disorder.
    • Infections: Can occur in other organs, including bacterial endocarditis, hepatitis, and HIV infection.
    • Hepatitis C Prevalence: Up to 90% in individuals who inject opioids.
    • HIV Prevalence: High among individuals who inject drugs, many with opioid use disorder.
    • Tuberculosis: Particularly serious problem among individuals who use drugs intravenously, especially heroin.
    • Mortality Rate: 6-20 times higher than the general population.
    • Fatal Overdoses: Due to prescription opioids increasing dramatically in the United States since 1999.
    • Heroin Overdose Increase: Sharp increase in fatal overdoses due to heroin since 2010.
    • Synthetic Opioid Overdose Increase: Fatal overdoses due to synthetic opioids have almost doubled the rates for prescription opioid or heroin overdoses by 2017.
    • Nonfatal Overdoses: Resulting in hospitalization and emergency department visits have also increased.
    • Differentiation from Opioid Intoxication, Withdrawal, and Opioid-Induced Mental Disorders: Opioid use disorder describes a problematic pattern of opioid use that involves impaired control over opioid use, social impairment, risky opioid use, and pharmacological symptoms. Intoxication, withdrawal, and opioid-induced mental disorders describe psychiatric syndromes that occur in the context of heavy use.
    • Alcohol and Sedative Intoxication: Similarities to opioid intoxication, but pupillary constriction and response to naloxone challenge can differentiate.
    • Opioid Withdrawal Symptoms: Resemble symptoms seen in sedative-hypnotic withdrawal but are accompanied by rhinorrhea, lacrimation, and pupillary dilation.
    • Other Substance Use Disorders: Opioid use disorder is often associated with other substance use disorders.
    • Depressive Disorder: Individuals with opioid use disorder are at risk for persistent depressive disorder or major depressive disorder.

    Opioid Withdrawal

    • Occurs when an individual stops using opioids for pain management, medical management of pain, opioid agonist therapy, illicit use, or attempts to self-treat symptoms of mental disorders with opioids.
    • ICD-10-CM Codes: F11.13 (mild opioid use disorder), F11.23 (moderate or severe opioid use disorder), F11.93 (absence of opioid use disorder).
    • Diagnostic Features: Presence of a characteristic withdrawal syndrome after cessation of prolonged opioid use.
    • Opioid Antagonist Administration: Can precipitate withdrawal after a period of opioid use.
    • Opioid Partial Agonist Administration: Can precipitate withdrawal in an individual currently using a full opioid agonist.
    • Characteristic Symptoms: Anxiety, restlessness, achy feeling, irritability, increased sensitivity to pain, dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, increased sweating, diarrhea, yawning, fever, insomnia.
    • Piloerection and Fever: Associated with more severe withdrawal and not often seen in routine clinical practice.
    • Clinically Significant Distress or Impairment: Symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • Distinction from Opioid Addiction or Use Disorder: Opioid withdrawal does not necessarily require drug-seeking behaviors.
    • Gender Differences: Males may experience piloerection, sweating, and spontaneous ejaculations.
    • Speed and Severity: Depend on the half-life of the opioid used.
    • Short-Acting Opioids: Symptoms begin within 6-12 hours after the last dose.
    • Long-Acting Opioids: Symptoms take 2-4 days to emerge.
    • Chronic Symptoms: Anxiety, dysphoria, anhedonia, craving, insomnia, can last for weeks to months.
    • Course of Withdrawal: Can be part of an escalating pattern in which an opioid is used to reduce withdrawal symptoms, leading to recurrent episodes.

    Opioid Use Disorder and Withdrawal Comorbidity

    • Opioid Use Disorder and Withdrawal can be comorbid.
    • Comorbid Disorders: Opioid-induced depressive disorder, anxiety disorder, sleep disorder, and sexual dysfunction.
    • Unspecified Opioid-Related Disorders: Symptoms characteristic of an opioid-related disorder cause distress but do not meet the full criteria for a specific opioid-related disorder.

    Sedative-, Hypnotic-, or Anxiolytic-Related Disorders

    • Problematic Pattern of Use: Leads to clinically significant impairment or distress.
    • Diagnostic Criteria: At least two of the following:
      • Taking sedatives, hypnotics, or anxiolytics in larger amounts or over a longer period than intended.
      • Persistent desire or unsuccessful efforts to cut down or control sedative use.
      • Spending a great deal of time obtaining, using, or recovering from sedative effects.
      • Craving or strong desire to use sedatives.
      • Recurrent use resulting in failure to fulfill major role obligations.
      • Continued use despite persistent or recurrent social or interpersonal problems caused by use.
      • Giving up or reducing important activities because of use.
      • Recurrent use in hazardous situations.
      • Continued use despite knowledge of having a persistent or recurrent physical or psychological problem caused by use.
    • Substances Included: Benzodiazepines, benzodiazepine-like drugs, carbamates, barbiturates, and barbiturate-like hypnotics.
    • Prescription vs. Illegal Use: Available both by prescription and illegally.
    • Craving: Typical feature of sedative, hypnotic, or anxiolytic use disorder.
    • Misuse with Other Substances: May occur in conjunction with other substances.
    • Consequences of Misuse: Repeated absences, poor work performance, school absences, suspensions or expulsions, neglect of children or household, limited contact with family or friends, avoiding work or school, or stopping participation in hobbies, sports, or games.
    • Tolerance and Withdrawal: Very significant levels can develop.
    • Inappropriate Prescription and Use: Must be determined when an individual abruptly discontinues long-term benzodiazepine use at prescribed doses.
    • Severity: Based on the number of criteria endorsed.
    • Association with Other Substance Use Disorders: Often associated with other substance use disorders like alcohol, cannabis, opioid, and stimulant use disorders.
    • Tolerance and Respiratory Depression: Tolerance develops to sedative effects, leading to higher doses and potential for respiratory depression and hypotension.
    • Prevalence: 0.3% among adolescents aged 12-17 years and adults aged 18 years and older.
    • Prevalence by Age: Decreases as a function of age, with the greatest prevalence among individuals aged 18-29 years (0.5%) and the lowest among individuals 65 years and older (0.04%).
    • Usual Course: Individuals in their teens or 20s escalate occasional use to the point at which they develop problems that meet criteria for a diagnosis.

    Sedative, Hypnotic, or Anxiolytic Use Disorder

    • There are two primary clinical courses associated with this disorder.
      • One starts with intermittent social use and progresses to daily use and high tolerance, followed by interpersonal issues, cognitive problems, and withdrawal.
      • The other occurs when individuals use benzodiazepine prescribed for anxiety, insomnia, or physical concerns. As they become tolerant or need higher doses, they seek multiple physicians for more prescriptions.
    • The disorder typically begins during adolescence or early adulthood.
    • The risk for misuse and disorder decreases with age after 30, but side effects of these medications increase with age. Cognitive impairment and slower metabolism of sedatives increase as people age.
    • The disorder can be diagnosed via urine and blood tests. In the US, benzodiazepines are more commonly reported by non-Hispanic Whites than other races.
    • There is no gender difference in the prevalence of the disorder.
    • Urine tests show positive for long-acting drugs such as diazepam or flurazepam for up to a week.
    • Studies in the US show a link between hypnotics and suicide, but it's unclear if this is due to underlying conditions such as depression and insomnia.
    • Functional consequences of the disorder are similar to alcohol use, including disinhibited behavior, accidents, interpersonal difficulties, and work/school performance interference.
    • These agents can lead to aggressive behavior, arguments, and fights, resulting in legal and interpersonal problems.
    • Physical examination may reveal slowed pulse, decreased respiratory rate, and slight blood pressure drop.
    • Acute intoxication can cause accidental injuries and vehicle accidents.
    • Long-term use, even at prescribed doses, can increase the risk of cognitive issues and falls in older adults.
    • The link between these medications and increased risk for major neurocognitive disorder remains unclear.
    • High doses can be lethal, especially when mixed with other central nervous system depressants like opioids or alcohol. Intravenous use can lead to complications from contaminated needles.
    • The disorder must be differentiated from intoxication, withdrawal, substance-induced mental disorders, and alcohol use disorder, which is diagnosed primarily based on clinical history.
    • Many individuals taking benzodiazepines as prescribed for medical reasons don't meet diagnostic criteria for the disorder because their use isn't problematic or interfering with their lives.
    • Nonmedical use is linked to alcohol use disorder, tobacco use disorder, and illicit drug use.
    • The disorder may overlap with antisocial personality disorder, depressive, bipolar, and anxiety disorders, and other substance use disorders. Antisocial behavior and antisocial personality disorder are particularly linked to the disorder when illegal substances are used.
    • Comorbidity with other substance use disorders and psychiatric disorders increases the risk of progressing to the disorder and decreases the likelihood of remission.

    Sedative, Hypnotic, or Anxiolytic Intoxication

    • Diagnostic criteria include recent use of sedative, hypnotic, or anxiolytic with clinically significant maladaptive behavioral or psychological changes.
    • Signs or symptoms during or shortly after use include slurred speech, incoordination, unsteady gait, nystagmus, impaired cognition (attention & memory), stupor, or coma.
    • Memory impairment is a key feature and often resembles "alcoholic blackouts," which can be distressful.
    • Symptoms shouldn't be due to medical conditions or other mental disorders.
    • Intoxication can happen with prescribed medications, borrowed medication, or intentional use for intoxication.
    • Individuals may take more medication than prescribed, use various medications, or mix with alcohol, increasing the effects.
    • Prevalence is unknown, but it's likely many nonmedical users have experienced symptoms meeting the criteria for intoxication.
    • Differentiation from Alcohol Use Disorder requires evidence of sedative, hypnotic, or anxiolytic medication use through self-report, informant report, or toxicology testing.
    • Lower doses can be intoxicating in cases of cognitive impairment, traumatic brain injury, or delirium from other causes.

    Sedative, Hypnotic, or Anxiolytic Withdrawal

    • This condition develops after several weeks or more of regular use when there's a decrease in intake.
    • Symptoms include autonomic hyperactivity, hand tremor, insomnia, nausea, vomiting, transient visual/tactile/auditory hallucinations or illusions, psychomotor agitation, anxiety, and grand mal seizures.
    • These symptoms cause significant distress or impairment.
    • The symptoms shouldn't be due to medical conditions or other mental disorders.
    • Relief of symptoms with administration of sedative-hypnotic agents supports the diagnosis.
    • The withdrawal syndrome varies based on the substance and its pharmacokinetics/pharmacodynamics. Shorter-acting substances can begin within hours, while longer-acting substances may not start for 1-2 days or longer.
    • The time course is generally predicted by the substance's half-life.
    • The length of substance use and dosage influence the severity of withdrawal. Withdrawal can occur with as little as 15mg of diazepam daily for months.
    • Higher doses, like 40mg of diazepam or equivalent, are more likely to cause significant withdrawal symptoms, and even higher doses can cause seizures or delirium.

    Sedative, Hypnotic, or Anxiolytic Withdrawal Delirium

    • Characterized by disturbances in consciousness and cognition, with visual, tactile, or auditory hallucinations.
    • Prevalence is unknown.
    • Diagnostic markers include seizures and autonomic instability in the context of prolonged exposure to these medications.
    • Alcohol withdrawal shares similarities but doesn't include the most extreme manifestations, like delirium tremens or true seizures.
    • Include stimulant use disorder, stimulant intoxication, and stimulant withdrawal.
    • Diagnostic criteria for use disorder include a pattern of amphetamine-type substance, cocaine, or other stimulant use resulting in significant impairment or distress, as manifested by at least one of the following:
      • Taking more than intended
      • Persistent desire or unsuccessful attempts to reduce use
      • Significant time spent obtaining, using, or recovering from stimulant use
      • Craving or strong urge to use
      • Recurrent use leading to failure to fulfill role obligations at work, school, or home
      • Continued use despite social or interpersonal problems caused by the stimulant
      • Giving up important activities due to use
      • Recurrent use in hazardous situations
      • Continued use despite knowing it is linked to physical or psychological problems
      • Tolerance
      • Withdrawal
    • Early remission means no criteria met for at least 3 months but less than 12 months.
    • Sustained remission means no criteria met for a period of 12 months or longer.
    • This chapter looks at stimulants, which are psychoactive substances that increase brain activity and can temporarily elevate alertness, mood, and awareness.
    • Stimulants covered include amphetamine, prescription stimulants like methylphenidate, and methamphetamine.
    • Amphetamine-related disorders and cocaine-related disorders are grouped under "stimulant-related disorders." They have different ICD-10-CM codes.
    • These substances include stimulants with a substituted phenylethylamine structure, such as amphetamine, dextroamphetamine, and methamphetamine. Also included are substances with different structures but similar effects, such as methylphenidate, modafinil, and armodafinil.
    • Routes of administration include oral, intravenous, and nasal (methamphetamine).
    • Cocaine is a naturally occurring substance produced by the coca plant. It is consumed in various preparations with varying potency and speed of onset.
    • Cocaine hydrochloride powder is usually snorted or injected intravenously. Crack is easily vaporized and inhaled, leading to rapid onset of effects.
    • Individuals exposed to amphetamine or cocaine can develop use disorder in as little as a week.
    • Tolerance occurs with repeated use, regardless of administration route.
    • Withdrawal symptoms, particularly increased sleep, appetite, and dysphoria, can occur and increase craving.
    • Most individuals with use disorder experience tolerance or withdrawal.
    • Usage patterns and course are similar for amphetamine and cocaine disorders due to their similar psychoactive and sympathetic effects.
    • Amphetamine is longer-acting than cocaine and used less frequently per day.
    • Usage can be chronic or episodic, with binges between periods of non-use.
    • Aggressive or violent behavior is common with high doses smoked, ingested, or administered intravenously.
    • Intense temporary anxiety similar to panic disorder is seen with high-dose use.
    • Withdrawal is associated with temporary but intense depressive symptoms that can resemble major depressive episodes, which typically resolve within a week.
    • Tolerance to amphetamine-type substances develops, leading to dosage escalation. Some users experience sensitization, where effects are enhanced.
    • Associated features of stimulants include feelings of well-being, confidence, and euphoria when injected or smoked.
    • Dramatic behavioral changes, including chaotic behavior, social isolation, aggressive behavior, and sexual dysfunction, can quickly develop with use disorder.
    • Temporary depressive symptoms may meet criteria for major depressive episodes. Some individuals develop conditioned responses to drug-related stimuli.
    • Stimulant use disorder is prevalent in the US, with an average age of 23 years for primary methamphetamine treatment admissions and 44 years for cocaine treatment admissions.
    • Some individuals use stimulants to control weight or improve performance.
    • Initial use may involve obtaining prescribed methylphenidate or amphetamine salts for people with attention-deficit/hyperactivity disorder.
    • Patterns of administration include episodic or daily use, binges, chronic daily use, and intravenous use.
    • Rapid progression to severe-level use can occur within weeks to months, while intravenous and oral use lead to more gradual progression.
    • With continued use, pleasurable effects decrease due to tolerance, and dysphoric effects increase.

    Risk Factors For Stimulant Use Disorder

    • Comorbid bipolar disorder, schizophrenia, antisocial personality disorder, and other substance use disorders are risk factors for developing stimulant use disorder and relapse to cocaine use.
    • Higher stress reactivity is associated with increased frequency of cocaine use in some U.S. treatment samples.
    • Conduct disorder in childhood and antisocial personality disorder are linked to the development of stimulant-related environmental disorders.
    • In the United States, prior use of other substances, being male, having a Cluster B personality disorder, family history of substance use disorder, and being separated, divorced, or widowed all increase the risk of cocaine use.
    • Men who have sex with men have a higher risk of methamphetamine use.
    • Predictors of cocaine use among U.S. teenagers include prenatal cocaine exposure, postnatal cocaine use by parents, and exposure to community violence during childhood.
    • Research in industrialized countries indicates that exposure to intimate partner violence or childhood mistreatment frequently occurs alongside stimulant use, particularly in women.
    • Socioeconomic status, including food insecurity, has a dose-dependent effect on the risk of stimulant use.
    • For youth, especially girls, risk factors include living in an unstable home environment, having a psychiatric condition, criminal behavior, and associating with dealers and users.
    • The prevalence of cocaine use in the United States increased between 2001-2002 and 2012-2013 among non-Latinx Whites, African Americans, and Latinx, but the prevalence of cocaine use disorder increased only among Whites.
    • Approximately 64% of individuals admitted to publicly funded substance abuse treatment programs for primary methamphetamine/amphetamine-related disorders are non-Hispanic White, followed by 20% of Hispanic origin, 3% Asian and Pacific Islander, and 6% non-Hispanic Black.

    Stimulant Use Disorder and Suicide

    • Stimulant use disorders are associated with increased suicide mortality rates.
    • A systematic review revealed that regular or problematic amphetamine use is linked to increased suicide mortality.
    • A general population study of adults in the United States found an association between prescription stimulant use disorder and suicidal thoughts.
    • In a study of individuals admitted to substance use treatment, those with cocaine use disorder were significantly more likely to report suicidal thoughts compared to those with other substance use disorders.
    • A study of both men and women in the U.S. Veterans Administration healthcare system found that 639 cocaine and amphetamine use disorders were associated with increased rates of suicide deaths.

    Medical Complications of Stimulant Use

    • Various medical conditions can occur depending on the route of administration, including sinusitis, irritation, bleeding of the nasal mucosa, and a perforated nasal septum.
    • Individuals who smoke stimulants are at increased risk of respiratory problems, such as coughing, bronchitis, and pneumonitis.
    • The risk of HIV and hepatitis C infection increases with frequent intravenous injections and unsafe sexual activity.
    • Other sexually transmitted diseases, hepatitis B, tuberculosis, and other lung infections are also observed.
    • Weight loss and malnutrition are common.
    • Stimulant intoxication, stimulant withdrawal, and stimulant-induced mental disorders are frequent among both methamphetamine and cocaine users.
    • Neurocognitive impairment is common among both users, including deficits related to attention, impulsivity, verbal learning/memory, working memory, and executive functioning.
    • Transient psychosis and seizures have also been reported with chronic use of either cocaine or methamphetamine, possibly related to patterns of use or the exacerbation of preexisting vulnerabilities.

    Diagnosing Stimulant Use Disorder

    • Stimulant use disorder is distinguished from stimulant intoxication, stimulant withdrawal, and stimulant-induced mental disorders (e.g., stimulant-induced depressive disorder).
    • Stimulant use disorder describes a problematic pattern of stimulant use involving impaired control over stimulant use, social impairment attributable to stimulant use, risky stimulant use (e.g., continued stimulant use despite medical complications), and pharmacological symptoms (the development of tolerance or withdrawal).
    • Stimulant intoxication, stimulant withdrawal, or stimulant-induced mental disorders occur frequently in individuals with stimulant use disorder.
    • Stimulant-related disorders often co-occur with other substance use disorders, especially those involving substances with sedative properties.
    • Individuals admitted to treatment for cocaine use are likely to also use heroin, PCP, or alcohol, and those admitted for amphetamine-type substance use disorder are likely to use marijuana, heroin, or alcohol.
    • Stimulant use disorder may be associated with posttraumatic stress disorder, antisocial personality disorder, attention deficit/hyperactivity disorder, and gambling disorder.
    • Cardiopulmonary problems are often present in individuals seeking treatment for cocaine-related problems, with chest pain being the most common.

    Stimulant Intoxication

    • Stimulant intoxication is a condition characterized by clinically significant behavioral or psychological changes that develop during or shortly after the use of stimulants, such as amphetamine-type substances, cocaine, or other stimulants.
    • These changes can include euphoria, affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, or anger, stereotyped behaviors, and impaired judgment.
    • The ICD-10-CM code depends on whether the stimulant is an amphetamine-type substance, cocaine, or other stimulant, whether there is a comorbid amphetamine-type substance or other stimulant use disorder, and whether or not there are perceptual disturbances.
    • Diagnostic features of stimulant intoxication include auditory hallucinations, paranoid ideation, and the presence of two or more signs or symptoms that develop during or shortly after stimulant use.
    • Intoxication, either acute or chronic, is often associated with impaired social or occupational functioning.
    • Severe intoxication can lead to convulsions, cardiac arrhythmias, hyperpyrexia, and death.
    • For the diagnosis of stimulant intoxication to be made, the symptoms must not be attributable to another medical condition and are not better explained by another mental disorder.
    • While stimulant intoxication occurs in individuals with stimulant use disorders, intoxication is not a criterion for stimulant use disorder, which is confirmed by the presence of two of the 11 diagnostic criteria for use disorder.
    • The magnitude and direction of behavioral and physiological changes depend on many variables, including the dose used and the characteristics of the individual using the substance or the context (e.g., tolerance, rate of absorption, chronicity of use, context in which taken).
    • Stimulant effects such as euphoria, increased pulse and blood pressure, and psychomotor activity are most commonly seen, while depressant effects such as sadness, bradycardia, decreased blood pressure, and decreased psychomotor activity are less common and generally emerge only with chronic high-dose use.
    • The prevalence of stimulant intoxication is not known, but it can be used as a proxy for the likelihood of stimulant use.
    • In the United States, the estimated 12-month prevalence of cocaine use is 2.2% for individuals aged 12 and older, with 3% of men/boys and 1.4% of women/girls using cocaine in the last 12 months.
    • Twelve-month prevalence of cocaine use is 2.3% among Whites, 2.2% among Hispanics, 1.7% among African Americans, and 1% among Asian Americans.
    • The estimated 12-month prevalence of methamphetamine use in the United States is 0.6% for individuals aged 12 and older, with 0.8% among men/boys and 0.4% among women/girls.
    • Twelve-month prevalence of methamphetamine use is 0.7% among Whites, 0.6% among Hispanics, 0.2% among African Americans, and 0.1% among Asian Americans.
    • Stimulant intoxication is distinguished from stimulant-induced mental disorders (e.g., stimulant-induced anxiety disorder, with onset during intoxication) because the symptoms in the latter disorders are in excess of those usually seen in stimulant intoxication, predominate in the clinical presentation, and meet full criteria for the relevant disorder.
    • Salient mental disturbances associated with stimulant intoxication should be distinguished from the symptoms of schizophrenia, bipolar and depressive disorders, generalized anxiety disorder, and panic disorder.
    • Comorbidity is important in understanding the typical overlap of stimulant intoxication with stimulant use disorder.
    • The ICD-10-CM code depends on whether the stimulant is an amphetamine-type substance, cocaine, or other stimulant, and whether or not there is a comorbid amphetamine-type substance, cocaine, or other stimulant use disorder.

    Stimulant Withdrawal

    • If mild amphetamine-type substance or other stimulant use disorder is comorbid, the ICD-10-CM code is F15.13.
    • For amphetamine-type substance or other stimulant withdrawal occurring in the absence of amphetamine-type substance or other stimulant use disorder, the ICD-10-CM code is F15.93.
    • Diagnostic features of stimulant withdrawal include the presence of a characteristic withdrawal syndrome that develops within a few hours to several days after the cessation of prolonged stimulant use.
    • The withdrawal syndrome is characterized by the development of dysphoric mood accompanied by two or more physiological changes: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation.
    • Bradycardia is often present and is a reliable measure of stimulant withdrawal.
    • Anhedonia and drug craving can also be present but are not part of the diagnostic criteria.
    • Acute withdrawal symptoms, such as "crashing" or other forms of stimulant withdrawal, are often seen after periods of repetitive high-dose use.
    • Depressive symptoms with suicidal thoughts or behavior can occur and are generally the most serious problems seen during "crashing" or other forms of stimulant withdrawal.
    • Stimulant withdrawal is distinguished from stimulant-induced mental disorders (e.g., stimulant-induced depressive disorder, with onset during withdrawal) because the symptoms in these latter disorders are in excess of those usually associated with stimulant withdrawal, predominate in the clinical presentation, and are severe enough to warrant clinical attention.
    • Comorbidity is another factor that may be encountered when stimulant withdrawal is distinguished from stimulant use disorder.

    Stimulant-Induced Mental Disorders

    • Stimulant-Induced Mental Disorders, such as cocaine-related and other stimulant-induced mental disorders, are described in other chapters of the manual with disorders with which they share phenomenology.
    • These stimulant-induced mental disorders are diagnosed instead of stimulant intoxication or stimulant withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
    • Unspecified Stimulant-Related Disorder applies to presentations in which symptoms characteristic of a stimulant-related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific stimulant-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
    • The ICD-10-CM code depends on whether the stimulant is an amphetamine-type substance, cocaine, or other stimulant.
    • The ICD-10-CM code for an unspecified amphetamine-type substance or other stimulant–related disorder is F15.99.
    • Tobacco-Related Disorders include tobacco use disorder, tobacco withdrawal, tobacco-induced mental disorders, and unspecified tobacco-related disorders.
    • Diagnostic criteria for tobacco use disorder include a problematic pattern of tobacco use leading to clinically significant impairment or distress, persistent desire or unsuccessful efforts to cut down or control tobacco use, significant time spent in activities necessary to obtain or use tobacco, craving, recurrent tobacco use resulting in failure to fulfill major role obligations, continued tobacco use despite persistent or recurrent social or interpersonal problems caused or exacerbated by tobacco, tolerance, withdrawal, and maintenance therapy.
    • If a tobacco withdrawal or tobacco-induced sleep disorder is also present, the comorbid tobacco use disorder is indicated in the 4th character of the tobacco-induced disorder code.
    • For example, if there is comorbid tobacco-induced sleep disorder and tobacco use disorder, only the tobacco-induced sleep disorder code is given, with the 4th character indicating whether the comorbid tobacco use disorder is moderate or severe.
    • Tobacco use disorder is a condition that can develop with the use of various forms of tobacco, including cigarettes, chewing tobacco, snuff, pipes, cigars, electronic nicotine delivery devices (e-cigarettes), and prescription nicotine-containing medications.
    • The name of this substance category was changed from "nicotine" in prior editions of the DSM to "tobacco" in DSM-5 due to the harms from addiction being associated mostly with tobacco and much less with nicotine.
    • Tobacco use disorder is common among individuals who use cigarettes and smokeless tobacco daily, is less common among those who use e-cigarettes, and is uncommon among those who do not use tobacco daily or use nicotine medications.
    • Tolerance to tobacco is exemplified by the disappearance of nausea and dizziness after intake and by a more intense effect of tobacco the first time it is used during the day.
    • Cessation of tobacco use can produce a well-defined withdrawal syndrome.
    • Many individuals with tobacco use disorder use tobacco to relieve or avoid withdrawal symptoms, such as after being in a situation where use is restricted.
    • Many individuals with tobacco use disorder have tobacco-related physical symptoms or diseases and continue to smoke.
    • The large majority report craving when they do not smoke for several hours.
    • Spending excessive time using tobacco can be exemplified by chain-smoking.
    • Because tobacco sources are readily and legally available, spending a great deal of time attempting to procure tobacco or recovering from its effects is uncommon.
    • Giving up important social, occupational, or recreational activities can occur when an individual forgoes an activity because it occurs in tobacco use-restricted areas.
    • Associated features of tobacco use disorder include smoking within 30 minutes of waking, smoking daily, smoking more cigarettes per day, and waking at night to smoke.
    • Environmental cues can evoke craving and withdrawal.
    • Serious medical conditions often occur, including lung and other cancers, cardiac and pulmonary disease, perinatal problems, cough, shortness of breath, and accelerated skin aging.
    • The 12-month prevalence of DSM-5 tobacco use disorder in the United States in 2012-2013 was 20% among adults age 18 years and older, 29.6% among Native Americans, 22.3% among non-Latinx Whites, 20.1% among African Americans, 12.2% among Latinx, and 11.2% among Asian Americans and Pacific Islanders.
    • Prevalence was higher among men, those who were young, unmarried, less educated, poor, or residing in the southern United States, and those with almost any psychiatric disorder.
    • The prevalence among current daily smokers is approximately 50%.
    • Nondaily smoking has become more prevalent in the United States since the late 1990s, particularly among individuals aged 18-34 years, Blacks, Hispanics, and those with at least a college education.
    • Risk factors for tobacco use include externalizing personality traits, children with attention-deficit/hyperactivity disorder or conduct disorder, adults with depressive, bipolar, anxiety, personality, psychotic, or other substance use disorders, low incomes and low educational levels, and genetic factors contributing to the onset of tobacco use, continuation of tobacco use, and development of tobacco use disorder.
    • Culture-related diagnostic issues include acceptance of tobacco use varying across cultural contexts, with age-standardized prevalence of daily tobacco smoking ranging from 4.7% in Western Sub-Saharan Africa to 24.2% in Eastern Europe.
    • Prevalence of tobacco use in the United States varies by age, gender, and ethnoracial background, with lower rates of smoking onset and progression to daily smoking among Black youth, especially young women.
    • Liver enzyme polymorphisms that vary across ethnoracial groups can affect nicotine metabolism, contributing to variation in smoking behavior.
    • Higher tobacco use disorder prevalence is also associated with exposure to racism and ethnic discrimination.

    Tobacco Use Disorder: Sex and Gender Factors

    • The ratio of men to women among U.S. smokers is approximately 1.4:1, which has been stable between 2004 and 2014.
    • The literature suggests that negative reinforcement is a greater motivator in women than in men.
    • Menstrual cycle effects on smoking are found inconsistently, but tobacco withdrawal appears worse in the luteal phase of the cycle.
    • Pregnant females smoke at a lower rate than nonpregnant females but relapse back to smoking rapidly after delivery.

    Tobacco Use Disorder: Diagnostic Markers

    • Diagnostic markers such as carbon monoxide in the breath and nicotine and its metabolite cotinine in blood, saliva, or urine are weakly associated with tobacco use disorder.
    • Past-year cigarette use is associated with a two- to threefold increased risk of suicidal thoughts and behavior, with earlier age at first tobacco use increasing risk.
    • Medical consequences of tobacco use often begin when users are in their 40s and become progressively more debilitating over time.
    • Smoking is a common cause of various medical conditions, including cardiovascular illnesses, chronic obstructive pulmonary disease, cancers, and perinatal problems.
    • It also increases the prevalence of major depressive disorder, which is almost twice as high in individuals with depression.
    • Psychiatric comorbidities associated with smoking include alcohol and other substance, depressive, bipolar, anxiety, personality, and attention-deficit/hyperactivity disorders.
    • In the United States, individuals with a psychiatric disorder are three times more likely than others to have tobacco use disorder.

    Tobacco Withdrawal

    • Tobacco withdrawal is diagnosed by the ICD-10-CM code F17.203, which indicates the comorbid presence of a moderate or severe tobacco use disorder.
    • Withdrawal symptoms impair the ability to stop tobacco use, and they are largely due to nicotine deprivation.
    • Symptoms are more intense among individuals who smoke cigarettes and also use smokeless tobacco or electronic cigarettes daily.
    • Abstinence from tobacco can produce clinically significant mood changes and functional impairment.
    • The most commonly endorsed signs and symptoms are anxiety, irritability, and difficulty concentrating.
    • The least commonly endorsed symptoms are depression and insomnia.
    • Tobacco withdrawal usually begins within 24 hours of stopping or cutting down tobacco use, peaks at 2-3 days after abstinence, and usually lasts 2-3 weeks.

    Tobacco Withdrawal

    • Prolonged withdrawal symptoms beyond 1 month can occur, but are uncommon.
    • Smokers with mental health conditions like depression, bipolar disorder, anxiety disorders, ADHD, and substance use disorders are more prone to severe withdrawal.
    • Genetics influence the likelihood of withdrawal upon quitting.
    • Tests for nicotine metabolites like cotinine in bodily fluids can help diagnose withdrawal.
    • Withdrawal can cause significant distress and functional impairment in a minority of smokers.
    • Withdrawal can make it difficult to stop or control tobacco use. Rare cases link withdrawal with the development or recurrence of mental health disorders.
    • Tobacco withdrawal symptoms often overlap with other substance withdrawal syndromes.
    • Admission to smoke-free units can induce withdrawal symptoms that may mimic or intensify other conditions or medication side effects.
    • This category applies to substances not included in the 9 main substance classes (alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants, or tobacco).
    • These substances include anabolic steroids, nonsteroidal anti-inflammatory drugs, corticosteroids, antiparkinsonian medications, antihistamines, nitrous oxide, amyl-, butyl-, or isobutyl-nitrites, betel nut, and kava.
    • Unknown substance-related disorders are linked to unidentified substances or new market drugs.
    • Substances belonging to a known category should be coded within that category, not under "other substance."
    • A diagnosis of other (or unknown) substance use disorder is supported by reported use of an unlisted substance, frequent intoxication with negative drug screens, or symptoms characteristic of an unidentified substance.
    • The prevalence of most other (or unknown) substance use disorders is likely lower than those involving known substance classes.
    • Risk factors include presence of other substance use disorders, conduct disorder, or antisocial personality disorder in the individual or their family, early onset of substance problems, easy availability of the substance, childhood maltreatment, and limited self-control.

    Other (or Unknown) Substance Intoxication

    • Characterized by clinically significant behavioral or psychological changes developing during or after using a substance not included in the 9 main classes, or an unknown substance.
    • Clinical judgment is used to assess symptoms as the variety of intoxicating substances makes it difficult to provide concrete examples.
    • The prevalence of other (or unknown) substance intoxication remains unknown.
    • Intoxication effects can last from hours to days, with some substances causing permanent impairment.
    • Functional consequences include workplace dysfunction, social problems, failures in role obligations, accidents, fighting, high-risk behavior, and overdose.

    Other (or Unknown) Substance Withdrawal

    • Withdrawal signs typically appear hours after substance use ends, with severity varying based on the substance and dosage.
    • Withdrawal-associated dysphoria contributes to relapse.
    • Functional consequences include intense drug craving, anxiety, depression, agitation, psychotic symptoms, cognitive impairments, and related problems like workplace dysfunction, social problems, failures in role obligations, accidents, fighting, high-risk behavior, suicide attempts, and overdose.
    • Identifying the substance used, assessing symptoms, and determining the appropriate treatment plan are crucial for diagnosis.
    • This diagnosis is used when symptoms of a substance-related disorder cause significant distress or impairment, but don't meet the full criteria for any specific disorder in the substance-related category.

    Gambling Disorder

    • Characterized by persistent and recurrent problematic gambling behavior that disrupts personal, family, or vocational pursuits.
    • Four or more criteria must be present within a 12-month period, including chasing losses, lying to conceal involvement, and jeopardizing relationships or careers.
    • Symptoms can manifest in various ways like impulsivity, competitiveness, restlessness, boredom, and overconfidence.
    • It is more common in women than men, with a lifetime prevalence rate of 0.4%-1.0%.
    • The onset can occur during adolescence or young adulthood, but it often manifests later in life.
    • The progression is generally faster in women.
    • Gambling patterns can be regular or episodic, and gambling disorder can be persistent or in remission.
    • Internet gambling has been linked to risky and problematic gambling among youth.
    • Some characteristics of video gaming overlap with gambling behavior.

    Gambling Disorder

    • Gambling disorder is more common among younger and middle-aged adults than older adults.
    • Younger individuals prefer different forms of gambling compared to older adults.
    • Older adults are more likely to develop problems with slot machines or bingo.
    • Risk factors for gambling disorder:
      • Increased rates of gambling disorder
      • Antisocial personality disorder
      • Depressive and bipolar disorders
      • Substance use disorders, particularly alcohol use disorder
    • Gambling problems are more frequent in monozygotic twins and first-degree relatives of individuals with moderate to severe alcohol use disorder than in the general population.
    • Many individuals, including adolescents and young adults, will resolve their gambling disorder problems over time.
    • Previous gambling problems predict future gambling problems.
    • Psychopathology, like attention deficit/hyperactivity and anxiety disorders, increases the risk of gambling disorder and persistence of addiction symptoms.
    • Gambling disorder can be categorized into different types, including pai gow, cockfights, blackjack, and horse racing.
    • Indigenous populations in Canada, New Zealand, and the United States have high prevalence rates of gambling problems, possibly due to limited economic opportunities, the expectation that gambling may help advance social goals, and the location of casinos on some U.S. tribal lands.
    • U.S.-born individuals have higher rates of gambling problems than first-generation immigrants to the United States.
    • Men develop gambling disorder at higher rates than women, though the gap is narrowing.
    • Women may gamble as a maladaptive approach to negative affect, while men may gamble for the thrill.
    • Compared to men, women may experience more shame related to gambling.
    • Men tend to gamble on cards, sports, and horse racing while women are more likely to gamble on slot machines and bingo.
    • Women with gambling disorder are more likely than men with gambling disorder to have depressive, bipolar, and anxiety disorders.

    Suicide and Gambling Disorder

    • A study in the U.S. found that up to half of those in treatment for gambling disorder had suicidal thoughts, with 17% reporting attempted suicide.
    • A study in Sweden found individuals with gambling disorder aged 20 to 74 years are 15 times more likely to die by suicide than people without the disorder.

    Functional Consequences of Gambling Disorder

    • Gambling disorder can jeopardize or lose important relationships with family and friends.
    • It can affect employment or educational activities.
    • It can lead to absenteeism or poor work or school performance.

    Substance Addiction Disorders

    • Substance addiction disorders are a significant public health issue often overlooked.
    • They often lead to loneliness and blame in individuals and families.
    • They should be recognized and treated as medical problems.

    Understanding Addiction

    • The definition and classification of substance addiction disorders are still debated.
    • Substance addiction may alter the limbic-based interactions with pleasure, social valuation of comfort, and fear.
    • Current research does not offer a comprehensive view of the phenomena.

    Experimental Studies on Substance Addiction

    • Experimental studies focus on the time sequence of addiction-related phenomena.
    • Experimental models do not allow complete modeling of human addiction complexity.
    • Many potential psychological and molecular mechanisms of responses to addictive drugs are unclear.
    • Research should include studies of neurocognitive mechanisms underlying individual differences in addicted subjects’ ability to regulate emotions, motivation, and reward evaluations.

    Addiction Research

    • Addiction research has used animal models, but human features should be emphasized.
    • Functional neuroimaging has been used to describe dependence-related phenomena in humans.
    • This method provides insight into the functioning of the human brain regarding addiction.

    The Nature of Addiction

    • Addiction is a complex, controversial, and significant problem of abnormal behavior.
    • The answer to understanding addiction depends on the underlying concept, drawing from medicine, psychology, philosophy, and political science.
    • Psychological theories and models of addiction often don’t offer much practical advice for clinicians.

    Psychological Theories and Models of Addiction

    • Psychological theories and models can provide practical insights to understand why people become addicted, what they get from addiction, and what clinicians can do about it.
    • A psychological perspective can be helpful when addictive substance use results in negative health, social, or psychiatric consequences.

    The Biopsychosocial Model

    • The biopsychosocial model is the prevailing conceptual model for understanding substance use and substance use disorders.
    • It aims to identify genetic and environmental factors to aid in the development of specific therapies for each disorder.
    • Addiction has been understood as a developmental biopsychosocial disorder characterized by both physical craving for drugs and emotional pain.
    • The most illuminating way to consider addiction is as an unconscious prioritization of certain brain reward pathways over other pathways that provide deep reward and gratification.

    Neuroregulatory Experiments and the Biopsychosocial Model

    • Neuroregulatory experiments suggest that brain development abnormalities, dysregulation, and structural changes associated with addiction are likely due to the interplay between individual vulnerabilities and unhealthy environmental factors.
    • The biopsychosocial model of addiction offers useful insights.
    • Substantial evidence shows that addiction has causal explanations at the levels of genes, neurobiology, psychology, and sociology.
    • Substance use treatment is currently relatively ineffective, but insights from the biopsychosocial model could lead to more targeted treatments.

    Cognitive-Behavioral Models of Substance Addiction

    • Cognitive-behavioral models are not comprehensive, but several models are consistent with cognitive-behavioral aspects of substance addiction, particularly the role of existing and acquired life stressors as triggers for addictive behaviors.
    • These behaviors may relieve negative affect or distract from stressors.
    • Temporally proximate life stressors are a common cognitive-behavioral trigger of substance use in transactional theory.
    • Therapists can learn to anticipate stressful experiences that may cause substance-seeking.

    The Neurobiology of Addiction

    • Addiction begins in the brain, and altered brain biology contributes to behavioral, psychological, and biological aspects of the disease.
    • Neuroscience can help us understand the anatomy and physiology of the brain, the functions of brain cells and neurotransmitters, and how substances or activities affect brain functioning.
    • Addiction is associated with the brain’s neural reward circuitry, which regulates subjective pleasure experienced within the brain and the motivational saliency assigned to reward-associated cues in the environment.
    • Understanding the regions and networks that serve specific functions in addiction disorder can advance treatment options for individuals in recovery.

    Neurotransmitter Systems and Addiction

    • Neurotransmitter systems play a crucial role in addiction disorders, including the cholinergic, serotonergic, noradrenergic, and glutamatergic neurotransmitter systems.
    • These systems modulate substance-dependent dopamine-driven reinforcement.
    • They code the “affective cluster" of the disorder.
    • Each neurotransmitter system has at least two receptor types that are chemically unique and can be modified for therapeutic purposes.

    Assessment and Diagnosis of Substance Addiction Disorders

    • Assessment of substance addiction disorder is essential to create treatment recommendations and plans.
    • It systematically evaluates the development of a problem, possible causal factors, as well as the individual’s intrinsic physiological characteristics, personality, and life adjustments.
    • Assessors initially focus on perception and cognition.
    • Data are used to describe disorders of substance us and abuse, primarily of psychoactive substances, related to psychological and physiological functions.
    • Screening tools and questionnaires have been created to determine if a substance use disorder is present.
    • Basic screening tools detect problematic substance use but cannot provide diagnoses.
    • A score above a certain level indicates a need for a comprehensive assessment.
    • The CAGE Questionnaire is a popular screening tool for older adults.
    • Diagnosing substance use disorder requires a trained professional to perform a comprehensive assessment.
    • This assessment typically includes reviewing the diagnostic criteria.
    • The most telling aspects of a substance use problem are the continuing desire to use the substance and difficulty discontinuing use.
    • Continuing desire to use the substance, the inability to stop, and the availability of the substance are further indications of the addiction process.
    • Individuals may given up or reduce social or occupational activities.
    • With continued use, the user may develop tolerance, requiring larger amounts to achieve the desired effect.
    • The person may experience withdrawal when the substance is not used.

    Substance Addiction Treatment

    • Substance addiction treatment has evolved over the past 40 years.
    • Early treatments were rooted in psychoanalytic premises, which viewed substance abuse as a response to underlying conflicts or psychological symptoms.
    • Confrontational and aggressive methods were used to enlist individuals in long-term treatment.
    • There are three major areas of substance addiction treatment:
      • Primary Treatment (de-addiction)
      • Extended Care
      • Aftercare
    • Primary De-addiction Treatment is time-limited, lasting from a few days to several weeks.
    • Long-term consequences of addiction-inducing drugs may take up to 12 months to resolve, or may require lifelong maintenance interventions.
    • Post-treatment social support helps with resolution.
    • Heavy metal substance overdose cleansing is only part of a solution to addiction.
    • Historical treatment approaches often involved medical interventions to reduce anxiety or mood and to aid withdrawal.
    • Empirical evaluations show that high levels of controlled social interventions are more effective in preventing dropouts and alleviating discomfort.
    • Pharmacological interventions are crucial in treating opioid use disorders, alcohol, tobacco, and heroin addiction.
    • There is resistance to generally using opioid substitution therapy for opioid use disorder.
    • The literature on pharmacological treatment focuses on the effectiveness of medications, the pharmacological harms they present, the extent to which they reduce overall drug use, and their acceptability to service providers and users.

    Psychosocial Interventions for Substance Addiction

    • Psychosocial interventions help individuals understand the illness, manage cravings and triggers, and develop skills to change cognitions and behaviors.
    • A group cognitive-behavioral model posits that substance addiction is a maladaptive way of coping with stress.
    • Change occurs by developing alternative coping skills.
    • Cognitive-behavioral therapy (CBT) challenges and changes addictive beliefs and behaviors.
    • Anger management therapy increases awareness of maladaptive anger roles, decreases physiological arousal, and modifies rigid thought processes about anger.
    • Art therapy can be used to promote exploration of difficult thoughts and feelings that individuals may struggle to articulate.

    Recovery and Relapse Prevention

    • Recovery and relapse prevention are essential goals of addiction treatment.
    • Treatment providers must understand recovery is a process and a difficult journey with challenges and obstacles.
    • Clients returning to formal treatment settings often find themselves at risk for substance use.
    • Clients face internal and external stressors in the days, weeks, and months after treatment.

    Obstacles to Recovery

    • Clients must cope with strong physical, emotional, and cognitive cravings.
    • They have to manage high-risk social and environmental situations related to use.
    • They must learn to manage substantial negative affectivity without resorting to substance use.

    The Stages of Change Model

    • The Stages of Change Model can help clinicians understand the dynamics of behavior change.
    • The model consists of five stages:
      • Precontemplation
      • Contemplation
      • Preparation
      • Action
      • Maintenance
    • Precontemplation is the non-conscious level of change status, where the person has no conscious thoughts about changing.
    • Contemplation is the point of conscious thoughts toward the addictive problem, where the sufferer evaluates the pros and cons of their situation.
    • The Preparation phase is the prelude to action, where more detailed and definite plans are articulated.
    • Motivation for change progresses as the sufferer considers whether action is viable.
    • Coping strategies are essential to overcome the addiction problem.
    • Many anti-drug education programs warn young people about drugs.
    • Stressful events and low mood can lead to relapse.

    Addiction Disorders in Pregnant Individuals

    • Addiction disorders (AD) can be classified based on an individual's global functioning level.
    • This is applicable to pregnant patients and those with comorbid illnesses.
    • The perinatal period is a critical time for families.
    • Addiction disorders in pregnant women affect pregnancy outcomes and the neurobehavioral development of newborns.
    • Alcohol consumption during pregnancy is higher than other addictive substances or prescribed medications in the United States and European countries.
    • Alcohol not only causes physical malformations, but it also damages the developing infant’s emotional, cognitive, mental health, social behavior, and learning.

    Fetal Alcohol Spectrum Disorders (FASD)

    • FASD is the spectrum of alcohol teratogenic effects in the adoptee while in utero.
    • There are three primary diagnostic categories:
      • Fetal Alcohol Syndrome
      • Partial Fetal Alcohol Syndrome
      • Alcohol-Related Neurodevelopmental Disorder

    Fetal Alcohol Spectrum Disorders (FASD)

    • Alcohol consumption during pregnancy is a risk factor for incomplete cognitive development, behavioral, emotional, motor, and communication development.
    • FASD is a primary cause of mental retardation and mental disorders in adopted children.

    Alcohol Addiction and Maternal-Infant Bonding

    • Uncontrolled alcohol addiction during pregnancy increases the likelihood of maternal-infant bonding disconnection.
    • Both alcohol addiction and FASD require a high level of attachment and bonding between a woman and the baby.

    Adolescent Substance Abuse

    • Adolescent substance abuse is a growing concern and requires comprehensive treatment.
    • Marijuana remains the most common drug among adolescents, but other illicit substances are becoming increasingly prevalent.
    • Factors like diagnosis, normative criteria, and severity of problems are more crucial than bio-behavioral features in diagnosing adolescent substance abuse.

    Pregnant Women and Substance Use

    • Pregnant women face unique challenges due to perinatal substance use, which can harm the developing fetus.
    • Psychologists play a crucial role in identifying and treating pregnant women with substance use disorders and advocating for specialized healthcare and social services for both mothers and children.
    • Informed consent, confidentiality, privilege, mandated treatment, and vulnerable populations are ethical and legal considerations in addiction treatment.
    • Confidentiality is an important professional concern when working with addicted clients.
    • State and country laws regarding confidentiality must be understood and followed by helping professionals.
    • Informed consent requires clinicians to disclose treatment information to clients.
    • Clients must have the capacity to understand the information, retain it, and make informed decisions about their participation.

    Dual Diagnosis Treatment

    • Dual diagnosis treatment addresses co-occurring substance-related and psychiatric disorders in an integrated manner.
    • Individuals with dual diagnosis often self-medicate with alcohol or drugs to manage mental health symptoms.
    • Treatment requires two coordinated approaches: addressing both psychiatric and AOD problems, and developing a comprehensive plan that integrates drugs, biological, and psychosocial aspects.

    Challenges in Dual Diagnosis

    • Dual diagnosis clients often have multiple care providers in different systems.
    • Diagnostic and treatment decisions involve both addiction and psychiatric components.
    • Preventing mislabeling and inappropriate psychopharmacological treatment is essential.

    Comorbidities in Addiction

    • Comorbidities are common, especially in stimulant addicts.
    • Physical fitness, nutritional behavior, and sexual health need enhanced clinical attention during addiction treatment.

    Evidence-Based Practices in Addiction Treatment

    • Evidence-based practices are similar across different types of substance addiction.
    • Clinical trials literature on alcoholism treatment has primarily focused on 12-step programs and intensive outpatient treatment approaches.
    • Short-term, brief, and intensive partial hospitalization, and outpatient substance abuse treatments, along with aftercare resources, are effective.

    Motivational Interviewing

    • Motivational interviewing aims to resolve ambivalence about substance use behavior.
    • Empathy is crucial in building a patient-clinician relationship.

    Cognitive-Behavioral Therapy

    • Cognitive-Behavioral Therapy (CBT) focuses on stimulus control and coping skills.
    • It emphasizes general problem-solving skills for coping with addictive cues.
    • Cognitive intervention is the primary method, but classical crisis intervention can also be helpful.
    • Relaxation can be effective after cognitive intervention.

    Cultural Competence in Addiction Treatment

    • Therapists must be aware of their personal biases and professional limitations, which can negatively affect the therapeutic alliance.
    • It is important to understand deeply rooted biases concerning substance abuse and addiction in different cultures, and to respect each patient's religiosity and spirituality.
    • Cultural competence can be implemented through the integration of cultural values in the treatment process.

    Prevention Strategies for Substance Use Disorder (SUD)

    • Prevention strategies aim to prevent the development of substance use behaviors and environmental changes that may increase access to substances.
    • Universal programs provide information, awareness, and support for promoting healthier alternatives.
    • Educational curriculums discourage substance use and focus on resisting substances, promoting healthy living, and increasing access to healthy alternatives.
    • Successful programs enhance self-esteem, assertiveness, goal-setting, communication skills, and provide interdisciplinary approaches.

    Primary Prevention

    • Primary prevention aims to avoid the occurrence of mental disorders, reducing the general prevalence of substance addiction disorders.
    • It is more cost-effective to invest in reducing causal risk factors for a disorder than to manage its consequences.

    Youth Intervention for Primary Prevention

    • Key developmental tasks in adolescence that increase the risk of drug abuse include: increased substance accessibility, societal attitudes towards addiction, genetic sensitivity, family members who use substances, association with substance users, family problems, and place of birth.
    • Effective primary prevention strategies focus on recognizing and educating parents, teachers, and professionals to minimize risky environments.

    Harm Reduction Strategies

    • Aim to minimize harms associated with substance use and misuse, without necessarily pressuring people to stop using drugs.
    • Emphasize minimizing harmful use and its unintended consequences, recognizing that harm can come from the substances themselves and from related social problems.

    Role of Families and Support Systems in Addiction

    • Family and support systems can be influenced by individuals, their families, cultural norms, and physiological mechanisms.
    • Family systems can provide opportunities for substance use development, with some members using substances as emotional release or escape.
    • Addictive individuals often struggle with immaturity, impulsivity, and emotional dependence.
    • Addicted families struggle with rigidity and overcontrol.

    Family Therapy Approaches

    • Family therapy aims to optimize understanding and treatment of family symptoms and functioning, focused on changing emotional relationships among family members.
    • This approach focuses on cognitive and emotional attachments, encouraging closeness, autonomy, and health and balance.

    Community Resources for Recovery

    • Various community resources are available to facilitate and enhance recovery.
    • These resources include pre-vocational and vocational programs, social skills training, psychoeducation groups, case management, support groups, and other programs.

    Professional Development and Self-Care for Clinicians

    • Clinicians need to prioritize professional development and self-care, including self-awareness and peer support.
    • Managing personal and professional life is essential for preventing burnout, promoting health and family resilience, and maintaining balance between work demands and personal life.
    • Supervision and consultation are crucial for learning, development, and receiving feedback on professionalism.

    Future Directions in Addiction Research and Treatment

    • Future research will focus on genetics, brain function, and a comprehensive approach to care that considers the nature of addiction, individual and societal vulnerability, individual and community strengths.
    • Innovative treatment approaches will use evidence-based practices and customized care within a service-oriented clinical operating system.

    Unorthodox Treatment Approaches

    • Unorthodox treatment approaches that do not use research-based knowledge bases may face difficulties, especially when dealing with patient-to-patient attacks.
    • Self-help group models that incorporate the knowledge bases, beliefs, attitudes, and behaviors of patients within their community can be effective in reducing these attacks.
    • Neuroscience advancements allow inferences about brain functions through observing injuries or brain lesions.

    Brain Function & Neuroscience

    • By understanding the relationship between different behaviors and specific brain regions, inferences can be drawn about neural processes, replacing previous euphemisms.
    • The discovery of electrical and chemical communication within the brain, in the 19th century, led to using circuits to understand the nervous system.
    • Highly controlled methods, informed by the understanding of brain circuits, allow for further inferences about nervous processes.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge on substance use disorders and their classifications with this informative quiz. Explore key terminology, behavioral indicators, and drug categories relevant to clinical settings. Expand your understanding of the impact of substance use on mental health.

    More Like This

    Psychology: Substance Use Disorders
    16 questions

    Psychology: Substance Use Disorders

    BetterForeshadowing avatar
    BetterForeshadowing
    Understanding Substance Use Disorders
    5 questions

    Understanding Substance Use Disorders

    AwesomeGreenTourmaline avatar
    AwesomeGreenTourmaline
    Substance Use Disorders Pt.1, Ch 14
    72 questions

    Substance Use Disorders Pt.1, Ch 14

    QualifiedMint avatar
    QualifiedMint
    Substance Use Disorders Overview
    22 questions

    Substance Use Disorders Overview

    WillingPoisson avatar
    WillingPoisson
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser