Substance- Related

Addictive Disorders

Jazzy Rejel Goloso

Reporter
Encompasses 10 separate classes of drugs
1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinogens
5. Inhalants
6. Opioids
7. Sedatives , hypnotics & anxiolytics
8. Stimulants
9. Tobacco
10. Other (or unknown ) substances
Addictive Disorders
Includes Gambling Disorder

Other potential behavioral

addictions ( internet
addiction, sex addiction,
exercise addiction ,
shopping addiction, etc.)
not included due to
insufficient peer- reviewed
evidence to established the
diagnostic criteria and
course descriptions..
 Diagnostic Criteria 312.31 (F63.0)
A. Persistent and recurrent problematic gambling behavior leading to clinically
significant impairment or distress, as indicated by the individual exhibiting four
(or more) of the following in a 12-month period:

1. Needs to gamble with increasing amounts of money in order to achieve the

desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving
past gambling experiences, handicapping or planning the next venture, thinking
of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious,
depressed).
6. After losing money gambling, often returns another day to get even (chasing
ones losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career
opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations
caused by gambling.

B. The gambling behavior is not better explained by a manic episode.

 Substance Related Disorders

Divided into two groups

Substance Induced Disorders : includes

conditions of intoxications or withdrawal and other
induced mental disorders .

Substance Use Disorders : relates to

pathological patterns of behaviors related to the use
of particular substance.
 Substance Induced Disorders

Essential Feature the development of a reversible

substance specific syndrome due to the recent
ingestion of a substance.

Includes intoxication , withdrawal and other

substance/ medication induced mental disorders
Substance Intoxication
Substance Intoxication can occur in individuals
without a Substance Use Disorder

Substance intoxication must include problematic

behavior

Substance intoxication does not apply to tobacco.

 Substance Use Disorder

Using larger amounts or for longer time than

intended
Persistent desire or unsuccessful attempts to cut
down or control use
Great deal of time obtaining, using, or recovering
Craving
Fail to fulfill major roles (work, school, home)
Persistent social or interpersonal problems caused
by substance use
 Alcohol Use Disorders
A problematic pattern of alcohol use
leading to clinically significant
impairment or distress , as manifested by
at least two of the following , occurring
within a 12 month period:

1. Alcohol is often taken in larger amounts or

over a longer period was intended.
2. There is persistent desire or unsuccessful
efforts to cut down or control alcohol use.
3. Craving , or a strong desire or urge to use
alcohol
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role
obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by
the effects of alcohol.
7. Important social, occupational, or recreational activities are
given up or reduced because of alcohol use.
Alcohol Intoxication
Diagnostic Criteria
A. Recent ingestion of alcohol.
B. Clinically significant problematic behavioral or psychological changes
(e.g., inappropriate sexual or aggressive behavior, mood lability, impaired
judgment) that developed during, or shortly after, alcohol ingestion.
C. One (or more) of the following signs or symptoms developing during, or
shortly after, alcohol use:

1. Slurred speech.
2. Incoordination.
3. Unsteady gait.
4. Nystagmus.
5. Impairment in attention or memory.
6. Stupor or coma.

D. The signs or symptoms are not attributable to another medical condition and are
not better explained by another mental disorder, including intoxication with another
substance.
Alcohol Withdrawal
Diagnostic Criteria
A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
B. Two (or more) of the following, developing within several hours to a few days after
the cessation of (or reduction in) alcohol use described in Criterion A:
1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
2. Increased hand tremor.
3. Insomnia.
4. Nausea or vomiting.
5. Transient visual, tactile, or auditory hallucinations or illusions.
6. Psychomotor agitation.
7. Anxiety.
8. Generalized tonic-clonic seizures.
C. The signs or symptoms in Criterion B cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are
not better explained by another mental disorder, including intoxication or
withdrawal from another substance.
 Caffeine-Related Disorders

More than 85% of children and adults consume

caffeine regularly .
Most widely used drug in the world Symptoms
include tolerance and withdrawal
only Caffeine Intoxication and Withdrawal
Significant growth in energy drinks with young
individuals Taking oral contraceptives decreases
elimination of caffeine (Increased risk of
intoxication)
Cannabis Related Disorders

Cannabis-related disorders share

many of the same root causes
with other addictive substances.
The initial desire for a "high,"
combined with the widely held
perception that cannabis use is
not dangerous, often leads to
experimentation in the teen
years.
 Cannabis Use Disorder
Diagnostic Criteria
A. A problematic pattern of cannabis use leading to clinically significant impairment
or distress, as manifested by at least two of the following, occurring within a 12-
month period:
1. Cannabis is often taken in larger amounts or over a longer period than was
intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis
use.
3. A great deal of time is spent in activities necessary to obtain cannabis, use
cannabis, or recover from its effects.
4. Craving, or a strong desire or urge to use cannabis.
5. Recurrent cannabis use resulting in a failure to fulfill major role obligations at
work, school, or home.
6. Continued cannabis use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of cannabis.
7. Important social, occupational, or recreational activities are given up or reduced
because of cannabis use.
Cannabis-related disorders reflect the problematic use of
cannabis products to varying degrees.
These dis orders include:

Cannabis dependence: The compulsive need to use

the drug, coupled with problems associated with
chronic drug use.

Cannabis abuse: Periodic use that may cause legal

problems, problems at work, home, or school, or
danger when driving.
 Cannabis intoxication: The direct effects of acute
cannabis use and reactions that accompany it such as
feeling "high," euphoria, sleepiness, lethargy,
impairment in short-term memory, stimulated
appetite, impaired judgment, distorted sensory
perceptions, impaired motor performance, and other
symptoms
Diagnosis

cannabis-related disorders is made in a number of ways.

Intoxication is easiest to diagnose because of clinically
observable signs, including reddened eye membranes,
increased appetite, dry mouth, and increased heart rate. It
is also diagnosed by the presence of problematic behavioral
or psychological changes such as impaired motor
coordination, judgment, anxiety, euphoria, and social
withdrawal. Occasionally, panic attacks may occur, and
there may be impairment of short-term memory.
Hallucinogens
are a chemically diverse group
of drugs that cause changes in a
person's thought processes,
perceptions of the physical
world, and sense of time passing.
Hallucinogens can be found
naturally in some plants, and can
be synthesized in the laboratory.
Most hallucinogens are abused
as recreational drugs.
Hallucinogens are also called
psychedelic drugs.
 Psychological symptoms of hallucinogen intoxication include:

distortion of sight, sound, and touch

confusion of the sensessounds are "seen" or vision is
"heard"
disorientation in time and space
paranoia
unreliable judgment and increased risk taking
anxiety attacks
flashbacks after the drug has been cleared from the body
blissful calm or mellowness
reduced inhibitions
elation or euphoria
impaired concentration and motivation
long-term memory loss
personality changes, especially if there is a latent psychiatric
disorder
psychological drug dependence
 The inhalants are a class of drugs
Inhalants that include a broad range of
chemicals found in hundreds of
different products, many of which
are readily available to the general
population.

These chemicals include volatile

solvents (liquids that vaporize at
room temperature) and aerosols
(sprays that contain solvents and
propellants). Examples include
glue, gasoline, paint thinner, hair
spray, lighter fluid, spray paint, nail
polish remover, correction fluid,
rubber cement, felt-tip marker
Inhalant dependence
inhalant dependence,
or addiction , is essentially a
syndrome in which a person
continues to use inhalants in spite
of significant problems caused by
or made worse by the use of
these substances. People who
use inhalants heavily may
develop tolerance to the drug,
which indicates that they
are physically dependent on it.
Tolerance is the reduced
response to a drug that develops
with repeated use.
Diagnostic Criteria

A. A problematic pattern of use of a hydrocarbon-based inhalant substance

leading to clinically significant impairment or distress, as manifested by at least two
of the following, occurring within a 12-month period:

1. The inhalant substance is often taken in larger amounts or over a longer period
than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control use of
the inhalant substance.
3. A great deal of time is spent in activities necessary to obtain the inhalant
substance, use it, or recover from its effects.
4. Craving, or a strong desire or urge to use the inhalant substance.
5. Recurrent use of the inhalant substance resulting in a failure to fulfill major role
obligations at work, school, or home.

6. Continued use of the inhalant substance despite having persistent or recurrent

social or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given
up or reduced because of use of the inhalant substance.
8. Recurrent use of the inhalant substance in situations in which it is
physically hazardous.
9. Use of the inhalant substance is continued despite knowledge of
having a persistent or recurrent physical or psychological
problem that is likely to have been caused or exacerbated by the
substance.
10. Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of the inhalant

substance to achieve
intoxication or desired effect.
b. A markedly diminished effect with continued use of the same
amount of the inhalant substance.
Inhalant intoxication

When a person uses enough

of an inhalant, they will get
"high" from it. The symptoms
of intoxication differ slightly
depending on the type of
inhalant, the amount used,
and other factors. There is,
however, a predictable set
of symptoms of inhalant
intoxication. When too much
of the substance is taken, an
individual can overdose.
Opioids
Opioids are a class of
drugs that include both
natural and synthetic
substances. The natural
opioids (referred to as
opiates) include opium
and morphine.
Opioid Use Disorder
Diagnostic Criteria

A. A problematic pattern of opioid use leading to clinically

significant impairment or distress, as manifested by at least two of
the following, occurring within a 12-month period:
1. Opioids are often taken in larger amounts or over a longer
period than was in tended.
2. There is a persistent desire or unsuccessful efforts to cut down
or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the
opioid, use the opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role
obligations at work, school, or home.
6. Continued opioid use despite having persistent or recurrent social
or interpersonal problems caused or exacerbated by the effects of
opioids.
7. Important social, occupational, or recreational activities are given
up or reduced be cause of opioid use.
8. Recurrent opioid use in situations in which it is physically
hazardous.
9. Continued opioid use despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to have
been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of opioids to achieve
intoxication or desired effect.
b. A markedly diminished effect with continued use of the same
amount of an opioid.
Opioid Withdrawal
Diagnostic Criteria
A. Presence of either of the following;
1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e.,several
weeks or longer).
2. Administration of an opioid antagonist after a period of opioid use.

B. Three (or more) of the following developing within minutes to several days after Criterion
A:
1. Dysphoric mood.
2. Nausea or vomiting.
3. Muscle aches.
4. Lacrimation or rhinorrhea.
5. Pupillary dilation, piloerection, or sweating.
6. Diarrhea.
7. Yawning.
8. Fever.
9. Insomnia.
Opioid intoxication

An individual who uses opioids typically

experiences drowsiness ("nodding off"), mood
changes, a feeling of heaviness, dry mouth, itching,
and slurred speech.

Severe intoxication from an overdose of opioids is

life-threatening because breathing may stop.
Sedative, Hypnotic or Anxiolytic Drug Use
Disorder
Sedative-hypnotic
drugs sometimes
called "depressants"
and anxiolytic
(antianxiety) drugs slow
down the activity of the
brain.
Sedative, Hypnotic, or Anxiolytic Use Disorder
Diagnostic Criteria
A. A problematic pattern of sedative, hypnotic, or anxiolytic use
leading to clinically significant impairment or distress, as
manifested by at least two of the following, occurring within a
12-month period:

1. Sedatives, hypnotics, or anxiolytics are often taken in larger

amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut

down or control sedative, hypnotic, or anxiolytic use.
3. A great deal of time is spent in activities necessary to
obtain the sedative, hypnotic, or anxiolytic; use the
sedative, hypnotic, or anxiolytic; or recover from its
effects.

4. Recurrent sedative, hypnotic, or anxiolytic use

resulting in a failure to fulfill major role obligations at
work, school, or home (e.g., repeated absences from
work or poor work performance related to sedative,
hypnotic, or anxiolytic use; sedative-, hypnotic-, or
anxiolytic-related absences, suspensions, or expulsions
from school; neglect of children or household).
Stimulant

Stimulants, sometimes
called uppers, temporarily
increase alertness and
energy. The most commonly
used street drugs that fall
into this category are
cocaine and amphetamines.
Stimulant Use Disorder
Diagnostic Criteria
A. A pattern of amphetamine-type substance, cocaine, or other stimulant use
leading to clinically significant impairment or distress, as manifested by at least
two of the follow ing, occurring within a 12-month period:
1. The stimulant is often taken in larger amounts or over a longer period than
was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control
stimulant use.
3. A great deal of time is spent in activities necessary to obtain the stimulant,
use the stimulant, or recover from its effects.
4. Craving, or a strong desire or urge to use the stimulant.
5. Recurrent stimulant use resulting in a failure to fulfill major role obligations
at work, school, or home.
Stimulant Intoxication
Diagnostic Criteria

A. Recent use of an amphetamine-type substance, cocaine, or other stimulant.

B. Clinically significant problematic behavioral or psychological changes (e.g., euphoria or
affective blunting: changes in sociability: hypervigilance: interpersonal sensitivity:
anxiety, tension, or anger; stereotyped behaviors: impaired judgment) that developed
during, or shortly after, use of a stimulant.
C. Two (or more) of the following signs or symptoms, developing during, or shortly after,
stimulant use:

1. Tachycardia or bradycardia.
2. Pupillary dilation.
3. Elevated or lowered blood pressure.
4. Perspiration or chills.
5. Nausea or vomiting.
6. Evidence of weight loss.
7. Psychomotor agitation or retardation.
8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.
9. Confusion, seizures, dyskinesias, dystonias, or coma.
Tobacco
Tobacco contains the psychoactive
drug nicotine, which is a CNS (Central
Nervous System) stimulant.

The immediate effects of nicotine

administration are tachycardia,
hypertension, increased respiration,
hyperglycemia, enhanced memory
storage, improved concentration,
and appetite suppression. Nicotine
can be administered through several
routes, including Inhalation (smoking
cigarettes, cigars, or pipes) Buccal
(Chewing tobacco) and insulfation
(snuff).
Tobacco Use Disorder
Diagnostic Criteria A. A problematic pattern of tobacco use
leading to clinically significant
impairment or distress, as manifested by
at least two of the following, occurring
within a 12-month period:
1. Tobacco is often taken in larger
amounts or over a longer period than was
intended.
2. There is a persistent desire or
unsuccessful efforts to cut down or control
tobacco use.
3. A great deal of time is spent in
activities necessary to obtain or use
tobacco.
4. Craving, or a strong desire or urge to
use tobacco.
5. Recurrent tobacco use resulting in a failure to fulfill major
role obligations at work, school, or home (e.g., interference
with work).
6. Continued tobacco use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of tobacco (e.g., arguments with
others about tobacco use).
7. important social, occupational, or recreational activities
are given up or reduced because of tobacco use.
8. Recurrent tobacco use in situations in which it is physically
hazardous (e.g., smoking in bed).
Tobacco Withdrawal
Diagnostic Criteria

A. Daily use of tobacco for at least several weeks.

B. Abrupt cessation of tobacco use, or reduction in the
amount of tobacco used, followed
within 24 hours by four (or more) of the following signs or
symptoms:

1. Irritability, frustration, or anger.

2. Anxiety.
3. Difficulty concentrating.
4. Increased appetite.
5. Restlessness.
6. Depressed mood.
7. Insomnia.