Diagnostic Criteria - Substance Use Disorders

Substance Use Disorders

Diagnostic Criteria

·        Two types of disorder:

o  Substance use disorders: abuse and dependence 

o  Substance induced disorders: secondary to substance use (eg withdrawal, psychosis, persisting dementia or amnestic disorders, etc). Require evidence of substance use and are not related to pre-existing problems

·        Abuse vs. dependence: 

o  Abuse implies use is causing job, social, legal or physical problems or impairing function in some way

o  Dependence (a step worse) requires signs of withdrawal and tolerance

·        Used to be a definition for „the addictive personality type‟: but research has shown no consistent correlation with the proposed criteria

Substance Abuse

·        A maladaptive pattern of substance use leading to significant impairment or distress, manifested by one (ie fairly low threshold) or more of the following occurring in the same 12 month period:

o   Recurrent substance use resulting in a failure to fulfil major role obligations at work, school or home

o   Recurrent substance use in which it is physically hazardous (eg driving)

o   Recurrent substance-related legal problems (eg arrests for disorderly conduct) 

o   Continued use despite it causing or exacerbating persistent or recurrent social or interpersonal problems 

·        Symptoms have never meet the criteria for substance dependence for this class of substance

Substance Dependence

·        A maladaptive pattern of substance use leading to significant impairment or distress, manifested by three or more of the following occurring in the same 12 month period: 

o   Tolerance: either ­ amounts to achieve intoxication or diminished effect with same amount 

o   Withdrawal: either characteristic withdrawal syndrome for that substance, or the same or a closely related substance is taken to avoid withdrawal symptoms

o   Substance is taken in larger amounts or over a longer period than was intended

o   There is a persistent desire or unsuccessful efforts to cut down or control use

o   A great deal of time is spent obtaining, using or recovering from its effects

o   Important social, occupational or recreational activities are given up or reduced as a result 

o   Use is continued despite knowing that has caused or exacerbated a physical or psychological problem