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PSYCHIATRIC DISORDERS: SUBSTANCE ABUSE

Ria Maria Theresa

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Substance Abuse

A maladaptive pattern of use leading to impairment, in at least one of the following, occurring within a 12-month period:  recurrent substance use resulting in a failure to

fulfill major role obligations at work, school, or home

recurrent substance use in situations in which it is physically hazardous

recurrent substance-related legal problems continued substance use despite having

persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

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DSM-IV-TR Criteria for Substance Withdrawal

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

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

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

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DSM-IV-TR Criteria for Substance Intoxication

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

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

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

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DSM-IV-TR Criteria for Substance Abuse

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: recurrent substance use resulting in a failure to fulfill

major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

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recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

The symptoms have never met the criteria for Substance Dependence for this class of substance.

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DSM-IV-TR Diagnostic Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: tolerance, as defined by either of the following: a need for markedly increased amounts of the

substance to achieve intoxication or desired effect

markedly diminished effect with continued use of the same amount of the substance

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Substance DependenceA maladaptive pattern of use, leading to

impairment as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 

tolerance withdrawal the substance is often taken in larger amounts or over

a longer period than was intended  there is a persistent desire or unsuccessful efforts to

cut down or control substance use  a great deal of time is spent in activities necessary to

obtain the substance, use the substance, or recover from its effects 

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

the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

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withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the

substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

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

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

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

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

the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

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Cannabinoids

Hashish, Marijuana swallowed, smokedEffects: euphoria, slowed thinking and reaction time, confusion, impaired balance and coordination Consequences: cough, frequent respiratory infections, impaired memory and learning, increased heart rate, anxiety, panic attacks

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Specify if:With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present)Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present) Course specifiers (see Table 12.1-5 for definitions):Early Full RemissionEarly Partial RemissionSustained Full RemissionSustained Partial RemissionOn Agonist TherapyIn a Controlled Environment

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Terms Used in Dependence and Abuse

Dependence The repeated use of a drug or chemical substance, with or without physical dependence. Physical dependence indicates an altered physiologic state caused by repeated administration of a drug, the cessation of which results in a specific syndrome.Abuse Use of any drug, usually by self-administration, in a manner that deviates from approved social or medical patterns.Misuse Similar to abuse, but usually applies to drugs prescribed by physicians that are not used properly.

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Addiction The repeated and increased use of a substance, the deprivation of which gives rise to symptoms of distress and an irresistible urge to use the agent again and which leads also to physical and mental deterioration. The term is no longer included in the official nomenclature, having been replaced by the term dependence, but it is a useful term in common usage.Intoxication A reversible syndrome caused by a specific substance (e.g., alcohol) that affects one or more of the following mental functions: memory, orientation, mood, judgment, and behavioral, social, or occupational functioning.

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Withdrawal A substance-specific syndrome that occurs after stopping or reducing the amount of the drug or substance that has been used regularly over a prolonged period of time. The syndrome is characterized by physiologic signs and symptoms in addition to psychological changes, such as disturbances in thinking, feeling, and behavior. Also called abstinence syndrome or discontinuation syndrome.

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Tolerance Phenomenon in which, after repeated administration, a given dose of drug produces a decreased effect or increasingly larger doses must be administered to obtain the effect observed with the original dose. Behavioral tolerance reflects the ability of the person to perform tasks despite the effects of the drug.Cross-tolerance Refers to the ability of one drug to be substituted for another, each usually producing the same physiologic and psychological effect (e.g., diazepam and barbiturates). Also known as cross-dependence

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Neuroadaptation Neurochemical or neurophysiologic changes in the body that result from the repeated administration of a drug. Neuroadaptation accounts for the phenomenon of tolerance. Pharmacokinetic adaptation refers to adaptation of the metabolizing system in the body. Cellular or pharmacodynamic adaptation refers to the ability of the nervous system to function despite high blood levels of the offending substance.

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Codependence Term used to refer to family members affected by or influencing the behavior of the substance abuser. Related to the term enabler, which is a person who facilitates the abuser's addictive behavior (e.g., providing drugs directly or money to buy drugs). Enabling also includes the unwillingness of a family member to accept addiction as a medical-psychiatric disorder or to deny that person is abusing a substance.

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Depressants Barbiturates, Benzodiazepines, GHB,

Rohypnol, Quaalude swallowed, injected Effects: reduced anxiety, feeling of well-

being, lowered inhibitions, slowed pulse and breathing, lowered blood pressure, poor concentration

Consequences: fatigue, confusion, impaired coordination, memory, judgment, respiratory depression and arrest, death

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Dissociative Anesthetics

Ketamine, PCP How Consumed: Injected,

swallowed, smoked, snorted Effects: increased heart rate and

blood pressure, impaired motor function, delirium, panic, aggression

Consequences: memory loss, numbness, nausea/vomiting, depression

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Hallucinogens

LSD, Mescaline, Mushrooms How Consumed: swallowed, smoked Effects: increased body temperature,

heart rate, blood pressure, loss of appetite, sleeplessness, numbness, weakness, tremors, altered states of perception and feeling, nausea

Consequences: persisting perception disorder (flashbacks)

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Opiods

Codeine, heroin, morphine, opium, Oxycodone, Hydrocodone

How Consumed: injected, swallowed, smoked, snorted

Effects: pain relief, euphoria, drowsiness

Consequences: nausea, constipation, confusion, sedation, respiratory depression and arrest, unconsciousness, coma, death

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Stimulants

Amphetamine, cocaine, MDMA, methamphetamine, nicotine, Ritalin

How Consumed: injected, smoked, snorted, swallowed

Effects: increased heart rate, blood pressure, metabolism, feelings of exhilaration, energy, increased mental alertness

Consequences: rapid or irregular heart beat, reduced appetite, weight loss, heart failure, nervousness, insomnia

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DSM-IV-TR Criteria for Polysubstance Dependence

This diagnosis is reserved for behavior during the same 12-month period in which the person was repeatedly using at least three groups of substances (not including caffeine and nicotine), but no single substance has predominated. Further, during this period, the dependence criteria were met for substances as a group but not for any specific substance.

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Alcohol-Related Disorders

Alcohol intoxication can cause irritability, violent behavior, feelings of depression, and, in rare instances, hallucinations and delusions.

Long-term, escalating levels of alcohol consumption can produce tolerance as well as such intense adaptation of the body that cessation of use can precipitate a withdrawal syndrome usually marked by insomnia, evidence of hyperactivity of the autonomic nervous system, and feelings of anxiety.

Epidemiological Data for Alcohol-Related Disorders

Race and Ethnicity Whitesthe highest rate

Gender Men >

Region and Urbanicity Alcohol use is highest in western states and lowest in southern states

Education -About 70 percent of adults with college degrees -40 percent of those with less than a high school education.

Socioeconomic Class -all socioeconomic classes.

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Antisocial Personality Disorder- A relation between antisocial

personality disorder and alcohol-related disorders has frequently been reported.

- common in men with an alcohol-related disorder

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Mood Disorders 30 to 40 percent of persons with an

alcohol-related disorder meet the diagnostic criteria for major depressive disorder

Depression is more common in women than in men with these disorders

family history of alcohol abuse risk for suicide

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Anxiety Disorders 25 to 50 percent of all persons with

alcohol-related disorders also meet the diagnostic criteria for an anxiety disorder

Phobias and panic disorder are particularly frequent comorbid diagnoses in these patients

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Suicide the prevalence of suicide among

persons with alcohol-related disorders range from 10 to 15 percent

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DSM-IV-TR Alcohol-Related Disorders

Alcohol use disordersAlcohol dependenceAlcohol abuseAlcohol-induced disordersAlcohol intoxicationAlcohol withdrawalSpecify if:With perceptual disturbances

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Alcohol intoxication deliriumAlcohol withdrawal deliriumAlcohol-induced persisting dementiaAlcohol-induced persisting amnestic disorderAlcohol-induced psychotic disorder, with delusionsSpecify if:With onset during intoxicationWith onset during withdrawal

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Alcohol-induced psychotic disorder, with hallucinationsSpecify if:With onset during intoxicationWith onset during withdrawalAlcohol-induced mood disorderSpecify if:With onset during intoxicationWith onset during withdrawal

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Alcohol-induced anxiety disorderSpecify if:With onset during intoxicationWith onset during withdrawalAlcohol-induced sexual dysfunctionSpecify if:With onset during intoxication

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Alcohol-induced sleep disorderSpecify if:With onset during intoxicationWith onset during withdrawalAlcohol disorder not otherwise specified

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DSM-IV-TR Diagnostic Criteria for Alcohol Intoxication

Recent ingestion of alcohol. Clinically significant maladaptive

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

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

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

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DSM-IV-TR Diagnostic Criteria for Alcohol Withdrawal

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

Two (or more) of the following, developing within several hours to a few days after Criterion A: autonomic hyperactivity (e.g., sweating or pulse rate

greater than 100) increased hand tremor insomnia nausea or vomiting transient visual, tactile, or auditory hallucinations or

illusions psychomotor agitation anxiety grand mal seizures

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

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

Specify if:With perceptual disturbances

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Drug Therapy for Alcohol Intoxication and Withdrawal

Clinical Problem Drug Route Dosage Comment

Tremulousness and mild to moderate agitation

Chlordiazepoxide

Oral 25-100 mg every 4-6 hr

Initial dose can be repeated every 2 hr until patient is calm; subsequent doses must be individualized and titrated

Diazepam Oral 5-20 mg every 4-6 hr

Hallucinosis Lorazepam Oral 2-10 mg every 4-6 hr

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Extreme agitation

Chlordiazepoxide

Intravenous0.5 mg/kg at 12.5 mg/min

Give until patient is calm; subsequent doses must be individualized and titrated

Withdrawal seizures

Diazepam Intravenous0.15 mg/kg at 2.5 mg/min

Delirium tremens

Lorazepam Intravenous0.1 mg/kg at 2.0 mg/min

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Amphetamine (or Amphetamine-like)-Related Disorders

The major amphetamines currently available and used in the United States are dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), a mixed dextroamphetamine-amphetamine salt (Adderall), and the amphetamine-like compound methylphenidate (Ritalin).

These drugs go by such street names as ice, crystal, crystal meth, and speed. As a general class,

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DSM-IV-TR Diagnostic Criteria for Amphetamine Intoxication

Recent use of amphetamine or a related substance (e.g., methylphenidate).

Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of amphetamine or a related substance.

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Two (or more) of the following, developing during, or shortly after, use of amphetamine or a related substance: tachycardia or bradycardia apillary dilation elevated or lowered blood pressure perspiration or chills nausea or vomiting evidence of weight loss psychomotor agitation or retardation muscular weakness, respiratory depression, chest

pain, or cardiac arrhythmias confusion, seizures, dyskinesias, dystonias, or coma

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

Specify if:With perceptual disturbances

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DSM-IV-TR Diagnostic Criteria for Amphetamine Withdrawal

Cessation of (or reduction in) amphetamine (or a related substance) use that has been heavy and prolonged.

Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A: fatigue vivid, unpleasant dreams insomnia or hypersomnia increased appetite psychomotor retardation or agitation

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

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

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DSM-IV-TR Diagnostic Criteria for Amphetamine- Related Disorder Not Otherwise Specified

The amphetamine-related disorder not otherwise specified category is for disorders associated with the use of amphetamine (or a related substance) that are not classifiable as amphetamine dependence, amphetamine abuse, amphetamine intoxication, amphetamine withdrawal, amphetamine intoxication delirium, amphetamine-induced psychotic disorder, amphetamine-induced mood disorder, amphetamine-induced anxiety disorder, amphetamine-induced sexual dysfunction, or amphetamine-induced sleep disorder.

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Caffeine-Related Disorders Caffeine is the most widely consumed

psychoactive substance in the world several caffeine-related disorders (e.g.,

caffeine intoxication, caffeine-induced anxiety disorder, and caffeine-induced sleep disorder).

Other caffeine-related disorders, such as caffeine withdrawal and caffeine dependence, are not official diagnoses in DSM-IV-TR, but they can also be of clinical interest.

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DSM-IV-TR Diagnostic Criteria for Caffeine Intoxication

Recent consumption of caffeine, usually in excess of 250 mg (e.g., more than 2-3 cups of brewed coffee).

Five (or more) of the following signs, developing during, or shortly after, caffeine use: restlessness nervousness excitement insomnia flushed face diuresis gastrointestinal disturbance muscle twitching rambling flow of thought and speech tachycardia or cardiac arrhythmia periods of inexhaustibility psychomotor agitation

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

The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder).

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DSM-IV-TR Research Criteria for Caffeine Withdrawal

Prolonged daily use of caffeine. Abrupt cessation of caffeine use, or

reduction in the amount of caffeine used, closely followed by headache and one (or more) of the following symptoms: marked fatigue or drowsiness marked anxiety or depression nausea or vomiting

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

The symptoms are not due to the direct physiological effects of a general medical condition (e.g., migraine, viral illness) and are not better accounted for by another mental disorder.

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Cannabis-Related DisordersDSM-IV-TR Cannabis-Related Disorders

Cannabis use disordersCannabis dependenceCannabis abuseCannabis-induced disordersCannabis intoxicationSpecify if:With perceptual disturbancesCannabis intoxication delirium

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Cannabis-induced psychotic disorder, with delusionsSpecify if:With onset during intoxicationCannabis-induced psychotic disorder, with hallucinationsSpecify if:With onset during intoxicationCannabis-induced anxiety disorderSpecify if:With onset during intoxicationCannabis-related disorder not otherwise specified

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DSM-IV-TR Diagnostic Criteria for Cannabis Intoxication

Recent use of cannabis. Clinically significant maladaptive

behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.

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Two (or more) of the following signs, developing within 2 hours of cannabis use: conjunctival injection increased appetite dry mouth tachycardia

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

Specify if:With perceptual disturbances

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DSM-IV-TR Diagnostic Criteria for Cocaine Intoxication

Recent use of cocaine. Clinically significant maladaptive

behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of cocaine.

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Two (or more) of the following, developing during, or shortly after, cocaine use: tachycardia or bradycardia pupillary dilation elevated or lowered blood pressure perspiration or chills nausea or vomiting evidence of weight loss psychomotor agitation or retardation muscular weakness, respiratory depression, chest

pain, or cardiac arrhythmias confusion, seizures, dyskinesias, dystonias, or coma

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

Specify if:With perceptual disturbances

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DSM-IV-TR Diagnostic Criteria for Cocaine Withdrawal

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

Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A: fatigue vivid, unpleasant dreams insomnia or hypersomnia increased appetite psychomotor retardation or agitation

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

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

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Hallucinogen-Related Disorders

lysergic acid diethylamide (LSD) Mescaline Methylene-dioxyam-phetamine

(MDA) Methylenedi-oxymetham-phetamine

(MDMA Psilocybin Morning glory Nutmeg and mace

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DSM-IV-TR Hallucinogen-Related Disorders

Hallucinogen use disordersHallucinogen dependenceHallucinogen abuseHallucinogen-induced disordersHallucinogen intoxicationHallucinogen persisting perception disorder (flashbacks)Hallucinogen intoxication deliriumHallucinogen-induced psychotic disorder, with delusions   Specify if:      With onset during intoxication

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Hallucinogen-induced psychotic disorder, with hallucinations   Specify if:      With onset during intoxicationHallucinogen-induced mood disorder   Specify if:      With onset during intoxicationHallucinogen-induced anxiety disorder   Specify if:      With onset during intoxicationHallucinogen-related disorder not otherwise specified

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DSM-IV-TR Diagnostic Criteria for Hallucinogen Intoxication

Recent use of a hallucinogen. Clinically significant maladaptive behavioral or

psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, hallucinogen use.

Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use.

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Two (or more) of the following signs, developing during, or shortly after, hallucinogen use: pupillary dilation tachycardia sweating palpitations blurring of vision tremors incoordination

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

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DSM-IV-TR Diagnostic Criteria for Hallucinogen Persisting Perception Disorder (Flashbacks)

The reexperiencing, following cessation of use of a hallucinogen, of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia).

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

The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better accounted for by another mental disorder (e.g., delirium, dementia, schizophrenia) or hypnopompic hallucinations.

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Inhalant-Related Disorders toluene n-hexane methyl butyl ketone Trichloroethylene Trichloroethane Dichloromethane Gasoline and butane

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DSM-IV-TR Inhalant-Related Disorders

Inhalant use disordersInhalant dependenceInhalant abuseInhalant-induced disordersInhalant intoxicationInhalant intoxication deliriumInhalant-induced persisting dementiaInhalant-induced psychotic disorder, with delusionsSpecify if:   With onset during intoxication

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Inhalant-induced psychotic disorder, with hallucinationsSpecify if:   With onset during intoxicationInhalant-induced mood disorderSpecify if:   With onset during intoxicationInhalant-induced anxiety disorderSpecify if:   With onset during intoxicationInhalant-related disorder not otherwise specified

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DSM-IV-TR Diagnostic Criteria for Inhalant Intoxication

Recent intentional use or short-term, high-dose exposure to volatile inhalants (excluding anesthetic gases and short-acting vasodilators).

Clinically significant maladaptive behavioral or psychological changes (e.g., belligerence, assaultiveness, apathy, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, use of or exposure to volatile inhalants.

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Two (or more) of the following signs, developing during, or shortly after, inhalant use or exposure: dizziness nystagmus incoordination slurred speech unsteady gait lethargy depressed reflexes psychomotor retardation tremor generalized muscle weakness blurred vision or diplopia stupor or coma euphoria

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

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Nicotine-Related Disorders Nicotine is one of the most highly

addictive and heavily used drugs in the United States and around the world.

It causes lung cancer, emphysema, and cardiovascular disease

and secondhand smoke is associated with lung cancer in adults and respiratory illness in children

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DSM-IV-TR Nicotine-Related Disorders

Nicotine use disorderNicotine dependenceNicotine-induced disorderNicotine withdrawalNicotine-related disorder not otherwise specified

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DSM-IV-TR Diagnostic Criteria for Nicotine Withdrawal

Daily use of nicotine for at least several weeks. Abrupt cessation of nicotine use, or reduction in

the amount of nicotine used, followed within 24 hours by four (or more) of the following signs: dysphoric or depressed mood insomnia irritability, frustration, or anger anxiety difficulty concentrating restlessness decreased heart rate increased appetite or weight gain

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

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

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Opioid-Related Disorders

Morphine Heroin (diacetylmorphine) ,Hydromorphone (dihydromorphinone), Oxymorphone (dihydrohydroxymorphinone) ,Levorphanol , Methadone ,Meperidine (pethidine) Fentanyl Codeine , Hydrocodone (dihydrocodeinone) ,Drocode (dihydrocodeine) , Oxycodone (dihydrohydroxycodeinone), , Propoxyphene , Buprenorphine , Pentazocine ,Nalbuphine , Butorphanol .

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DSM-IV-TR Diagnostic Criteria for Opioid Intoxication

Recent use of an opioid. Clinically significant maladaptive

behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, opioid use.

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Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use: drowsiness or coma slurred speech impairment in attention or memory

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

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DSM-IV-TR Diagnostic Criteria for Opioid Withdrawal

Either of the following: cessation of (or reduction in) opioid use that has been heavy and

prolonged (several weeks or longer) administration of an opioid antagonist after a period of opioid

use Three (or more) of the following, developing within

minutes to several days after Criterion A: dysphoric mood nausea or vomiting muscle aches lacrimation or rhinorrhea pupillary dilation, piloerection, or sweating diarrhea yawning fever insomnia

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

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

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Sedative-, Hypnotic-, or Anxiolytic-Related Disorders

(1)sedatives are drugs that reduce subjective tension and induce mental calmness; however, the same can be said of anxiolytics;

(2)hypnotics are drugs used to induce sleep; but sedatives and anxiolytics given in sufficiently high doses also produce sleep; and

(3)hypnotics in low doses, instead of inducing sleep, produce daytime sedation just as do sedatives and anxiolytics.

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DSM-IV-TR Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication

Recent use of a sedative, hypnotic, or anxiolytic.

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

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One (or more) of the following signs, developing during, or shortly after, sedative, hypnotic, or anxiolytic use: slurred speech incoordination unsteady gait nystagmus impairment in attention or memory stupor or coma

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

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DSM-IV-TR Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Withdrawal

Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use that has been heavy and prolonged.

Two (or more) of the following, developing within several hours to a few days after criterion A: autonomic hyperactivity (e.g., sweating or pulse rate

greater than 100) increased hand tremor insomnia nausea or vomiting transient visual, tactile, or auditory hallucinations or

illusions psychomotor agitation anxiety grand mal seizures

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

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

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Anabolic-Androgenic Steroid Abuse

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Other Substance- Related Disorders

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TERIMA KASIH