Substance Abuse & Addiction Disorders

Alcohol-Related Disorders
What is Alcohol Use Disorder?

Alcohol use disorder, also known as alcoholism, is a problematic pattern of alcohol use leading to significant impairment or distress, as demonstrated by at least two of the following factors, occurring within a 12-month period:

  • Alcohol often consumed in larger amounts or over a longer period than was intended.
  • Persistent desire or unsuccessful efforts to cut down or control alcohol use.
  • Excessive time spent obtaining alcohol, using alcohol, or recovering from its effects.
  • Craving, or a strong desire, to use alcohol.
  • Recurrent alcohol use resulting in a failure to fulfill major obligations at work, school, or home.
  • Continued alcohol use despite having persistent or recurrent social/interpersonal problems caused or exacerbated by the effects of alcohol.
  • Important social, occupational, or recreational activities given up or reduced because of alcohol use.
  • Recurrent alcohol use in situations in which it is physically hazardous to consume alcohol.
  • Continued alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  • Tolerance, as defined by either of the following:
    • A need for increased amounts of alcohol to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of alcohol.
  • Withdrawal, as demonstrated by either of the following:
    • Characteristic alcohol withdrawal syndrome symptoms
    • Alcohol (or a closely related substance, such as benzodiazepine) is consumed to relieve or avoid withdrawal symptoms.

Alcohol use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

What is the diagnosis for Alcohol Intoxication?

A diagnosis of “alcohol intoxication” is based on a person’s recent ingestion of alcohol with:

  • Significant problematic behavioral of psychological changes, such as inappropriate sexual or aggressive behavior, strong mood changes or impaired judgment, that developed during or shortly after alcohol ingestion.
  • One or more of the following signs or symptoms developed during, or shortly after, alcohol use:
    • Slurred speech
    • Incoordination
    • Unsteady gait
    • Rapid eye movements
    • Impairment in attention or memory
    • Stupor or coma

The signs or symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

What is the diagnosis for Alcohol Withdrawal?

A diagnosis of “alcohol withdrawal” is based on a person stopping or reducing heavy or prolonged alcohol with two or more of the following symptoms:

  • Hyperactivity of the nervous system, such as sweating or a pulse rate greater than 100 beats per minute
  • Increased hand tremor
  • Insomnia
  • Nausea or vomiting
  • Transient visual, tactile, or auditory hallucinations or illusions
  • Psychomotor agitation, (e.g., fidgeting, tapping toes)
  • Anxiety
  • Generalized tonic-clonic seizures (involving muscle convulsions, stiffness, loss of consciousness)

The symptoms cause significant distress or impairment in social, occupation, or other important areas of functioning. In addition, they are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.

What are other Alcohol-Induced Disorders?

Other alcohol-induced disorders include:

  • Alcohol-induced psychotic disorder
  • Alcohol-induced bipolar disorder
  • Alcohol-induced depressive disorder
  • Alcohol-induced anxiety disorder
  • Alcohol-induced sleep disorder
  • Alcohol-induced sexual dysfunction
  • Alcohol-induced persisting dementia
  • Alcohol-induced persisting amnestic disorder

What is an Unspecific Alcohol-Related Disorder?

The diagnosis of “unspecific alcohol-related disorder” is used for alcohol-related disorders that do not meet the diagnostic criteria for any of the other alcohol-related disorders.

What are the treatments for Alcohol Use Disorder, or alcoholism?

Three general steps are involved in treating the alcoholic person: intervention, detoxification, and rehabilitation.

Intervention

The goal in the intervention step is to break through feelings of denial and help the person realize the adverse consequences likely to occur if the disorder is not treated. This step often involves convincing patients that they are responsible for their own actions while reminding them of how alcohol has created significant life impairments.

Detoxification

Most persons with alcohol dependence have relatively mild symptoms when they stop drinking. If the patient is in relatively good health, is adequately nourished, and has a good social support system, the depressant withdrawal syndrome usually resembles a mild case of the flu. To aid in the patient’s alcohol withdrawal, a brain depressant such as chlordiazepoxide or lorazepam may be given for 4-5 days. For patients with severe withdrawal symptoms, either benzodiazepines or antipsychotic agents, such as haloperidol, may be given.

Symptoms of anxiety, insomnia, and mild autonomic overactivity are likely to continue for 2 to 6 months after the acute withdrawal period has passed. In some cases, medications such as acamprosate (Campral) may help diminish some of the symptoms.

Rehabilitation

The treatment process used in both inpatient and outpatient settings involves intervention, optimizing physical and psychological functioning, enhancing motivation, reaching out to family, and using the first 2 to 4 weeks of care as an intensive period of help. These efforts are followed by at least 3 to 6 months of less frequent outpatient care.

Counseling

Whether in an inpatient or outpatient setting, individual or group counseling is usually offered a minimum of three times a week for the first 2 to 4 weeks, followed by less intense efforts, such as once a week, for the subsequent 3 to 6 months.

Much time in counseling focuses on how to build a lifestyle free of alcohol. Discussions cover the need for a sober peer group, a plan for social and recreational events without drinking, and approaches for reestablishing communication with family members and friends.

An important aspect of recovery involves helping family members and close friends understand alcoholism and realize that rehabilitation is an ongoing process that lasts for 6 to 12 or more months.

Participation in self-help groups such as Alcoholics Anonymous is associated with improved outcomes for recovery from alcoholism.

Are there medications to treat alcoholism or Alcohol Use Disorder?

During the initial alcohol detoxification period, either benzodiazepines such as chlordiazepoxide, or antipsychotic agents, such as haloperidol, may be given for 4-5 days to help patients through severe alcohol withdrawal.

Most clinical trials indicate no benefit in prescribing antidepressants or lithium to treat the average alcoholic person who has no independent or long-lasting psychiatric disorder.

Newer drugs that may be used to help prevent alcohol cravings and relapsed include naltrexone hydrochloride (Revia and Vivitrol) and acamprosate (Campral).

Is there a genetic risk for alcoholism?

Yes. Studies show that close relatives of individuals with an alcohol disorder are at three to four times greater risk for severe alcohol problems. The rate of alcohol problems increases with the number of alcoholic relatives, the severity of their illness, and the closeness of their genetic relationship to an individual.

What is Fetal Alcohol Syndrome?

Fetal alcohol syndrome is the leading cause of intellectual disability in the United States. It occurs when a pregnant woman drinks alcohol, exposing the fetus to alcohol in utero. The alcohol inhibits intrauterine growth and postnatal development. Microcephaly, craniofacial malformations, and limb and heart defects are common in affected infants. Short adult stature and development of a range of adult maladaptive behaviors have also been associated with fetal alcohol syndrome. Women with alcohol-related disorders have a 35 percent risk of having a child with defects.

Caffeine-Related Disorders
What is Caffeine Intoxication?

A diagnosis of “caffeine intoxication” applies when a person has consumed a high dose of caffeine (typically in excess of 250 mg) with five or more of the following symptoms:

  • Restlessness
  • Nervousness
  • Excitement
  • Insomnia
  • Flushed face
  • Diuresis
  • Gastrointestinal disturbance
  • Muscle twitching
  • Rambling flow of thought and speech
  • Rapid heartbeat or cardia arrhythmia
  • Periods of inexhaustibility
  • Psychomotor agitation

The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

What is the diagnosis for Caffeine Withdrawal?

A diagnosis of “caffeine withdrawal” is based on abrupt cessation or reduction in caffeine use, after prolonged daily use, followed within 24 hours by three or more of the following symptoms:

  • Headache
  • Marked fatigue or drowsiness
  • Disease, depressed mood, or irritability
  • Difficulty concentrating
  • Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness)

The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not associated with the physiological effects of another medical condition (e.g., migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Are there other Caffeine Induced Disorders?

Yes, other caffeine-induced disorders include caffeine-induced anxiety disorder and caffeine-induced sleep disorder. These disorders are diagnoses instead of caffeine intoxication or caffeine withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.

What is the treatment for Caffeine Addiction?

Since caffeine-related disorder is not recognized as a diagnosable condition, there is no standardized treatment. It is on the list of substance-related disorders that require more investigation because progressive caffeine overuse that results in a dependency could lead to negative physical, psychological, and social consequences.

The recommended treatment for caffeine addiction is to gradually reduce consumption of caffeine over time. Stopping all caffeine use abruptly is more likely to produce withdrawal symptoms. Analgesics, such as aspirin, almost always can control the headaches and muscle aches that may accompany withdrawal.

Cannabis-Related Disorders
What is Cannabis Use Disorder (Marijuana Addiction)?

Cannabis use disorder, also known as marijuana addiction, is a problematic pattern of cannabis use leading to significant impairment or distress, as demonstrated by at least two of the following signs or symptoms occurring within a 12-month period:

  • Cannabis is often taken in larger amounts or over a longer period than was intended.
  • Persistent desire or unsuccessful efforts to reduce or control cannabis use.
  • Excessive time spent to obtain cannabis, use cannabis, or recover from its effects.
  • Craving, or a strong desire to use cannabis.
  • Recurrent cannabis use resulting in a failure to fulfill major obligations at work, school or home.
  • Continued cannabis use despite having persistent or recurrent social/interpersonal problems caused or exacerbated by the effects of cannabis.
  • Important social, occupational or recreational activities are given up or reduced because of cannabis use.
  • Recurrent cannabis use in situations in which it is physically hazardous to consume cannabis.
  • Cannabis 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 cannabis.
  • Tolerance, as defined by either of the following:
    • A need for increased amounts of cannabis to achieve intoxication or desired effect.
    • Markedly diminished effect with continued use or the same amount of cannabis.
  • Withdrawal, as demonstrated by either of the following:
    • Characteristic withdrawal syndrome for cannabis.
    • Cannabis is taken to relive or avoid withdrawal symptoms.

Cannabis use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

The risk of developing cannabis dependence is around 1 in 10 for anyone who uses cannabis. The earlier the age of first use, the more often cannabis has been used, and the longer it has been used, the higher the risk of dependence.

What is the diagnosis for Cannabis or Marijuana Intoxication?

A diagnosis of cannabis or marijuana intoxication is based on a person’s recent use of cannabis (marijuana) while showing:

  • Significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment or social withdrawalthat developed during, or shortly after, cannabis use.
  • Two or more of the following signs or symptoms developing within 32 hours of cannabis use:
    • Red/bloodshot eyes
    • Increased appetite
    • Dry mouth
    • Rapid heartbeat (tachycardia)

The signs and symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

Cannabis intoxication commonly heightens the user’s sensitivities to external stimuli, reveals new details, makes colors seem brighter and richer, and subjectively slows the appreciation of time. In high doses, users may experience depersonalization and derealization. Cannabis use impairs motor skills for 8 to 12 hours and can interfere with the operation of motor vehicles and other heavy machinery. The delirium associated with cannabis intoxication is characterized by marked impairment on cognition and performance tasks. Even modest doses of cannabis impair memory, reaction time, perception, motor coordination, and attention.

What is the diagnosis for Cannabis or Marijuana Withdrawal?

A diagnosis for cannabis withdrawal is based on cessation of marijuana use that has been heavy or prolonged, usually daily or almost daily use, over a period of at least a few months, with three or more of the following symptoms:

  • Irritability, anger or aggression
  • Nervousness or anxiety
  • Sleep difficulty (insomnia, disturbing dreams)
  • Decreased appetite or weight loss
  • Restlessness
  • Depressed mood
  • At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache

The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. In addition, they are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.

What are other Cannabis-Induced or Marijuana-Induced Disorders?

Other cannabis-induced disorders include:

  • Cannabis-induced psychotic disorder, which is rare.
  • Cannabis-induced anxiety disorder, which involves short-lived anxiety states often provoked by paranoid thoughts.
  • Cannabis-induced sleep disorder, which involves difficulties falling asleep and staying asleep
What is Unspecified Cannabis-Related Disorder?

The diagnosis of “unspecified cannabis-related disorder” applies when a person has symptoms characteristic of a cannabis-related disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning. However, the symptoms do not meet the full criteria for any specific cannabis-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

What are treatments for Cannabis Use Disorder?

Treatment of cannabis use involves the same process and approaches as the treatment of any substance abuse disorder. Steps include intervention, abstinence and support achieved through the use of individual, family and group psychotherapies. For some patients, an antianxiety medication may be useful for short-term relief of withdrawal symptoms. For other patients, cannabis use may be related to an underlying depressive disorder that may respond to specific antidepressant treatment. 

Gambling Disorder
What is the diagnosis for Gambling Disorder?

A diagnosis of “gambling disorder” is based on persistent and recurrent problematic gambling behavior leading to significant impairment or distress, as indicated by four or more the following symptoms in a 12-month period:

  • Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
  • Is restless or irritable when attempting to cut down or stop gambling.
  • Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
  • 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).
  • Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
  • After losing money gambling, often returns another day to get even (“chasing” one’s losses).
  • Lies to conceal the extend of involvement with gambling.
  • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
  • Relies on others to provide money to relieve desperate financial situations caused by gambling.

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

A gambling disorder is rated as mild with 4-5 symptoms, moderate with 6-7 symptoms, and severe with 8-9 symptoms.

How common is gambling addiction?

Gambling problems are prevalent in an estimated 3 to 5 percent of the general population, and approximately 1 percent of individuals meet the criteria for a gambling disorder. Gambling addiction is more common in men and young adults than in women and older adults. Approximately two-thirds of pathological gamblers are men. Individuals with a substance abuse disorder have a greater tendency to have a gambling problem.

Do obsessive gamblers tend to have other mental health problems?

Yes, there is a strong connection between pathological gambling and mood disorders (especially major depression and bipolarity) and other substance use and addictive disorders, notably alcohol and stimulant abuse, as well as caffeine and tobacco dependence.

Are there other factors that predispose a person to gambling addiction?

Yes, several factors may predispose individuals to develop gambling disorder, including loss of a parent by death, separation, divorce, or desertion before a child is 15 years of age. Other contributing factors may include inappropriate parental discipline (absence, inconsistency or harshness of discipline), exposure to and availability of gambling activities for adolescents, a family emphasis on material and financial status, and a lack of family emphasis on saving, planning and budgeting.

Several studies have suggested that gamblers’ risk-taking behavior may have an underlying neurobiological cause related to an individual’s brain chemistry.

What are treatments for Gambling Addiction?

Gamblers seldom come forward voluntarily to be treated for gambling addiction. In some cases, hospitalization may help by removing an individual from his or her gambling environment. Gamblers Anonymous, modeled on Alcoholics Anonymous, is an effective treatment for some individuals.

Insight-oriented psychotherapy can also be effective after an individual has stopped gambling for 3 months.

Pharmacological treatment is also effective in helping to manage gambling disorder. Effective medications include antidepressants, notably selective serotonin reuptake inhibitors (SSRIs) and bupropion (Wellbutrin, Zyban); mood stabilizers, including sustained-release lithium (Eskalith) and antiepileptics such as topiramate (Topamax); atypical antipsychotics; and opioid agents such as naltrexone (ReVia).

Hallucinogen-Related Disorders
What is the diagnosis for Phencyclidine (PCP) Intoxication?

A diagnosis of phencyclidine (PCP) intoxication is based on the recent use of phencyclidine (or a pharmacologically similar substance) that causes:

  • Significant problematic behavioral changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment)
  • Within 1 hour, two or more of the following symptoms:
    • Rapid eye movements
    • Hypertension or rapid heartbeat
    • Numbness or less responsiveness to pain
    • Stumbling, falling down, incoordination
    • Slurred speech
    • Muscle rigidity
    • Seizures or coma
    • Hearing sensitivity


The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

What is Phencyclidine Use Disorder?

Phencyclidine use disorder is a pattern of phencyclidine (PCP) use (or a pharmacologically similar substance) that causes significant impairment or distress, as demonstrated by at least two of the following factors occurring within a 12-month period:

  • Phencyclidine is often used in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control phencyclidine use.
  • A great deal of time is spent trying to obtain phencyclidine or recover from its effects.
  • Person has a craving or strong desire to use phencyclidine.
  • Recurrent phencyclidine use results in a failure to fulfill major obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to phencyclidine use; suspensions or expulsions from school; neglect of children or household).
  • Phencyclidine use continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of phencyclidine use (e.g., arguments with a spouse about consequences of intoxication; physical fights).
  • Important social, occupational, or recreational activities are given up or reduced because of phencyclidine use.
  • Recurrent phencyclidine use takes place in situations where it is physically hazardous (e.g., driving a car or operating a machine)
  • Phencyclidine use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by the drug.
  • Tolerance has been built up, as defined as either of the following:
    • A need for markedly increased amounts of phencyclidine to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of phencyclidine.

Phencyclidine use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

Are there other Phencyclidine-Induced Disorders?

Yes, other phencyclidine-induced disorders include phencyclidine-induced psychotic disorder, phencyclidine-induced bipolar disorder, phencyclidine-induced depressive disorder, phencyclidine-induced anxiety disorder, and phencyclidine-induced intoxication delirium. These phencyclidine-induced disorders are diagnosed instead of phencyclidine intoxication or phencyclidine withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.

What is an Unspecified Phencyclidine-Related Disorder?

A diagnosis of “unspecific phencyclidine-related disorder” is given when symptoms of a phencyclidine (PCP) disorder are present that cause significant distress or impairment in social, occupational, or other important areas of functioning. However, the symptoms to 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.

What is the diagnosis for Other Hallucinogen Intoxication?

A diagnosis “other hallucinogen intoxication” is based on the recent use of a hallucinogen (other than phencyclidine) that causes:

  • Significant problematic behavior or psychological changes (e.g., marked anxiety or depression, delusions/ideas of reference, fear of “losing one’s mind,” paranoid ideation, impaired judgment)
  • Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias
  • Two or more of the following signs developing during, or shortly after, hallucinogen use:
    • Pupillary dilation
    • Rapid heartbeat
    • Sweating
    • Palpitations
    • Blurred vision
    • Tremors
    • Incoordination
What is Hallucinogen Persisting Perception Disorder?

A diagnosis of “hallucinogen persisting perception disorder” may be given when:

  • A person reexperiences one or more of the perceptual symptoms that were experienced while intoxicated with a 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)
  • The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
  • The symptoms are not attributable to another medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better explained by another mental disorder (e.g., delirium, major neurocognitive disorder, schizophrenia) or hypnopompic hallucinations.

Three comorbid conditions are associated with hallucinogen persisting disorder: panic disorder, major depression, and alcohol dependence.

Are there other Hallucinogen Use Disorders?

Yes. A diagnosis of “other hallucinogen use disorder” is made when there is a problematic pattern of hallucinogen use (other than phencyclidine) that causes significant impairment or distress, as demonstrated by at least two of the following factors occurring within a 12-month period:

  • The hallucinogen 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 hallucinogen use.
  • A great deal of time is spent trying to obtain the hallucinogen or recover from its effects.
  • Person has a craving or strong desire to use the hallucinogen.
  • Recurrent hallucinogen use results in a failure to fulfill major obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to hallucinogen use; suspensions or expulsions from school; neglect of children or household).
  • Hallucinogen use continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the hallucinogen (e.g., arguments with a spouse about consequences of intoxication; physical fights).
  • Important social, occupational, or recreational activities are given up or reduced because of hallucinogen use.
  • Recurrent hallucinogen use takes place in situations where it is physically hazardous (e.g., driving a car or operating a machine)
  • Hallucinogen use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by the drug.
  • Tolerance has been built up, as defined as either of the following:
    • A need for markedly increased amounts of phencyclidine to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of phencyclidine.
What are treatments for Hallucinogen Use Disorders?

Patients experiencing intense and unpleasant hallucinogen intoxication can be helped by a quiet environment, verbal reassurance, and the passage of time. More rapid relief of intense anxiety is likely after oral administration of 20 mg of diazepam (Valium) or an equivalent dose of a benzodiazepine.

Hallucinogen Persistent Perception Disorder

Treatment for hallucinogen persistent perception disorder is palliative in nature. Pharmacological approaches include long-lasting benzodiazepines, such as clonazepam (Klonopin), anticonvulsants including valproic acid (Depakene) and carbamazepine (Tegretol). Currently, no drug is completely effective in treating symptoms. Behavioral treatment is also necessary. The patient must be instructed to avoid use of over-the-counter drugs, caffeine, and alcohol, as well as physician and emotional stressors. Marijuana smoke is a particularly strong intensifier of the disorder, even when passively inhaled.

Hallucinogen-Induced Psychosis

Hallucinogen-induced psychosis benefits from the same treatments as other forms of psychoses. In addition to antipsychotic medications, other effective treatments may include lithium carbonate, carbamazepine, and electroconvulsive therapy. Medical therapies are best applied in a context of supportive, educational, and family therapies.

Phencyclidine (PCP) Use Disorder

Treatment of PCP intoxication aims to address significant medical, behavioral, and psychiatric issues. No drug is known to function as a direct PCP antagonist. Treatment must therefore be supportive and directed at specific symptoms and signs of toxicity. Patients should be treated in an environment that is as quiteand isolated as possible. Because PCP disrupts sensory input, environmental stimuli can cause unpredictable, exaggerated, distorted, or violent reactions. Pharmacological sedation can be accomplished with oral or IM antipsychotics or benzodiazepines.

Inhalant-Related Disorders
What is the diagnosis for Inhalant Intoxication?

A diagnosis of “inhalant intoxication” is based on:

  • Recent intended or unintended short-term, high-dose exposure to inhalant substances, including volatile hydrocarbons such as toluene or gasoline. (Examples of other inhalant substances include glues and adhesives, aerosol paint sprays, hair sprays, and paint thinners).
  • Significant problematic behavioral or psychological changes (such as belligerence, assaultiveness, apathy, or impaired judgement) that developed during, or shortly after, exposure to inhalants.
  • Two or more of the following symptoms developed during, or shortly after, inhalant use or exposure:
    • Dizziness
    • Rapid eye movements
    • Incoordination
    • Slurred speech
    • Unsteady gait
    • Lethargy
    • Depressed reflexes
    • Psychomotor retardation
    • Tremor
    • Generalized muscle weakness
    • Blurred vision or seeing double
    • Stupor or coma
    • Euphoria

The symptoms are not attributable to another medication condition or mental disorder, including intoxication with another substance.

What is Inhalant Use Disorder?

A diagnosis of “inhalant use disorder” is based on a problematic pattern of using a hydrocarbon-based inhalant substance leading to significant impairment or distress. Inhalant substances include solvents for glues and adhesives; propellants (e.g., for aerosol paint sprays, hair sprays); paint thinners; and fuels (e.g., gasoline and propane). Inhalants are associated with a number of problems including conduct disorder, mood disorders, suicidality, and physical and sexual abuse or neglect.

A diagnosis for inhalant use disorder requires at least two of the following factors, occurring within a 12-month period:

  • The inhalant 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 use of the inhalant.
  • A great deal of time is spent trying to obtain the inhalant substance, use it, or recover from its effects.
  • A person has a craving or strong desire to use the inhalant.
  • Recurrent use of the inhalant substance results in a failure to fulfill major obligations at work, school, or home.
  • A person continues use of the substance despite having persistent or recurrent social or interpersonal problems caused of exacerbated by the effects of its use.
  • Important social, occupational, or recreational activities are given up or reduced because of using the inhalant.
  • There is recurrent use of the inhalant substance in situations that are physically hazardous.
  • Use of the inhalant substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by the substance.
  • Tolerance is developed, as defined by either of the following:
    • A need for increased amounts of the inhalant substance to achieve intoxication or desired effect.
    • A reduced effect with continued use of the same amount of the inhalant substance.

Inhalant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

What is Unspecific Inhalant-Related Disorder?

A diagnosis of “unspecific inhalant disorder” is given when symptoms of an inhalant-related disorder are present that cause significant distress or impairment in social, occupational, or other important areas of functioning. However, the symptoms to not meet the full criteria for any specific inhalant-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

What are treatments for Inhalant-Related Disorder?

Inhalant intoxication usually requires no medical attention and resolves spontaneously. Care primarily involves reassurance and quiet support. Sedative drugs, including benzodiazepines, should not be used because they worsen inhalant intoxication. No established treatment exists for cognitive and memory problems of inhalant-induced persisting dementia. The treatment of inhalant-induced psychotic disorder is brief, lasting a few hours to a few weeks beyond the intoxication. Sedative drugs should be avoided because they may aggravate the psychosis. Antianxiety medications and antidepressants are not useful in the acute phase of the disorder; however, they may be of use in cases of a coexisting anxiety or depressive illness.

For treating the inhalant-related disorders, day treatment and residential programs have been used successfully, especially for adolescent abusers with combined substance dependence and other psychiatric disorders. Treatment addresses the comorbid state which, in most cases, is conduct disorder, or maybe ADHD, major depressive disorder, dysthymic disorder, or PTSD. Both group and individual therapies are used that are behaviorally oriented. Treatment usually lasts 3 to 12 months. Participation in a 12-step program is required, and patients’ families are often involved in family therapy.

Opioid-Related Disorders
What is the diagnosis for Opioid Intoxication?

A diagnosis of “opioid intoxication” is based on recent use of an opioid with symptoms listed below. Opioids include heroine, fentanyl, and prescription pain relievers such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and others. 

Symptoms of opioid intoxication include:

  • Significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use.
  • Pupillary constriction and one or more of the following symptoms that developed during, or shortly after, opioid use:
    • Drowsiness or coma
    • Slurred speech
    • Impairment in attention or memory

The symptoms are not attributable to another medication condition or mental disorder, including intoxication with another substance.

What is the diagnosis for Opioid-Related Disorder?

Opioids include heroine, fentanyl, and prescription pain relievers such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and others. 

A diagnosis of “opioid-related disorder” is based on a problematic pattern of opioid use leading to significant impairment or distress, as demonstrated by at least two of the following factors, occurring within a 12-month period:

  • Opioids are often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to reduce or control opioid use.
  • A great deal of time is spent trying to obtain the opioid, use it, or recover from its effects.
  • A person has a craving or strong desire to use opioids.
  • Recurrent opioid use results in a failure to fulfill major obligations at work, school, or home.
  • A person continues opioid use despite having persistent or recurrent social or interpersonal problems caused of exacerbated by the effects of its use.
  • Important social, occupational, or recreational activities are given up or reduced because of opioid use.
  • There is recurrent use of the opioid in situations that are physically hazardous.
  • Opioid use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by the opioid.
  • Tolerance is developed, as defined by either of the following:
    • A need for increased amounts of opioids to achieve intoxication or desired effect.
    • A reduced effect with continued use of the same amount of an opioid.
  • Withdrawal, as demonstrated by either of the following:
    • Characteristic opioid withdrawal syndrome.
    • Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

Opioid use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

A diagnosis of “unspecified opioid-related disorder” may apply in situations in which a person shows symptoms characteristic of an opioid-related disorder, but the symptoms do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

What is the diagnosis for Opioid Intoxication?

A diagnosis of “opioid Intoxication” is based on the recent use of an opioid with the following symptoms:

  • Significant problematic behavioral of psychological changes (e.g., initial euphoria followed by apathy, unease, psychomotor agitation or retardation, impaired judgment) 
  • Pupillary constriction (or pupillary dilation due to severe overdose) and one or more of the following symptoms:
    • Drowsiness or coma
    • Slurred speech
    • Impairment in attention or memory

The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

What is the diagnosis for Opioid Withdrawal?

The diagnosis of “opioid withdrawal” may apply after a person stops/reduces opioid use that has been heavy and prolonged (i.e., several weeks or longer), or after the person has been given an opioid antagonist. Three or more of the following symptoms must be present within minutes to several days after stopping/reducing opioid use, or after receiving an opioid antagonist:

  • Uneasy, anxious, or depressed mood
  • Nausea or vomiting
  • Muscle aches
  • Excessive tearing or runny nose
  • Pupillary dilation, goosebumps, or sweating
  • Diarrhea
  • Yawning
  • Fever
  • Insomnia

The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.

Are there other Opioid-Induced Disorders?

Yes, other “opioid-induced disorders” include opioid-induced depressive disorder, opioid-induced anxiety disorder, opioid-induced sleep disorder, and opioid-induced sexual dysfunction. These opioid-induced disorders are diagnosed instead of opioid intoxication or opioid withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.

What are treatments for Opioid Use Disorder?

Medications, including buprenorphine (Suboxone, Subutex), methadone, and extended-release naltrexone (Vivitrol), are effective for the treatment of opioid use disorders.

Buprenorphine and methadone are “essential medicines” according to the World Health Organization.

A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid use disorder.

Medications should be combined with psychotherapy for effective treatment of opioid-related disorders. Individual psychotherapy, behavioral therapy, cognitive-behavioral therapy, family therapy, support groups (e.g., Narcotics Anonymous) and social skills training may all prove effective for specific patients. Family therapy is usually indicated when the patient lives with family members.

Sedative/Hypnotic/Anxiolytic-Related Disorders
What is Sedative, Hypnotic, or Anxiolytic Use Disorder?

A diagnosis for sedative, hypnotic or anxiolytic use disorder is based on a problematic pattern of drug use leading to significant impairment or distress, as demonstrated by at least two of the following, occurring within a 12-month period:

  • Sedatives, hypnotics, or anxiolytics (anti-anxiety drugs) are often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to reduce or control sedative, hypnotic, or anxiolytic use.
  • A great deal of time is spent trying to obtain the sedative, hypnotic, or anxiolytic; use it; or recover from its effects.
  • A person has a craving or strong desire to use the sedative, hypnotic, or anxiolytic.
  • Recurrent sedative, hypnotic, or anxiolytic use results in a failure to fulfill major obligations at work, school, or home.
  • A person continues sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused of exacerbated by the effects of its use.
  • Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use.
  • There is recurrent use of the sedative, hypnotic, or anxiolytic in situations that are physically hazardous.
  • Sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by the drug.
  • Tolerance is developed, as defined by either of the following:
    • A need for increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect.
    • A reduced effect with continued use of the same amount of the sedative, hypnotic, or anxiolytic.
  • Withdrawal, as demonstrated by either of the following:
    • Characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics.
    • Sedative, hypnotics, or anxiolytics (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

Sedative, hypnotic or anxiolytic use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms. A diagnosis of unspecified sedative, hypnotic, or anxiolytic-related disorder may apply when there are symptoms characteristic of sedative, hypnotic, or anxiolytic-related disorder but the symptoms do not meet the full criteria for one of these specific disorders, nor any of the disorders in the substance-related and addictive disorders diagnostic class.

What is the diagnosis for Sedative, Hypnotic or Anxiolytic Intoxication?

A diagnosis of sedative, hypnotic or anxiolytic intoxication is based on recent use of one of these drugs while demonstrating:

  • Significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood changes, impaired judgment)
  • One or more of the following symptoms:
    • Slurred speech
    • Incoordination
    • Unsteady gait
    • Rapid eye movements
    • Impairment in cognition (e.g., attention, memory)
    • Stupor or coma

The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

What is the diagnosis for Sedative, Hypnotic or Anxiolytic Withdrawal?

A diagnosis of sedative, hypnotic or anxiolytic withdrawal is based on a person stopping/reducing prolonged use of one of these drugs with two or more of the following symptoms appearing within several hours to a few days:

  • Autonomy hyperactivity (e.g., sweating or pulse rate greater than 100 pbm.
  • Hand tremor
  • Insomnia
  • Nausea or vomiting
  • Transient visual, tactile, or auditory hallucinations or illusions
  • Psychomotor agitation
  • Anxiety
  • Seizures
Are there Other Sedative, Hypnotic, or Anxiolytic-Induced Disorders?

Yes, other sedative, hypnotic, or anxiolytic-induced disorders include sedative, hypnotic, or anxiolytic-induced psychotic disorder; sedative, hypnotic, or anxiolytic-induced bipolar disorder; sedative, hypnotic, or anxiolytic-induced depressive disorder; sedative, hypnotic, or anxiolytic-induced anxiety disorder; sedative, hypnotic, or anxiolytic-induced sleep disorder; and sedative, hypnotic, or anxiolytic-induced sexual dysfunction. These disorders are diagnosed instead of sedative, hypnotic, or anxiolytic intoxication or withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.

What are treatments for sedative, Hypnotic, or Anxiolytic-Induced Disorders?

Recovery from a sedative, hypnotic, or anxiolytic-induced disorder typically involves a one-month period of abstinence, along with behavioral counseling that includes instruction on stress management, relaxation, and coping techniques. Medication may be used to reduce withdrawal symptoms and help maintain abstinence. Self-help groups such as 12-step programs and other types of recovery programs can provide long-term support and help prevent relapse.

Stimulant-Related Disorders
What is Stimulant Use Disorder?

A diagnosis of “stimulant use disorder” is based on a pattern of amphetamine-type substance, cocaine, or other simulant use leading to significant impairment or distress, as demonstrated by at least two of the following symptoms occurring with a 12-month period:

  • The stimulant is often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to reduce or control stimulant use.
  • A great deal of time is spent trying to obtain the stimulant, use it, or recover from its effects.
  • A person has a craving or strong desire to use the stimulant.
  • Recurrent stimulant use results in a failure to fulfill major obligations at work, school, or home.
  • A person continues stimulant use despite having persistent or recurrent social or interpersonal problems caused of exacerbated by the effects of its use.
  • Important social, occupational, or recreational activities are given up or reduced because of stimulant use.
  • There is recurrent use of the stimulant in situations that are physically hazardous.
  • Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by the stimulant.
  • Tolerance is developed, as defined by either of the following:
    • A need for increased amounts of the stimulant to achieve intoxication or desired effect.
    • A reduced effect with continued use of the same amount of the stimulant.
  • Withdrawal, as demonstrated by either of the following:
    • Characteristic withdrawal syndrome for the stimulant.
    • The stimulant (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

Stimulant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

A diagnosis of “unspecified stimulant disorder” may apply in situations in which a person shows symptoms characteristic of an opioid-related disorder, but the symptoms do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

What is the diagnosis for Stimulant Intoxication?

A diagnosis of “stimulant intoxication” is based on recent use of an amphetamine-type substance, cocaine, or other simulant while demonstrating the following:

  • Significant problematic behavioral or psychological changes (e.g. euphoria or blunted emotions, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension or anger, impaired judgment).
  • Two or more of the following symptoms:
    • Rapid heartbeat or slower than normal heart rate
    • Pupillary dilation
    • Elevated or lowered blood pressure
    • Perspiration or chills
    • Nausea or vomiting
    • Weight loss
    • Psychomotor agitation or retardation
    • Muscular weakness, respirator depression, chest pain, or cardia arrhythmias
    • Confusion, seizures, coma, involuntary movements/muscle contractions

The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.

What is the diagnosis for Stimulant Withdrawal?

A diagnosis of “stimulant withdrawal” is based on a person stopping/reducing prolonged amphetamine-type substance, cocaine, or other stimulant use while demonstrating two or more of the following symptoms within a few hours to several days:

  • Fatigue
  • Vivid, unpleasant dreams
  • Insomnia or sleeping too much
  • Increased appetite
  • Psychomotor retardation or agitation

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication or withdrawal with another substance.

Are there other Stimulant-Related Disorders?

Yes, other stimulant-related disorders include stimulant-induced psychotic disorder, simulant-induced bipolar disorder, stimulant-induced depressive disorder, stimulant-induced anxiety disorder, stimulant-induced obsessive-compulsive disorder, stimulant-induced sleep disorder, and stimulant-induced sexual dysfunction. These stimulant-induced disorders are diagnosed instead of stimulant intoxication or stimulant withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.

What are the treatments for Stimulant-Related Disorders?

Treatment of stimulant-related disorders first requires patients to remain abstinent from the drug. Treatment of specific amphetamine-induced disorders (e.g., psychotic disorder, anxiety disorder) with antipsychotic drugs and anxiolytics may be necessary on a short-term basis. Antipsychotics may be prescribed for the first few days. If there are no symptoms of psychosis, diazepam (Valium) is useful to treat patients’ agitation and hyperactivity. Coexisting conditions, such as depression, may respond to antidepressant medication. Bupropion (Wellbutrin) may be of use after patients have withdrawn from amphetamine use.

Patients withdrawing from cocaine typically experience fatigue, dysphoria, disturbed sleep, and some craving; many experience depression. No pharmacological agents reliably reduce the intensity of withdrawal, but recovery over a week or two is generally uneventful. Because of the cocaine user’s intense craving for the drug, attaining abstinence can be difficult. It may require complete or partial hospitalization to remove a patient from the usual settings in which they had obtained or used cocaine.

Stimulant addiction treatment involves non-confrontational behavioral counseling that provides general information about the addiction process and specifics about the individual treatment plan. Counseling may be offered to family and significant others. In addition to initial individual counseling, a treatment plan for a stimulant-related disorder usually includes setting up abstinence goals, attending group therapy, encouraging family support, and establishing long-term support and follow-up.

Tobacco-Related Disorders
What is Tobacco Use Disorder?

A diagnosis of “tobacco use disorder” is based on a problematic pattern of tobacco use (smoking cigarettes or pipes, or chewing tobacco), leading to significant impairment or distress as demonstrated by at least two of the following symptoms, occurring within a 12-month period:

  • Tobacco use is often done in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to reduce or control tobacco use.
  • A great deal of time is spent trying to obtain tobacco, use it, or recover from its effects.
  • A person has a craving or strong desire to use tobacco.
  • Recurrent tobacco use results in a failure to fulfill major obligations at work, school, or home.
  • A person continues tobacco use despite having persistent or recurrent social or interpersonal problems caused of exacerbated by the effects of its use (e.g., arguments with others about tobacco use).
  • Important social, occupational, or recreational activities are given up or reduced because of tobacco use.
  • There is recurrent use of tobacco in situations that are physically hazardous (e.g., smoking in bed).
  • Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by tobacco.
  • Tolerance is developed, as defined by either of the following:
    • A need for increased amounts of tobacco to achieve intoxication or desired effect.
    • A reduced effect with continued use of the same amount of tobacco.
  • Withdrawal, as demonstrated by either of the following:
    • Characteristic withdrawal syndrome for tobacco.
    • Tobacco (or a closely related substance, such as nicotine) is taken to relieve or avoid withdrawal symptoms.

Stimulant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

A diagnosis of “unspecified stimulant disorder” may apply in situations in which a person shows symptoms characteristic of an opioid-related disorder, but the symptoms do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

Stimulant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.

A diagnosis of “unspecified tobacco-related disorder” may apply in situations in which a person shows symptoms characteristic of a tobacco-related disorder, but the symptoms do not meet the full criteria for any specific tobacco-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.

Are there other Tobacco-Induced Disorders?

Yes, “tobacco-induced sleep disorder” is a diagnosis based on severe disturbance in sleep caused by tobacco use. Types of tobacco-induced sleep disorders include:

  • Insomnia type – characterized by difficulty falling asleep or maintaining sleep, frequent nocturnal awakenings, or nonrestorative sleep.
  • Daytime sleepiness type – characterized by excessive sleepiness/fatigue during waking hours, or, less commonly, a long sleep period.
  • Parasomnia type – Characterized by abnormal behavioral events during sleep.
  • Mixed type – characterized by a substance/medication-induced sleep problem with multiple types of sleep symptoms, but no symptom clearly predominates.
What is the diagnosis for Tobacco Withdrawal?

A diagnosis of “tobacco withdrawal” is based on stopping or reducing daily tobacco use (smoking or chewing tobacco) after at least several weeks. Four or more of the following symptoms are required for the diagnosis:

  • Irritability, frustration, or anger
  • Anxiety
  • Difficulty concentrating
  • Increased appetite
  • Restlessness
  • Depressed mod
  • Insomnia

The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.

What are treatments for Tobacco Use Disorder?

Tobacco use disorder is considered highly treatable when the appropriate pharmacological, behavioral, and psychosocial interventions are used. Treatment may include behavioral therapy, education about the nature and health consequences of tobacco addiction, individual and group addiction support programs, relapse prevention counseling, hypnosis, and tailored treatments for those with lower or higher motivation to quit. Nicotine replacement medications may be used to treat nicotine dependence. Non-nicotine medications may help patients who fail replacement therapy. Bupropion (Zyban) is an antidepressant medication that has both dopaminergic and adrenergic action. In one study, combined bupropion and nicotine patch had higher quite rates than either alone. Other medications that may be helpful include nortriptyline (Pamelor) and clonidine (Catapres).

Return To Mental Health Library
Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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