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Diagnosis and Recognition of OUD Joji Suzuki, MD Director, Division of Addiction Psychiatry Department of Psychiatry, Brigham and Women’s Hospital Assistant Professor of Psychiatry, Harvard Medical School

Substance use disorder Outline Key differences between DSM-IV and DSM-5 for opioid use disorder Another way to conceptualize addiction Importance of psychiatric comorbidities Substance use disorder (DSM-5)

Substance use disorder Outline Key differences between DSM-IV and DSM-5 for opioid use disorder Another way to conceptualize addiction Importance of psychiatric comorbidities Substance use disorder (DSM-5)

Substance use disorder Outline Key differences between DSM-IV and DSM-5 for opioid use disorder Another way to conceptualize addiction Importance of psychiatric comorbidities Substance use disorder (DSM-5)

DSM-IV vs DSM-5

Substance dependence Substance abuse (DSM-IV) (DSM-IV) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance abuse (DSM-IV) Using the substance in hazardous situations Recurrent legal problems related to substance use Failed role obligations due to substance use Social conflict due to the substance use Substance abuse (DSM-IV) 4 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance abuse (DSM-IV) Using the substance in hazardous situations Recurrent legal problems related to substance use Failed role obligations due to substance use Social conflict due to the substance use Substance abuse (DSM-IV) 4 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance abuse (DSM-IV) Using the substance in hazardous situations Recurrent legal problems related to substance use Failed role obligations due to substance use Social conflict due to the substance use Substance abuse (DSM-IV) 4 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance abuse (DSM-IV) Using the substance in hazardous situations Recurrent legal problems related to substance use Failed role obligations due to substance use Social conflict due to the substance use Substance abuse (DSM-IV) 4 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance abuse (DSM-IV) Using the substance in hazardous situations Recurrent legal problems related to substance use Failed role obligations due to substance use Social conflict due to the substance use Substance abuse (DSM-IV) 4 criteria 1 criterion Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance dependence (DSM-IV) 7 criteria Physiologic dependence of tolerance Withdrawal Frequently using more than intended Persistent desire or inability to cut back or stop Continued use despite knowledge of harm Spending a lot of time using and recovering from the substance Important activities are given up due to the substance. Substance dependence (DSM-IV) 7 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance dependence (DSM-IV) 7 criteria Physiologic dependence of tolerance Withdrawal Frequently using more than intended Persistent desire or inability to cut back or stop Continued use despite knowledge of harm Spending a lot of time using and recovering from the substance Important activities are given up due to the substance. Substance dependence (DSM-IV) 7 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance dependence (DSM-IV) 7 criteria Physiologic dependence of tolerance Withdrawal Frequently using more than intended Persistent desire or inability to cut back or stop Continued use despite knowledge of harm Spending a lot of time using and recovering from the substance Important activities are given up due to the substance. Substance dependence (DSM-IV) 7 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance dependence (DSM-IV) 7 criteria Physiologic dependence of tolerance Withdrawal Frequently using more than intended Persistent desire or inability to cut back or stop Continued use despite knowledge of harm Spending a lot of time using and recovering from the substance Important activities are given up due to the substance. Substance dependence (DSM-IV) 7 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance dependence (DSM-IV) 7 criteria 3 criteria Physiologic dependence of tolerance Withdrawal Frequently using more than intended Persistent desire or inability to cut back or stop Continued use despite knowledge of harm Spending a lot of time using and recovering from the substance Important activities are given up due to the substance. Substance dependence (DSM-IV) 7 criteria 3 criteria Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, D.C.: American Psychiatric Association.

Substance use disorder Substance abuse (DSM-IV) Substance dependence (DSM-IV) Substance use disorder (DSM-5) Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

Substance use disorder (DSM-5) Substance abuse (DSM-IV) Substance dependence (DSM-IV) Substance use disorder (DSM-5) Craving to use the substance Recurrent legal problems related to substance use Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

Substance use disorder (DSM-5) Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

Substance use disorder (DSM-5) Mild 2-3 criteria Moderate 4-5 criteria Severe 6 or more criteria Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

The three Cs of addiction Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.

The three Cs of addiction Inability to stop or reduce substance use Loss of Control Strong psychological urge to use Cravings Continued use despite consequences Consequences Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.

The three Cs of addiction Inability to stop or reduce substance use Loss of Control Strong psychological urge to use Cravings Continued use despite consequences Consequences Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.

The three Cs of addiction Inability to stop or reduce substance use Loss of Control Strong psychological urge to use Cravings Continued use despite consequences Consequences Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.

The three Cs of addiction Inability to stop or reduce substance use Loss of Control Strong psychological urge to use Cravings Continued use despite consequences Consequences Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.

Psychiatric comorbidities

Mood disorders Anxiety disorders Opioid use disorder Goldner, E. M.,et al (2014). Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: systematic review and meta-analyses. Addictive behaviors, 39(3), 520-531.

Address comorbidities simultaneously Mood disorders Anxiety disorders Address comorbidities simultaneously Opioid use disorder Goldner, E. M.,et al (2014). Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: systematic review and meta-analyses. Addictive behaviors, 39(3), 520-531.

30-day prevalence of Axis-I disorders among SUD treatment seekers Goldner, E. M.,et al (2014). Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: systematic review and meta-analyses. Addictive behaviors, 39(3), 520-531.

Substance use disorder Summary – Key Points DSM-5: Substance abuse and substance dependence were combined and renamed to “substance use disorder” 3 Cs of addiction: Loss of Control, Cravings and negative Consequences Psychiatric comorbidities  such as mood and anxiety disorders are common Substance use disorder (DSM-5)  

Substance use disorder Summary – Key Points DSM-5: Substance abuse and substance dependence were combined and renamed to “substance use disorder” 3 Cs of addiction: Loss of Control, Cravings and negative Consequences Psychiatric comorbidities  such as mood and anxiety disorders are common Substance use disorder (DSM-5)  

Substance use disorder Summary – Key Points DSM-5: Substance abuse and substance dependence were combined and renamed to “substance use disorder” 3 Cs of addiction: Loss of Control, Cravings and negative Consequences Psychiatric comorbidities  such as mood and anxiety disorders are common Substance use disorder (DSM-5)  

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