Assessment of Substance Use Disorders Methods vary, but generally fall into 3 categories: 1. Physiological or biochemical 2. Interview by clinician 3. Self-report screening tools or measures/intruments

SUBSTANCE CLASSES Major Stimulants Minor Stimulants (tobacco; caffeine) Depressants Alcohol Inhalants Benzodiazepines, barbiturates, sedatives, dissociative anesthetics Hallucinogens Cannabinoids Opioids

DSM-V SUBSTANCE CLASSES Diagnoses Associated with Substance Class (p. 482 in DSM-5) Diagnoses Associated with Substance Class Psychotic Bipolar Depressive Anxiety OCD & related Sleep Sexual Delirium Neuro-cognitive Sbst. use Intoxication Withdrawal Alcohol I/W I/W/P X Caffeine I Cannabis Hallucinogens Phencylidine Other Hallucinogens I* Inhalants I/P Opiods W Sedatives, hypnotics, or anxiolytics Stimulants** Tobacco Other X=category is recognized in DSM-5 I=specifier "with onset during intoxication" may be noted for the category W=specifier "with onset during withdrawal" may be noted for the category I/W=either of the above specifiers may be noted P=the disorder is persisting *also hallucinogen persisting perception disorder (flashbacks) **includes amphetamine-type substances, cocaine, & other or unspecified stimulants

SUBSTANCE RELATED DISORDERS DSM-IV CRITERIA FOR SUBSTANCE DEPENDENCE - need at least 3 of the following within 12-month period - symptoms present at least 1 month or occur repeatedly over time Tolerance (physical dependence present) Withdrawal Substance taken in larger amounts or over a longer period than intended (loss of control) Persistent desire, or unsuccessful efforts, to cut down or control substance use

CRITERIA FOR SUBSTANCE DEPENDENCE SUBSTANCE RELATED DISORDERS CRITERIA FOR SUBSTANCE DEPENDENCE Much time spent in activities needed to obtain, use, and recover from the substance Important social, family, school, work, or recreational activities are given up or reduced because of the substance use Substance use is continued despite knowing that physical or psychological problems are likely to be caused or exacerbated by the substance

SUBSTANCE DEPENDENCE – Course Specifiers SUBSTANCE RELATED DISORDERS SUBSTANCE DEPENDENCE – Course Specifiers Early full remission: > 1 month < 12 months Early partial remission: > 1 month < 12 months; one or more criteria for dependence or abuse met, but full criteria not met Sustained full remission: > 12 months Sustained partial remission: > 12 months, but 1 or more criteria met On agonist therapy In controlled environment

SUBSTANCE RELATED DISORDERS DSM-IV CRITERIA FOR SUBSTANCE ABUSE - need at least 1 of the following within 12-month period - symptoms have never met criteria for Dependence for this class of substance Failure to fulfill role obligations at school, work, or home (e.g., many absences or poor work performance; neglect of kids) Recurrent use in physically hazardous situations (e.g., driving) Recurrent legal problems (e.g., disorderly conduct) Continued use despite persistent social, interpersonal problems (e.g., verbal or physical aggression directed at spouse) ** MUST NOT MEET CRITERIA FOR SUBSTANCE DEPENDENCE (for a particular substance)

DSM-V SUBSTANCE USE DISORDER 11 GENERAL CRITERIA (etoh as ex.) Alcohol Use Disorder – a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: Alcohol 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 alcohol use. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. Craving, or a strong desire or urge to use alcohol. (new to DSM-5)

DSM-V SUBSTANCE USE DISORDER GENERAL CRITERIA, cont’d. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. Recurrent alcohol use in situations in which it is physically hazardous. Alcohol 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 alcohol.

DSM-V SUBSTANCE USE DISORDER GENERAL CRITERIA, cont’d. Tolerance, as defined by either of the following: A need for markedly 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 manifested by either of the following: The characteristic withdrawal syndrome for alcohol (refer to Criteria A & B of the criteria set for alcohol withdrawal, pp. 499-500) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

DSM-V SUBSTANCE USE DISORDER SPECIFIERS In early remission: After full criteria for alcohol use disorder previously met, none of the criteria for alcohol use disorder have been met for at least 3 months but for less than 12 months (with exception that Criterion A4, “Craving…” may be met). In sustained remission: After full criteria for alcohol use disorder previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that “Craving” may be met). In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted

DSM-V SUBSTANCE USE DISORDER SEVERITY Specify current severity: 305.00 Mild: Presence of 2-3 symptoms. 303.90 Moderate: Presence of 4-5 symptoms. 303.90 Severe: Presence of 6 or more symptoms.

SUBSTANCE RELATED DISORDERS Assessment Tools Semi-structured interviews / intakes Structured Clinical Interviews for the DSM (SCID) Survey instruments (e.g., AUI; Addiction Severity Index; DRINC-2R – Drinker Inventory of Consequences) Brief Screens (e.g., MAST; DAST; CAGE)

SUBSTANCE RELATED DISORDERS Assessment Tools Alcohol Use Inventory (AUI) AUDIT Drug Use Profile (just descriptive) MAST; DAST CAGE MAST DRINC-2R – Drinker Inventory of Consequences CAGE (Cut down, Annoyed by others who have commented that you drink too much, Guilty about your drinking, Eyeopener – ever had drink first thing in morning to steady your nerves or get rid of hangover) 4 questions; 2 or more affirmative responses indicates problematic drinking sensitivity: detects alcohol dependence in 85% of alcoholics specificity: can usually distinguish alcoholics from non-alcoholics 90+% of the time Criticisms of the CAGE: not very gender-sensitive; less effective in reliably assessing problems identifies only more severe types of alcohol problems is based on lifetime questions (have you ever…) so doesn’t account for recent windows of time Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association, 252(14), 1905-1907.