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2. 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

3. 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)

4. 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)

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)

6. DSM-IV vs DSM-5

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

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

21. 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.

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

23. 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),

24. 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),

25. 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),

26. 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),

27. Psychiatric comorbidities

28. 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),

29. 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),

30. 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),

31. 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)

32. 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)

33. 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)

34. End of presentation