1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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)

9. 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.

10. 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 )
Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

11. 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

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

13. 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)

14. 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),