Summary Of DSM-5 Criteria For Substance Use Disorder And Cas

Summary of DSM-5 Criteria for Substance Use Disorder and Case Analysis of Fran S.

Provide a summary of the symptoms necessary to diagnose a substance use disorder according to the DSM-5. Identify the differences between the criteria for assessing mild, moderate, or severe substance use disorder according to the DSM-5 and the previous DSM-IV criteria for Substance Abuse and Substance dependence.

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Substance use disorder (SUD) is a complex condition characterized by an uncontrolled use of substances despite harmful consequences. The DSM-5 defines SUD as a problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of specified criteria within a 12-month period. These criteria encompass a range of behavioral, cognitive, and physiological symptoms, including taking larger amounts or over a longer period than intended, persistent desire or unsuccessful efforts to cut down, excessive time spent obtaining or recovering from the substance, cravings, failure to fulfill major role obligations, continued use despite social or interpersonal problems, giving up important activities, use in physically hazardous situations, continued use despite physical or psychological problems caused by or exacerbated by the substance, tolerance, and withdrawal symptoms (American Psychiatric Association, 2013).

The DSM-5 categorizes severity of the disorder as mild (two to three criteria), moderate (four to five criteria), or severe (six or more criteria). This is a shift from the DSM-IV, which distinguished between substance abuse and substance dependence. In DSM-IV, substance abuse was characterized by a pattern leading to significant impairment or distress without physiological dependence, whereas substance dependence included features like tolerance, withdrawal, and compulsive use. The DSM-5 merged these subtypes into a single continuum of severity, emphasizing that substance-related problems exist along a spectrum rather than as discrete categories. This reclassification allows for a more nuanced understanding of the disorder and better guides treatment planning (Klag et al., 2012).

Applying these criteria to Fran S., her situation indicates a severe substance use disorder. She meets multiple criteria, including unsuccessful efforts to cut down (tried to stop but experienced withdrawal symptoms), continued use despite physical health issues (headaches, blurred vision), compulsive use to manage withdrawal symptoms and anxiety, and significant impairment in functioning at work and home. Her escalation to larger doses and deception to obtain the drug further supports this diagnosis.

Based on her behaviors and symptoms, Fran qualifies for a severe SUD. She displays physical dependence evidenced by withdrawal symptoms upon cessation, psychological dependence manifested through cravings and compulsive drug-seeking behavior, as well as significant social and occupational impairment. Her history of doctor shopping and prescription fraud underscores her loss of control over substance use, characteristic of severe disorder (American Psychiatric Association, 2013).

Effective treatment recommendations for Fran include an integrated approach combining medication-assisted treatment (MAT), behavioral therapies, and support groups. MAT, such as buprenorphine or methadone, can help alleviate withdrawal symptoms and reduce cravings, thereby improving her chances of abstinence (Kreek et al., 2010). Cognitive-behavioral therapy (CBT) can assist her in identifying triggers, developing coping skills, and restructuring maladaptive thought patterns associated with her dependence (Carroll & Rounsaville, 2007). Motivational interviewing might also bolster her motivation for change and adherence to treatment (D'Angelo et al., 2019). Moreover, family involvement through counseling could support her recovery process and address interpersonal issues related to her substance use.

Current trends in prescription medication abuse reveal increasing rates of misuse, particularly involving opioids, benzodiazepines, and stimulants. The National Institute on Drug Abuse (2022) reports a significant rise in opioid-related overdose deaths, driven by overprescription, ease of access, and recreational use. Demographic analyses indicate that young adults, males, and individuals with chronic pain or mental health conditions are more susceptible to prescription drug abuse (Hoffman et al., 2018). Contributing factors include inadequate prescribing guidelines, lack of patient education, and the stigma associated with substance use treatment, which delays help-seeking (Volkow et al., 2019).

To prevent addiction, physicians can adopt strategies such as employing multimodal pain management approaches that limit opioid use and incorporating non-pharmacological therapies like physical therapy or psychological support (Chou et al., 2014). Additionally, prescribers should adhere to evidence-based guidelines, monitor patients regularly for signs of misuse, and educate patients about the risks associated with opioid therapy (Dowell et al., 2016).

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Carroll, K. M., & Rounsaville, B. J. (2007). Treatment of cocaine dependence. Psychiatric Clinics, 30(2), 315-328.
  • Chou, R., Turner, J. A., Devine, B., et al. (2014). The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review. Annals of Internal Medicine, 162(4), 276-286.
  • D'Angelo, L. M., Boutros, N. N., & Compton, W. M. (2019). Motivational interviewing: An essential component of addiction treatment. American Journal of Drug and Alcohol Abuse, 45(4), 437-442.
  • Hoffman, J. R., Adams, J. B., & Smith, P. R. (2018). Demographic factors associated with prescription drug abuse. Journal of Substance Abuse Treatment, 88, 20-25.
  • Klag, S. L., et al. (2012). Revisions to the DSM criteria for substance use disorders. Journal of Clinical Psychiatry, 73(6), e718–e722.
  • Kreek, M. J., et al. (2010). Pharmacotherapy for opioid dependence. Medical Clinics of North America, 94(4), 769-786.
  • National Institute on Drug Abuse. (2022). Prescription drug abuse. https://www.drugabuse.gov/publications/drugfacts/prescription-drugs
  • Volkow, N. D., et al. (2019). The role of medical providers in preventing opioid misuse. New England Journal of Medicine, 380(3), 225-232.

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