Early Full Rmission: if, for at least 1 month, but less than 12 months, no criteria for Dependence or Abuse have been met

Early Full Rmission: if, for at least 1 month, but less than 12 months, one or more criteria for Dependence or Abuse have been met (but the full criteria for Dependence have not been met).

Sustained Full Remission: if none of the criteria for Dependence or Abuse have been met at any time during a period of 12 months or longer.

Sustained Partial Remission: if full criteria for Dependence have not been met for a period of 12 months or longer; however, one or more dciteria for Dependence or Abuse have ben met. 

On Agonist Therapy: if the individual is on a prescribed agonist medication such as methadone and no criteria for Dependence or Abuse have been met for that class of medication for at least the past month (except tolerance to, or withdrawal from, the agonist).  This category also applies to those being treated for Dependence using a partial agonist or an agonist / antagonist.

In a Controlled Environment: if the individual is in an environment where access to alcohol and controlled substances is restriced, and no criteria for Dependence or Abuse have been met for at least the past month.  Examples of these environments are closely supervised and substance-free jails, therapeutic communities, or locked hospital units. 

With Perceptual Disturbances: when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.  Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality.  When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered 

Criteria for Substance Dependence

A maladaptive pattern of sbstance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring at any time in the same 12-month period:

1 - tolerance, as defined by either of the following:

a - a need for markedly increased amounts of the substance to achieve intoxication or desired effect
b - markedly diminished effect with continued use of the same amount of the substnace

2 - withdrawal, as manifested by either of the following:

a- the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawl from the specific substances)
b - the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms 

3 - the substance is often taken in larger amounts or over a longer period than was intended

4 - there is a persistent desire or unsuccessful efforts to cut down or control substance use

5 - a great deal of time is spent in activities necessary to obtain the substance (visiting multiple doctors or driving long distances),use the substance(chain-smoking), or recover from its effects

6 - important social, occupational, or recreational activities are given up or reduced because of substance use

7 - the substance 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 the substance (current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal
Without Physiological Dependence: no evidence of tolerance or withdrawal
Course specifiers
Early Full Remission
Early Parial Remission
Sustained Full Remission
Sustained Partial Remission
On Agonist Therapy
In a Controlled Environment 

Criteria for Substance Abuse

A) A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, occuring within a 12-month period:

1 - recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (repeared absences or pro work performance related to substance use; substance-related absences, suspensions, or ecpulsions from school; neglect of children or household)

2 - recurrent substance use in situations in which it is physically hazardous(driving an automobile or operating a machine when impaired by substance use)

3 - recurrent substance-related legal problems(arrests for substance-related disorderly conduct)

4 - continuted substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (arguments with spouse about consequences of intoxication, physical fights)

B) The symptoms have never met the criteria for Substance Dependence for this class of substance. 

A) The development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance.  Note: Different substances may produce similar or identical syndromes.

B) Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system (Belligerence, mood lability, cognitive impairment, impaired judgment, impaired social or occupational functioning) and develop during or shortly after use of the substance.

C) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. 

A) The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged.

B) The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. 

A) Recent ingestion of alcohol.

B) Clinicaly significant maladaptive behavioral or psychological changes (inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaird social or occupational functioning) that developed during, or shortly after, alcohol ingestion.

C) One or more of the following signs, developing during, or shortly after, alcohol use:

1 - slurred speech
2 - incoordination
3 - unsteady gait
4 - nystagmus
5 - impairment in attention or memory
6 - stupor or coma

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. 

A) Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

B) Tow or more of the following, developing within several hours to a few days after Criterion A:

1 - autonomic hyperactivity (seating or pulse rate greater than 100)
2 - increased hand tremor
3 - insomnia
4 - nausea or vomiting
5 - transient visual, tactile, or auditory hallucinations or illusions
6 - psychomotor agitation
7 - anxiety
8 - grand mal seizures

C) The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:

With Perceptual Disturbances: in the rare instance when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.  Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality.  When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered.

A) Recent use of amphetamine or a related substance (methylphenidate).

B) Clinically significant maladaptive behavioral or psychological changes (euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of amphetamine or a related substance.

C) Two or more of the following, developing during, or shortly after, use of amphetamine or a related substance:

1 - tacycardia or bradycardia
2 - pupillary dilation
3 - elevated or lowered blood pressure
4 - perspiration or chills
5 - nausea or vomiting
6 - evidence of weight loss
7 - psychomotor agitation or retardation
8 - muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
9 - confusion, seizures, dyskineaias, dystonias, or coma

D) The symptoms are not due to a general medical condition and re not better accounted for by another mental disorder.

Specify if: With Perceptual Disturbances 

A) Cessation of (or reduction in) amphetamine (or a related substance) use that has been heavy and prolonged.

B) Dysphoric mood and two or more of the following physiological changes, developing within a few hours to several days after Criterion A:
1 - fatigue
2 - vivid, unpleasant dreams
3 - insomnia or hypersomnia
4 - increased appetite
5 - psychomotor retardation or agitation

C) The symptoms in Criterion B cause clinically significant distress or impariment in social, occupational, or other important areas of functioning.

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. 

A) Recent consumption of caffeine, usually in excess of 250 mg (more than 2-3 cups coffee)

B) Five or more of the following signs, developing during, or shortly after, caffeine use:

1 - restlessness
2 - nervousness
3 - excitement
4 - insomnia
5 - flushed face
6 - diuresis
7 - gastrointestinal disturbance
8 - muscle twitching
9 - rambling flow of thought and speech
10 - tachycardia or cardia arrhythmia
11 - periods of inexhaustibility
12 - psychomotor agitation

C) The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (an Anxiety Disorder). 

A) Recent use of cannabis 

B) Clinically significant maladaptive behavioral or psychological changes (impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.

C) Two or more of the following signs, developing within 2 hours of cannabis use:

1 - conjunctival injection
2 - increased appetite
3 - dry mouth
4 - tachycardia

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if: With Perceptual Disturbances

A) Recent use of cocaine

B) Clinically significant maladaptive behavioral or psychological changes (euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly afte, use of cocaine.

C) Two or more of the following, develping during, or shortly after, cocaine use:

1 - tachycardia or bradycardia
2  - pupillary dilation
3 - elevated or lowered blood pressure
4 - perspiration or chills
5 - nausea or vomiting
6 - evidence of weight loss
7 - psychomotor agitation or retardation
8 - muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
9 - confusion, seizures, dyskinesias, dystonias, or coma

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if: With Perceptual Disturbances 

A) Cessation of (or reduction in) cocaine use that has been heavy and prolonged.

B) Dysphoric mood and two or more of the following physiological changes, developing within a few hours to several days after Criterion A:

1 - fatigue
2 - vivid, unpleasant dreams
3 - insomnia or hypersomnia
4 - increased appetite
5 - psychomotor retardation or agitation

C) The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder 

A) Recent use of a hallucinogen.

B) Clinically significant maladaptive behavioral or psychological changes (marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, hallucinogen use.

C) Perceptual changes occurring in a state of full wakefulness and alertness (subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synethesias) that develped during, or shortly after, hallucinogen use.

D) Two or more of the following signs, developing during, or shortly after, hallucinogen use:

1 - pupillary dilation
2 - tachycardia
3 - sweating
4 - palpitations
5 - blurring of vision
6 - tremors
7 - incoordination

E) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. 

Hallucinogen Persisting Perception Disorder

(Flashbacks) 

A) The reexperiencing, following cessation of use of a hallucinogen, of one or more of the perceptual symptoms that were ecperienced while intoxicated with the hallucinogen (Geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia).

B) The symptoms in Criterion A cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C) The symptoms are not due to a general medical condition (anatomical lesions and infections of the brain, visual epilepsies) and are not better accounted forby another mental disorder (delirium, dementia, Schizophrenai) of hypnopompic hallucinations.