• MALADAPTIVE PATTERN OF DRUG USE LEADING TO CLINICAL IMPAIRMENT OF DISTRESS
• A CLUSTER OF COGNITIVE, BEHAVIORAL, PHYSIOLOGICAL SYMPTOMS
• REPEATED PATTERN OF SELF-ADMINISTERED CON LEAD TO TOLERANCE, WITHDRAWAL, COMPULSIVE DRUG TAKING BEHAVIOR
• PERSISTENT USE OF DRUG DESPITE KNOWING ITS PROBLEMATIC
• PERSON HAS CRAVING -STRONG DESIRE FOR DRUG
• 3 OR MORE SYMPTOMS OCCURRING IN 12 MTHS

1. TOLERANCE:

• A NEED TO INCREASE TH AMT OF DRUG USED TO ACHIEVE HIGH OR INTOXICATION
• MARKEDLY DIMINISHED EFFECT WITH CONTINUED USE

2.WITHDRAWAL

• SPECIFIC SYMPTOMS DEVELOPED DUE TO DRUG STOPPAGE
• SPECIFIC SYMPTOMS SYNDROME  CAUSE IMPAIRMENT/DISTRESS IN FUNCTIONING
• EITHER SAME DRUG OR AGONIST (METHADONE) IS GIVEN TO RELIEVE OR AVOID WITHDRAWAL SYMPTOMS

3. drug is taken in large amounts and over longer time period than intended

4. persistent desire or unsuccessful efforts to cut down or control drug use

5. much time spent on activities to get the drug, use it, and recover from its effects

6. social, occupational, recreational activities are impaired, reduced, given up to use drugs privately

7. continued drug use despite knowing it is problematic

1. WITH PHYSIOLOGICAL DEPENDENCE: EITHER TOLERANCE OR WITHDRAWAL IS EVIDENT
2. W/O PHYSIOLOGICAL DEPENDENCE: NO EVIDENCE OF TOLERANCE OR WITHDRAWAL

1. Early full remission:

- at least 1 mth - for less than 12 mth - there is no criteria for dependence or abuse

2. Early partial remission:

- at least 1 mth - for less than 12 mth - 1 or more criteria met for dependence or abuse

3. Sustained full remission:

- during 12 mth or longer - no criteria met for dependence or abuse

4. Sustained partial remission:

- during 12 mth or longer - 1 or more criteria met for dependence or abuse

1. On Agonist therapy:

- used if clt is precribed agonist med - methadone

- no criteria for dependence or abuse met for past mth

2. In a Controlled Environment:

- use if clt access to drugs are restricted

- no criteria for dependenceor abuse met for past mth

a. CritA. maladaptive pattern of recurrent drug use

- lead to clinical impaired/distress

- 1 or more symptoms occurring within 12 mths

- symptoms:

        1. recurrent drug use lead to unmet obligations

        2. recurrent drug use when physically hazardous - while driving

        3. recurrent drug-related problems

        4. continued drug use despite social, interpersonal problems

a. CritB. The symptoms have never met the criteria for substance dependence

1. critA When druug is stopped or reduced, drug specific symptoms developed or drug-specific withdrawal syndrome developed.
2. critB Cause clinical significant impairment and distress
3. critC not better accounted for by mental disorder or gmc

1.  crtiA. when drug has recently been ingested or exposed to, reversible drug-specific symptoms developed during or shortly after drug use
2. critB.cause clinical maladaptive behavioral and psychological changes  due to effect of drug on CNS

1. critA. recent alcohol use

2. critB. cause clinical significant maladaptive 

- behavioral/psychological changes

- developed during or shortly after use

• inappropriate sexual/aggressive behavior
• impaired judgment/functioning
• labile mood developed during or shortly after use

3. critC. physiological symptoms:

• slurred speech
• unsteady gait
• uncoordinated
• impaired memory/attention
• nystagmus - rapid eye movemt
• stupor/coma

 4. critD. not due - gmc/mental disorder

1. critA. when client stopped or reduced the heavy/prolonged alcohol use

2. critB. 2 or more symptoms develop within several hours to a few days

• autonomic hyperactivity - sweats/increased pulse over 100
• increased hand tremor
• grand mal seizures more than 3%
• hallucinations
• n/v, anxiety, psychomotor agitation

3. critC. cause clinical impairment and distress

4. critD. not due - gmc or mental disorder

a. types: metamphetamine - speed, methylphen - diet pill, dextramphetamine

b. taken: oral, snort, IV, smoked

1. critA. recent use

2. critB. clinical significant maladaptive

- behavioral and psychological changes

- occur during or shortly after drug use

• -euphoria
• -tension/anger
• -stereotyped behaviors
• -interpersonal sensitivity
• -hypervigilant
• -n/v, anxiety, impaired judgment/functioning

 3. critC. 2 or more physiological symptoms:develop during or shortly after amphet use

• -tachycardia
• -elevated BP
• -sweats/chills
• -dilated pupils
• -muscle weakness
• -confusion

4. critD. not due - gmc or mental disorder

With perceptual disturbance:

• client known hallucinations
• tactile, auditory, visual
• not external reality
• interal reality testing - client knows that the hallucinations are due to the drug use

1. critA. when the person stop or reduces the prolonged and heavy amphetamine use

2. critB. dysphoric mood plus 2 or more symptoms:

• -fatigue
• -vivid unpleasant dreams
• -insomnia/hypersomnia
• -increased appetite
• -psychomotor retardation

3. critC. cause clinical significant impairment/distress - social/work functioning

4. critD. not due - gmc or md

1. critA. recent ingestion of caffeine

• -more than 250mg
• -more than 2 cups of coffee

2. critB. 5 or more symptoms: developed during or shortly after drinking

• -nervous
• -excited
• -restless
• -muscle twitching
• -rambling
• -flush face
• -GI disturbance

3. critC. cause clinical impairment/distress in social/work functioning

4. critD. not due gmc or md

• Americans consume average 200mg per day
• 30% report consuming over 500mg per day
• weight aids 75-200mg per pill - highest
• cholate/cocoa 5mg per bar - lowest

1. critA. recent use

2. critB. clinical significant maladaptive - behavioral and psychological changes

• -impaired motor coordination
• -social withdrawal
• -euphoria
• -slowed time sensation
• -impaired judgment
• -anxiety

3. critC. 2 or more physiological symptoms developed within 2hrs of cannabis use

• -conjunctival injection
• -increased appetite
• -dry mouth
• -tachycardia

4. critD. not due - gms or md

• Irritable mood
• Anxiety
• Tremor
• Sweats
• Sleep and appetitedisturbances