Summary: Diagnosis Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Addiction Counselor Exam Review and Counselor Toolbox Objectives ~ Review the criteria for substance use disorder ~ Discuss substance induced disorders ~ Learn mnemonics to identify signs of intoxication and withdrawal as well as mental health symptoms Diagnosis and the DSM ~ The Diagnostic and Statistical Manual is created to ~ facilitate communication between and within professions regarding mental health and substance use disorders ~ Improve interrater reliability regarding diagnosis ~ Improve sharing of information about client presentation and needs ICD-10 ~ International Classification of Disease is used for diagnosis (like the DSM) Diagnosis of Substance Use Disorders ~ The DSM V recognizes 10 separate classes of drugs ~ Alcohol ~ Inhalants ~ Opioids ~ Sedatives ~ Hypnotics/Barbiturates ~ Anxiolytics ~ Stimulants ~ Caffeine ~ Tobacco ~ Cannabis ~ Hallucinogens ~ Other/Unknown substances SUD Diagnosis ~ Although how each types of drug acts in the brain differs, they all activate the brain’s reward system ~ Two groups of substance disorders ~ Substance use ~ Substance induced SUD Diagnosis ~ Diagnosis ~ Using in larger amounts or for longer than intended ~ Wanting to cut down or stop but failing ~ Spending increased time getting, using or recovering from use ~ Cravings and urges ~ Neglecting work, school, family, social obligations because of use ~ Continue to use even when it causes problems in relationships ~ Giving up important social, occupational, recreational activities because of use ~ Using in risky situations ~ Continuing to use despite knowing that it is making a physical or psychological problem worse ~ Tolerance ~ Withdrawal Diagnosis of Substance Use Disorders ~ SUD severity is dependent on how many symptoms are present ~ 2-3 symptoms = Mild ~ 4-5 = Moderate ~ More than 5 severe ~ Qualifiers ~ In early remission ~ In sustained remission ~ On maintenance therapy ~ In a controlled environment Substance Induced vs. Mental Illness Dx ~ Substance induced means that the current presenting symptoms are likely the result of use of a substance not an underlying (pre-existing) mental disorder ~ Concurrent mental disorders can (and often do) occur Substance-Induced Disorder Diagnosis ~ Result from effects of the use of a substance ~ Intoxication ~ Withdrawal ~ Anxiety or depressive disorders ~ Bipolar and related disorders ~ Psychotic disorders (hallucinations, delusions) ~ Sleep disorders ~ Sexual dysfunctions ~ Neurocognitive disorders ~ The teeter-totter principle helps predict symptoms in the withdrawal period (Polysubstance complicates things) Depressants ~ Alcohol, Sedative, Hypnotic, or Anxiolytic Intoxication (SAM'S GIN) Slurred Speech Attention impairment Memory impairment Stupor or coma or death Gait unsteady Incoordination Nystagmus Depressants ~ Alcohol, Sedative, Hypnotic, or Anxioloytic Intoxication Withdrawal (PAST NITES) Psychomotor agitation Anxiety Seizures (Grand-Mal) Transient hallucinations Nausea or vomiting Insomnia Tremor increased (hand) Excitability-autonomic (Increased HR and BP) Sweating (diaphoresis) Stimulants ~ Amphetamine/Cocaine Intoxication (A CODE BLUE) Agitation or retardation (psychomotor) Cardiac (tachycardia or bradycardia) Opening of the pupil Diaphoresis (or chills) Encephalopathic-like changes (seizures, confusion, dyskinesias, dystonias, or coma) Blood pressure (elevated or lowered) Loss of stomach content Unstable muscle-associated changes (diaphramatic, cardiac, and skeletal) i.e., muscle weakness, respiratory depression, arrhythmias Evidence of weight loss Stimulants Amphetamine/Cocaine Withdrawal (D-PANTS) Depression (suicidal) P -Psychomotor agitation or retardation A -Appetite increases N -Nightmares (vivid, unpleasant dreams) T -Tiredness (fatigue) S -Sleep (hypersomnia or insomnia) Cannabis and Hallucinogens Hallucinogen Intoxication (DISTORT) Disoriented (blurred) vision Incoordination Sweating Tachycardia Op
