changes in dsm v

7/29/2019 Changes in DSM V

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Over the Hills and Far, Far

away

DSM V, the Brave New World


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Presented by Rick Moldenhauer, MS,

LADC, ICADC, LPCC

Treatment Services Consultant/State OpioidTreatment Authority

P: (651) 431 2474

F: (651) 431 7449

Alcohol and Drug Abuse Division, DHS

PO Box 64977

St Paul, Minnesota 55164-0977

[email protected]


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Notice of Copyright and

Limitations on Use and Liability

"Copyright 2009, State of Minnesota, Department of Human Services"

"This curriculum was written by the Minnesota Department of HumanServices for use in its training regarding pharmacology of drugs of addiction.The curriculum was designed for the specific purposes that may or may notapply to other locations, and may require modifications of content and/or

form before it can be used in other jurisdictions. The Minnesota Departmentof Human Services makes no representations and accepts no liability on itsuse or results. This curriculum is made available free as part of trainingprovided by the Minnesota Department of Human Services and is availablefor personal use by a single requestor for a nominal fee, which covers thecost of making, certifying, compiling and copying the materials. Any use ofthis curriculum for other than personal use requires a licensing agreement

with the department. This curriculum may not be sold, used, or reproducedfor profit or financial gain. Those accessing or copying this document agreeto be bound by the aforementioned limitations on its use. "


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http://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Plus_sign.svg/200px-Plus_sign.svg.png


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For the draft language

www.dsm5.org

Substance-Related Disorder found in:

http://www.dsm5.org/ProposedRevisions/Pa

ges/Substance-RelatedDisorders.aspx
http://www.dsm5.org/http://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/


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History of the Diagnostic and Statistical

Manual of Mental Disorders (DSM)

DSM I.1952

DSM II1968

DSM III..1980 DSM III-R..1987

DSM IV..1994

DSM IV TR2000 DSM Vplanned June 2013


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Substance Related Disorders

Substance Use Disorders;

-Substance Dependency

-Substance Abuse

Substance- Induced Disorders-Substance Intoxication

-Substance Withdrawal

Substance-Induced Mental Health DisorderIncluded Elsewhere


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Specifiers

With Physiological

Dependence: Used

when there is

evidence of toleranceor withdrawal

Without Physiological

Dependence: Used

when there is no

evidence of toleranceor withdrawal.

Substance

dependence is

characterized by apattern of compulsive

use


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Course Specifiers

Course Specifiers is based on length of

time and number of criteria met

Divided into four categories as follows


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Early Full Remission

Early Full Remission

Dependence 1 month 0-11 months

at least 1 month, but less than 12 months, no criteria met


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Early Partial Remission

Early Partial Remission

Dependence 1 month 0-11 months

atleast one month, but less than 12 months, no criteria met


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Sustained Full Remission

Sustained Full Remission

Dependence 1 month 0-11 months+

at least 12 months, no criteria met


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Sustained Partial Remission

Sustained Partial Remission

Dependence 1 month 0-11 months+

one or more, but not full criteria for 12 months or longer


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Additional Course Specifiers

On Agonist Therapy:

Used when client has

no symptoms and is

on anagonist/antagonist

medication (e.g.

methadone,

dexamphetamine)

In a Controlled

Environment:

Used when access is

restricted (e.g.hospital, jail)


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Substance intoxication

Development of a reversible substance-

specific syndrome due to recent ingestion

(or exposure to) a substance


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Major Change!!!!!!!!!

DSM V will remove the segregation

between Abuse and Dependency

diagnosis, and will be replaced by single

term Substance Use Disorder withSeverity and Course Specifiers.


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Substance Use Disorder, DSM V

A. A maladaptive pattern of substance use leading toclinically significant impairment or distress, asmanifested by 2 (or more) of the following, occurringwithin a 12-month period:

1) recurrent substance use resulting in a failure to fulfillmajor role obligations at work, school, or home (e.g.,repeated absences or poor work performance related tosubstance use; substance-related absences,suspensions, or expulsions from school; neglect ofchildren or household)

2) recurrent substance use in situations in which it isphysically hazardous (e.g., driving an automobile oroperating a machine when impaired by substance use)


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3) continued substance use despite having persistent orrecurrent social or interpersonal problems caused orexacerbated by the effects of the substance (e.g.,arguments with spouse about consequences ofintoxication, physical fights)

4) tolerance, as defined by either of the following:

a. a need for markedly increased amounts of thesubstance to achieve intoxication or desired effect

b. markedly diminished effect with continued use ofthe same amount of the substance(Note: Tolerance is not counted for those takingmedications under medical supervision such asanalgesics, antidepressants, ant-anxiety medicationsor beta-blockers.)


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7) there is a persistent desire or unsuccessful

efforts to cut down or control substance use

8) a great deal of time is spent in activities

necessary to obtain the substance, use thesubstance, or recover from its effects

9) important social, occupational, or recreational

activities are given up or reduced because of

substance use


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10) 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 thesubstance

11) Craving or a strong desire or urge to use a

specific substance.


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Caffeine

DSM IV TR:

305.90 Caffeine Intoxication

292.89 Caffeine-Induced Anxiety Disorder

292.85 Caffeine-Induced Sleep Disorder

292.9 Caffeine-Induced Disorder Not

Otherwise Specified

DSM V:

305.90 Caffeine Intoxication

292.89 Caffeine-Induced Anxiety Disorder

292.85 Caffeine-Induced Sleep Disorder

292.9 Caffeine-Induced Disorder Not

Otherwise Specified


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Cannabis

DSM IV TR: 304.30 Cannabis Dependence

304.20 Cannabis Abuse

292.89 Cannabis Intoxication

292.81 Cannabis IntoxicationDelirium

292.11 Cannabis-InducedPsychotic Disorder with Delusions

292.12 Cannabis-InducedPsychotic Disorder withHallucinations

292.89 Cannabis-Induced Anxiety

Disorder 292.9 Cannabis-Related DisorderNot Otherwise Specified

DSM V: Cannabis Use Disorder

Cannabis Withdrawal

292.89 Cannabis Intoxication

292.81 Cannabis IntoxicationDelirium

292.11 Cannabis-InducedPsychotic Disorder with Delusions

292.12 Cannabis-InducedPsychotic Disorder withHallucinations

292.89 Cannabis-Induced Anxiety

Disorder 292.9 Cannabis-Related DisorderNot Otherwise Specified


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Cocaine

DSM IV TR 304.20 Cocaine Dependence

304.60 Cocaine Abuse

292.89 Cocaine Intoxication

292.0 Cocaine Withdrawal

292.81 Cocaine Intoxication Delirium

292.11 Cocaine-Induced Psychotic Disorderwith Delusions

292.12 Cocaine-Induced Psychotic Disorderwith Hallucinations

292.84 Cocaine-Induced Mood Disorder

292.89 Cocaine-Induced Anxiety Disorder

292.89 Cocaine-Induced Sexual Dysfunction

292.85 Cocaine-Induced Sleep Disorder

292.9 Cocaine-Related Disorder Not

Otherwise Specified

DSM IV Cocaine-Use Disorder

292.89 Cocaine Intoxication

292.0 Cocaine Withdrawal

292.81 Cocaine Intoxication Delirium

292.11 Cocaine-Induced Psychotic Disorderwith Delusions

292.12 Cocaine-Induced Psychotic Disorderwith Hallucinations

292.84 Cocaine-Induced Mood Disorder

292.89 Cocaine-Induced Anxiety Disorder

292.89 Cocaine-Induced Sexual Dysfunction

292.85 Cocaine-Induced Sleep Disorder

292.9 Cocaine-Related Disorder NotOtherwise Specified


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Hallucinogens

304.50 Hallucinogen Dependence 305.30 Hallucinogen Abuse

292.89 Hallucinogen Intoxication

292.89 Hallucinogen PersistingPerception Disorder

291.81 Hallucinogen IntoxicationDelirium

292.11 Hallucinogen-InducedPsychotic Disorder with Delusions

292.12 Hallucinogen-InducedPsychotic Disorder with Hallucinations

292.84 Hallucinogen-Induced MoodDisorder

292.89 Hallucinogen-Induced Anxiety

Disorder 292.9 Hallucinogen-Related Disorder

NOS

Hallucinogen-Use Disorder 292.89 Hallucinogen Intoxication

292.89 Hallucinogen PersistingPerception Disorder

291.81 Hallucinogen IntoxicationDelirium

292.11 Hallucinogen-Induced

Psychotic Disorder with Delusions 292.12 Hallucinogen-Induced

Psychotic Disorder with Hallucinations

292.84 Hallucinogen-Induced MoodDisorder

292.89 Hallucinogen-Induced AnxietyDisorder

292.9 Hallucinogen-Related DisorderNOS


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Nicotine

305.1 Nicotine

Dependence

292.0 Nicotine

Withdrawal

292.9 Nicotine-Related

Disorder NOS

Nicotine-Use Disorder

292.0 Nicotine

Withdrawal

292.9 Nicotine-Related Disorder

NOS


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Phencyclidine

304.60 PhencyclidineDependence

305.90 Phencyclidine Abuse

292.89 Phencyclidine Intoxication

292.81 Phencyclidine IntoxicationDelirium

292.11 Phencyclidine-InducedPsychotic Disorder with Delusions

292.12 Phencyclidine-InducedPsychotic Disorder withHallucinations

292.84 Phencyclidine-InducedMood Disorder

292.89 Phencyclidine-InducedAnxiety Disorder

292.9 Phencyclidine-RelatedDisorder NOS

Phencyclidine-Use Disorder 292.89 Phencyclidine Intoxication

292.81 Phencyclidine IntoxicationDelirium

292.11 Phencyclidine-InducedPsychotic Disorder with Delusions

292.12 Phencyclidine-InducedPsychotic Disorder withHallucinations

292.84 Phencyclidine-InducedMood Disorder

292.89 Phencyclidine-InducedAnxiety Disorder

292.9 Phencyclidine-RelatedDisorder NOS


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Polysubstance

304.80 Polysubstance

Dependence

Polysubstance-Use

Disorder


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What does this mean in

Minnesota?

Changes to Rule 25

assessment

Changes to DAANES

changes in dsm v

Documents