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{ DSM-5 Update: Substance-Related and Addictive Disorders Presented by: Nick Lessa, LCSW, MA, CASAC [email protected]

A DSM 5 Update: Substance - Related And Addictive Disorders

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Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5. Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City. Includes: Changes in the diagnostic criteria from the DSM–IV to the DSM-5 The distinction between Substance Use Disorders and the Substance - Induced Disorders Recording procedures for Substance Related Disorders

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Page 1: A DSM 5 Update: Substance - Related And Addictive Disorders

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DSM-5 Update: Substance-Related and Addictive Disorders

Presented by:Nick Lessa, LCSW, MA, [email protected]

Page 2: A DSM 5 Update: Substance - Related And Addictive Disorders

DSM- 5 Update

0A guide in the diagnosis of mental disorders

0Recently updated after 13 years since the DSM-IV-TR was released in 2000.

022 separate classifications involving 13 work groups

Page 3: A DSM 5 Update: Substance - Related And Addictive Disorders

Changes in Substance-Related Disorders Section from DSM-IV

0Removal of Substance Abuse and Substance Dependence.

0Severity of disorder (mild to severe) based on the number of symptom criteria met: 0 Mild: 2-3 symptoms0 Moderate: 4-5 symptoms 0 Severe: 6 or more symptoms

Page 4: A DSM 5 Update: Substance - Related And Addictive Disorders

Changes in Substance-Related Disorders Section from DSM-IV

0The word “addiction” is omitted due to its “uncertain definition and its potentially negative connotation.”

0 “Craving or strong desire” replaces “preoccupation”

0 Items deleted: “recurrent legal problems”, polysubstance category, physiological subtype

Page 5: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance-Related and Addictive Disorders

Encompasses 10 separate classes of drugs:1. Alcohol2. Caffeine3. Cannabis4. Hallucinogens5. Inhalants6. Opioids7. Sedatives, hypnotics,& anxiolytics8. Stimulants9. Tobacco10. Other (or unknown) substances

Page 6: A DSM 5 Update: Substance - Related And Addictive Disorders

Addictive Disorders

0 Includes Gambling Disorder

0Other potential behavioral addictions (internet addiction, sex addiction, exercise addiction, shopping addiction, etc.) not included due to “insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions…”

Page 7: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance-Related Disorders

0Divided into two groups

0Substance-Induced Disorders: includes conditions of intoxication or withdrawal and other induced mental disorders

0Substance-Use Disorders: relates to pathological patterns of behaviors related to the use of a particular substance

Page 8: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance-Induced Disorders

0Essential Feature – “the development of a reversible substance-specific syndrome due to the recent ingestion of a substance.”

0 Includes intoxication, withdrawal, and other substance/medication-induced mental disorders

Page 9: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Intoxication

0Substance intoxication can occur in individuals without a Substance Use Disorder

0Substance intoxication must include problematic behavior

0Substance intoxication does not apply to tobacco. (may explain society’s liberal view of use – nonproblematic)

Page 10: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Withdrawal

0Essential Feature – “the development of substance-specific problematic behavioral change, with physiological and cognitive concomitants, that is due to the cessation of, or reduction in, heavy and prolonged substance use.”

Page 11: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance/Medication-Induced Mental Disorders0The substance/medication-induced mental

disorders are potentially severe, usually temporary, but sometimes persisting CNS syndromes that develop in the context of the effects of substances of abuse, medications, or several toxins

0Likely to improve in a matter of days to weeks of abstinence

Page 12: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance/Medication-Induced Mental Disorders0The disorder developed within 1 month of

substance intoxication or withdrawal or taking a medication

0The disorder did not proceed the onset of severe intoxication, withdrawal or exposure to a medication

0The disorder not likely to be better explained by an independent mental condition

0Likely to disappear within 1 month of cessation of withdrawal, intoxication or use of meds

Page 13: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance/Medication-Induced Mental Disorders Exception to the 1 month rule includes:0Alcohol-induced, inhalant-induced, and

sedative/hypnotic/anxiolytic-induced neurocognitive disorders

0Hallucinogen Persisting Perception Disorder (e.g., “flashbacks”)

Page 14: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Use Disorders

0The Essential Feature – continued use despite significant substance-related problems

0Changes in brain circuits may persist, exhibited in repeated relapses & intense drug cravings

0Criteria include impaired control, social impairment, risky use, and pharmacological symptoms (withdrawal/tolerance)

Page 15: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Use Disorders

011 diagnostic criteria (some classes of substances have 10 criteria)

0 2 or more within a 12-month period

0Must include a pattern of use leading to clinically significant impairment or distress

Page 16: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Use Disorders: Diagnostic Criteria

1. Substance often taken in larger amounts or over a longer period of time than intended (impaired control)

2. A persistent desire or unsuccessful efforts to cut down or control use (impaired control)

3. A great deal of time spent in activities necessary to obtain the substance, use it, or recover from its effects (impaired control)

4. Craving, or strong desire or urge to use (impaired control) (New criteria)

Page 17: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Use Disorders: Diagnostic Criteria

5. Recurrent use resulting in failure to fulfill major role obligations at work, school, or home (social impairment)6. Continued use despite having persistent or recurrent social/interpersonal problems caused or exacerbated by use (social impairment)7. Important social, occupational, or recreational activities given up or reduced because of use (social impairment)

Page 18: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Use Disorders: Diagnostic Criteria

8. Recurrent use in situations which is physically hazardous (risky use)

9. Use is continued despite knowledge of having a persistent or recurrent physical/psychological problem likely to have been caused or exacerbated by use (risky use)

Page 19: A DSM 5 Update: Substance - Related And Addictive Disorders

Substance Use Disorders: Diagnostic Criteria

10. Tolerance: the need for markedly increased amounts of substance to achieve intoxication or desired effect, or a markedly diminished effect with continued use of same amount (pharmacological)11. Withdrawal: a characteristic syndrome, or use to relieve or avoid withdrawal (pharmacological)

Page 20: A DSM 5 Update: Substance - Related And Addictive Disorders

Recording Procedures for Substance Related Disorders

0New recording procedures to occur by 10/140Use the code for the class of substances, but

record the specific substance0Severity determined by # of symptom criteria0Mild (2-3); Moderate (4-5); Severe (6 or more)0Severity can change over the course of time

by reductions or increases0Record for each individual substance disorder

Page 21: A DSM 5 Update: Substance - Related And Addictive Disorders

Recording Procedures for Substance Related Disorders

Course Specifiers0“in early remission” (3-11 months)0“in sustained remission” (12 mos. or longer)0None of the criteria met for that duration with

exception of craving0“on maintenance therapy” (for opioids, tobacco)0“in a controlled environment” (access to

substance is restricted)

Page 22: A DSM 5 Update: Substance - Related And Addictive Disorders

Alcohol-Related Disorders

0Prevalence – 12% of males and 4.6% of females 18 and older. Significantly drops after age 65.

0Lifetime risk of major depressive disorders – 40%0Can lead to persisting neurocognitive disorders0Alcohol Intoxication includes 1 or more symptoms

of: slurred speech, incoordination, unsteady gait, nystagmus (involuntary eye movement), attention/memory impairment, stupor/coma

Page 23: A DSM 5 Update: Substance - Related And Addictive Disorders

Alcohol Use Disorders

0 Alcohol Withdrawal includes 2 or more of following after cessation of or reduction in alcohol use:0 Autonomic hyperactivity (sweating or pulse > 100)0 Increased hand tremor0 Insomnia0 Nausea or vomiting0 Transient visual, tactile, auditory hallucinations0 Psychomotor agitation0 Anxiety0 Seizures

Page 24: A DSM 5 Update: Substance - Related And Addictive Disorders

Caffeine-Related Disorders

0More than 85% of children and adults consume caffeine regularly

0Most widely used drug in the world0Symptoms include tolerance and withdrawal0No Caffeine Use Disorder (data unavailable yet);

only Caffeine Intoxication and Withdrawal0Significant growth in energy drinks with young

individuals0Taking oral contraceptives decreases elimination

of caffeine (Increased risk of intoxication)

Page 25: A DSM 5 Update: Substance - Related And Addictive Disorders

Caffeine Intoxication0 Intoxication must be in excess of 250 mg. & cause distress or

impairment0 5 or more of following:

0 Restlessness0 Nervousness0 Excitement0 Insomnia0 Flushed face0 Diuresis0 Gastrointestinal disturbance0 Muscle twitching0 Rambling flow of thought and speech0 Tachycardia or cardiac arrhythmia0 Periods of inexhaustibility0 Psychomotor agitation

Page 26: A DSM 5 Update: Substance - Related And Addictive Disorders

Caffeine Withdrawal

0Following cessation of or reduction in use within 24 hours by 3 or more of following:0 Headache (the hallmark feature)0 Marked fatigue or drowsiness0 Dysphoric mood, depressed mood, or irritability0 Difficulty concentrating0 Flu-like symptoms (nausea, vomiting, muscle

pain)

Page 27: A DSM 5 Update: Substance - Related And Addictive Disorders

Cannabis Related Disorders

0 Most widely used illicit substance in the U.S.0 Prevalence of disorder - 3% of adolescents and 1.5%

of adults0 Prevalence drops after age 650 More common for males than females0 Cannabis use disorders have increased over past

decade0 Difficult to distinguish between problem use and

non-problematic use0 Few clear medical conditions associated with use0 60% of adolescents also have Conduct D/O or AD/HD

Page 28: A DSM 5 Update: Substance - Related And Addictive Disorders

Cannabis Use Disorder

0At least 2 of the 11 symptom criteria

0 Includes tolerance and withdrawal

Page 29: A DSM 5 Update: Substance - Related And Addictive Disorders

Cannabis Intoxication

0 Can lead to substance-induced psychotic or anxiety D/O’s, sleep disorders, or delirium

0 Problematic behavioral or psychological changes (e.g., impaired judgment, motor coordination, social withdrawal, euphoria, anxiety, sensation of slowed time) and,

0 2 or more of the following:0 Conjunctival injection (red eyes)0 Increased appetite0 Dry mouth0 Tachycardia

Page 30: A DSM 5 Update: Substance - Related And Addictive Disorders

Cannabis Withdrawal

0 After heavy or prolonged use0 3 or more of the following developing within a

week:0 Irritability, anger, or aggression0 Nervousness or anxiety0 Sleep difficulty (insomnia or disturbing dreams)0 Decreased appetite or weight loss0 Restlessness0 Depressed mood0 Physical symptoms (sweating, fever, chills,

headache, shakiness/tremors, or stomach pain)

Page 31: A DSM 5 Update: Substance - Related And Addictive Disorders

Hallucinogen-Related Disorders

0Separate criteria for Phencyclidine Disorders (e.g., PCP, “angel dust”, ketamine, cyclohexamine, dizocilpine) and,

0 Other Hallucinogen Disorders (e.g., LSD, MDMA, DMT, psilocybin, mescaline, peyote, morning glory seeds, jimsonweed)

Page 32: A DSM 5 Update: Substance - Related And Addictive Disorders

Phencyclidine Use Disorder

010 symptom criteria (excludes withdrawal symptoms)

0Previously in the category of Dissociative Anesthetics

0Prevalence primarily in the African-American (49%) and Hispanic (29%) cultures. Only .5% of young Caucasians.

Page 33: A DSM 5 Update: Substance - Related And Addictive Disorders

Other Hallucinogen Use Disorder

010 symptom criteria (excludes withdrawal symptoms)

0Hallucinogen Use Disorder is one of the rarest. (.5% among adolescents and .2% in adults)

0Those who have this disorder have higher rates of other SUD’s as well

0Can lead to psychotic-induced, bipolar-induced, depressive-induced, anxiety-induced disorders and delirium

Page 34: A DSM 5 Update: Substance - Related And Addictive Disorders

Phencyclidine Intoxication

0 Problematic behavior (e.g., belligerent, assaultive, impulsive, unpredictable, agitated, impaired judgment) and, 2 or more of the following:

1. Vertical or horizontal nystagmus (involuntary eye movement)

2. Hypertension or tachycardia3. Numbness or diminished response to pain4. Ataxia (lack of muscle coordination)5. Dysarthria (difficulty articulating)6. Muscle rigidity7. Seizures or coma8. Hyperacusis (sensitivity to loud noises)

Page 35: A DSM 5 Update: Substance - Related And Addictive Disorders

Other Hallucinogen Intoxication

0Problem behavior or psychological changes (e.g., anxiety, depression, ideas of reference, “losing one’s mind”, paranoia, impaired judgment)

0Perceptual changes (e.g., intensified perceptions, illusions, hallucinations, derealization) and, 2 or more of the following:

0Pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremors, incoordination

Page 36: A DSM 5 Update: Substance - Related And Addictive Disorders

Hallucinogen Persisting Perception Disorder

0Following cessation of hallucinogen use, the reexperiencing of one or more of the perceptual symptoms that were experienced when intoxicated (e.g., trails, color flashes, geometric hallucinations, false perceptions of movement, intensified colors)

0Cause significant distress or impairment in important areas of functioning

Page 37: A DSM 5 Update: Substance - Related And Addictive Disorders

Inhalant Related Disorders

0 Involves any hydrocarbon-based substances (e.g., toxic gases from glues, fuels, paints, and other volatile substances)

0 No diagnosis of inhalant withdrawal0 Standard drug screens do not detect inhalants.

Detection is costly0 Prevalence is about 0.2%. Rare among females

and a preponderance of European American males0 Prevalence declines after adolescence0 Common with adolescent Conduct Disorder. Adult

use strongly associated with suicidality

Page 38: A DSM 5 Update: Substance - Related And Addictive Disorders

Inhalant Use Disorder

010 of the 11 standard symptom criteria. No withdrawal criteria.

0When possible, name the particular substance involved

Page 39: A DSM 5 Update: Substance - Related And Addictive Disorders

Inhalant Intoxication

0Problematic behavioral or psychological changes (e.g., belligerence, assaultive, apathy, impaired judgment)

02 or more of following: dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, muscle weakness, blurred vision, stupor/coma, and euphoria.

Page 40: A DSM 5 Update: Substance - Related And Addictive Disorders

Opioid-Related Disorders

0Prevalence is about 0.37% of adults0Lowest among African Americans, highest

among Native Americans0Hepatitis A, B, and C virus found in 80%-90%

of injection opioid users0HIV infection up to 60% of heroin users0A heightened risk for accidental and

deliberate overdoses

Page 41: A DSM 5 Update: Substance - Related And Addictive Disorders

Opioid Use Disorder

0 Includes all 11 standard, symptom criteria

0 Include the specifier “On maintenance therapy” when individual is taking a “prescribed” agonist medication (e.g., methadone, buprenorphine) or antagonist (e.g., naltrexone, Vivitrol)

Page 42: A DSM 5 Update: Substance - Related And Addictive Disorders

Opioid Intoxication

0Problem behavior or psychological changes (e.g., euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment)

0Pupillary constriction (or dilation due to severe overdose) and,

0One or more of the following: drowsiness/coma, slurred speech, impairment in attention or memory

Page 43: A DSM 5 Update: Substance - Related And Addictive Disorders

Opioid Withdrawal

03 or more of the following within minutes to several days after cessation of use or administration of an antagonist:

0Dysphoric mood, nausea/vomiting, muscle aches, lacrimation/rhinorrhea, pupillary dilation, piloerection/sweating, diarrhea, yawning, fever, and insomnia.

Page 44: A DSM 5 Update: Substance - Related And Addictive Disorders

Opioid Withdrawal

0Short-acting drugs (e.g., heroin) begin to have withdrawal symptoms within 6-12 hours after last dose

0Longer-acting drugs (e.g., methadone, buprenorphine) may take 2-4 days for symptoms to emerge

0Less acute withdrawal symptoms ( e.g., anxiety, insomnia, dysphoria, anhedonia) can last for weeks to months

Page 45: A DSM 5 Update: Substance - Related And Addictive Disorders

Sedative-, Hypnotic-, or Anxiolytic-Related Disorders

0 Includes benzodiazepines, benzodiazepine-like drugs (e.g., ambien, sonata), carbamates, barbiturates (e.g., secobarbital), and barbiturate-like hypnotics (e.g., quaalude)

0Also includes all prescription sleeping medications and almost all prescription anti-anxiety medications

Page 46: A DSM 5 Update: Substance - Related And Addictive Disorders

Sedative-, Hypnotic-, or Anxiolytic-Related Disorders

00.3% prevalence rate among adolescents and 0.2% among adults

0Females appear to be at a higher risk for prescription drug misuse of this class of substances

0Can be detected in tox screens for up to a week

0At high doses, can be lethal especially when mixed with alcohol

Page 47: A DSM 5 Update: Substance - Related And Addictive Disorders

Sedative, Hypnotic, or Anxiolytic Intoxication

0Problem behavior or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, and impaired judgment) and,

0One or more of the following: slurred speech, incoordination, unsteady gait, nystagmus, impairment in cognition (attention, memory), stupor/coma

Page 48: A DSM 5 Update: Substance - Related And Addictive Disorders

Sedative, Hypnotic, or Anxiolytic Withdrawal

0 Two or more of the following developing within several hours to a few days after cessation:

1. Autonomic hyperactivity (sweating, pulse rate > 100 bpm)

2. Hand tremor3. Insomnia4. Nausea or vomiting5. Transient hallucinations or illusions6. Psychomotor agitation7. Anxiety8. Grand mal seizures

Page 49: A DSM 5 Update: Substance - Related And Addictive Disorders

Sedative, Hypnotic, or Anxiolytic Withdrawal

0Grand mal seizures may occur in as many as 20-30% of cases undergoing untreated withdrawal

0 In severe withdrawal, visual, tactile, or auditory hallucinations or illusions can occur

0Withdrawal from shorter-acting substances can begin within hours, longer-acting within 1-2 days

Page 50: A DSM 5 Update: Substance - Related And Addictive Disorders

Stimulant Use Disorder

0Prevalence rate for cocaine use disorder for adults is 0.3%

0Greatest for 18-29 year-olds (0.6%)0Cocaine use disorder is virtually absent

among Native Americans and Alaska natives0Childhood conduct disorder and adult ASPD

are associated with later development of stimulant-related disorders

Page 51: A DSM 5 Update: Substance - Related And Addictive Disorders

Stimulant Use Disorder

0Stimulant-use disorder is associated with PTSD, ASPD, ADHD, and gambling disorder

066% of those with methamphetamine use disorders are non-Hispanic white, 21% Hispanic, 3% African-American

0Hair samples can detect the presence of stimulants for up to 90 days

Page 52: A DSM 5 Update: Substance - Related And Addictive Disorders

Stimulant Use Disorder

0Use leading to significant impairment or distress over a 12-month period

0Two or more of the 11 symptom criteria

Page 53: A DSM 5 Update: Substance - Related And Addictive Disorders

Stimulant Intoxication

0 Problem behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) &

0 Two or more of the following: tachycardia/bradycardia, pupillary dilation, elevated or lowered BP, perspiration/chills, nausea/vomiting, weight loss, psychomotor change, muscular weakness, respiratory depression, chest pain, cardiac arrhythmias, confusion, seizures, involuntary muscle movements, coma

Page 54: A DSM 5 Update: Substance - Related And Addictive Disorders

Stimulant Withdrawal

0Dysphoric mood and 2 or more of the following developing within a few hours to several days after cessation:0 Fatigue0 Vivid, unpleasant dreams0 Insomnia or hypersomnia0 Increased appetite0 Psychomotor retardation or agitation

Page 55: A DSM 5 Update: Substance - Related And Addictive Disorders

Tobacco-Related Disorders

0 Includes daily cigarette use or smokeless tobacco

0Features often include smoking within 30 minutes of waking, daily use, waking at night to smoke

0Nicotine dependence in about 13% of U.S. adults

0Nicotine dependence in about 50% of daily smokers

Page 56: A DSM 5 Update: Substance - Related And Addictive Disorders

Tobacco-Related Disorders

0 Initiation of smoking after age 21 is rare0Those who quit usually do so after age 300Non-daily smoking has become more

prevalent in the past decade especially among younger individuals

0More common among those with AD/HD, conduct d/o, mood, anxiety, personality, psychotic or other SUD’s

Page 57: A DSM 5 Update: Substance - Related And Addictive Disorders

Tobacco-Related Disorders

0 Individuals with low incomes and low educational levels are more likely to initiate tobacco use and less likely to stop

050% of smokers who do not stop using tobacco will die early from a tobacco-related illness

0There is no Tobacco Intoxication Disorder

Page 58: A DSM 5 Update: Substance - Related And Addictive Disorders

Tobacco Use Disorder

0Problematic pattern of use leading to significant impairment or distress as manifested by 2 or more of the 11 symptom criteria

0 Includes the specifier “on maintenance therapy” for those taking a nicotine replacement aid or a tobacco cessation medication

Page 59: A DSM 5 Update: Substance - Related And Addictive Disorders

Tobacco Withdrawal

0Cessation or reduction followed within 24 hours by 4 or more of the following:0 Irritability, frustration, or anger0 Anxiety0 Difficulty concentrating0 Increased appetite0 Restlessness0 Depressed mood0 Insomnia

Page 60: A DSM 5 Update: Substance - Related And Addictive Disorders

Other (or Unknown) Substance Use Disorder

0Problematic use of an “intoxicating substance” not able to be classified within the other categories

0Meets at least two or more of the 11 symptom criteria within a 12-month period

Page 61: A DSM 5 Update: Substance - Related And Addictive Disorders

Other (or Unknown) Substance Use Disorder

0Other includes anabolic steroids; non-steroidal anti-inflammatory drugs; cortisol; antiparkinsonian medications; antihistamines; nitrous oxide; amyl-, butyl-, or isobutyl-nitrates; betel nut; kava; and khat

0Unknown – when a substance is unknown0Also, includes the categories Intoxication and

Withdrawal

Page 62: A DSM 5 Update: Substance - Related And Addictive Disorders

Gambling Disorder

0Previously known as “Pathological Gambling” and was in category of Impulse Control Disorders

0Problematic gambling leading to significant impairment or distress

0Leading to four or more of the following symptoms over a 12-month period

Page 63: A DSM 5 Update: Substance - Related And Addictive Disorders

Gambling Disorder Diagnostic Criteria

1. Needs to gamble with increasing amounts of money for desired excitement

2. Is restless or irritable when attempting to cut down or stop gambling

3. Repeated unsuccessful efforts to control, cut back, or stop gambling

4. Often preoccupied with gambling5. Gambles when feeling distressed (helpless,

guilty, anxious, depressed)

Page 64: A DSM 5 Update: Substance - Related And Addictive Disorders

Gambling Disorder Diagnostic Criteria

6. After losing money gambling, often returns another day to get even7. Lies to conceal the extent of involvement with gambling8. Jeopardized or lost a significant relationship, job, or career opportunity due to gambling9. Relies on others to provide money to relieve financial situations caused by gambling

Page 65: A DSM 5 Update: Substance - Related And Addictive Disorders

Gambling Disorder Diagnostic Criteria

0Removal of the criteria “has committed acts of forgery, fraud, theft, or embezzlement to finance gambling”

0Can be specified as either “Episodic” or “Persistent” and “In early remission” or “In sustained remission”

Page 66: A DSM 5 Update: Substance - Related And Addictive Disorders

Gambling Disorder Severity Rating

0Mild: 4-5 criteria

0Moderate: 6-7 criteria

0Severe: 8-9 criteria

Page 67: A DSM 5 Update: Substance - Related And Addictive Disorders

Gambling Disorder

0About 0.2%-0.3% of general population03x more likely in males0Highest in African Americans (0.9%), whites

(0.4%), Hispanics (0.3%)0For females, the progression is more rapid0About 17% commit suicide0Often associated with SUDs and impulse –

control disorders (males) & mood/ anxiety D/O (females)