California State University, Northridge



Substance-Related Disorders

Necessary Clinical Information

( Identity of substance(s) used

( History of substance(s) used

( History of substance use emergencies and treatment

( Cognitive impairment (confusion, disorientation, impaired attention, rambling thought, drowsiness, etc.)

( Physiological signs (tachycardia, hypertension, hypotension, hyperpyrexia, pupillary dilatation or constriction, etc.)

( Neurological signs (slurred speech, incoordination, ataxia, dystonia, tremor, seizure, etc.)

( Psychomotor agitation or retardation

( Changes in mood, perception, and thought

( Changes in personality, mood, anxiety

( Urine drug screening, blood alcohol level

( Changes in social or family life

( Current and past legal problems

Making a Diagnosis

1. Does the client admit to using a substance?

2. Does the client have abnormal physiological signs or symptoms?

3. Does the client have a history of substance abuse?

4. Has the client experienced recent related legal problems?

5. Does the client have maladaptive behavioral or psychological changes?

Common Problems in Making a Diagnosis

1. The client may come close to fulfilling the criteria for the diagnosis yet not actually fulfill it. The clinician must weigh the clinical information and decide whether the evidence is sufficient to make a working diagnosis despite the uncertainty.

2. The client may exhibit signs and symptoms from several diagnoses.

3. The client may have unusual signs and symptoms that do not normally occur in typical intoxication or withdrawal syndromes.

Key Diagnostic Points

( Substance-induced (i.e., organic) psychiatric syndromes meeting the criteria for other diagnostic categories, such as major depression, are included in those categories rather than in the Substance-Related Disorders category.

( The diagnosis of a specific substance dependence requires evidence of either substance tolerance or withdrawal.

( The two main categories of criteria used in the diagnosis of substance dependence relate to the physiological effects of the substance and the behavioral problems associated with the use of the substance.

( The signs and symptoms of Alcohol Intoxication and Alcohol Withdrawal are identical to those of Sedative, Hypnotic, or Anxiolytic Intoxication and Sedative, Hypnotic, or Anxiolytic Withdrawal.

( The perceptual changes in Hallucinogen Intoxication occur while the client is in a state of full wakefulness and alertness.

( Nystagmus, hypertension, and numbness or diminished responsiveness to pain are the hallmarks of Phencyclidine Intoxication.

( Pupillary dilation is a sign of intoxication with some central nervous system stimulants (amphetamine, cocaine, hallucinogens) and a sign of withdrawal with some central nervous system depressants (opioids).

( Psychopathology occurring within 1 month after substance use may be etiologically related to the substance use.

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