Substance-Related and Addictive Disorders

Substance-Related and Addictive Disorders
Substance-Related and Addictive Disorders
16.1 The diagnostic criteria for substance abuse, substance dependence, substance
intoxication, and substance withdrawal were not equally applicable to all substances in DSM-IV. In DSM-5, this remains true, although substance use disorder
now replaces the diagnoses of substance abuse and substance dependence. For
which of the following substance classes is there adequate evidence to support
diagnostic criteria in DSM-5 for the three major categories of use disorder, intoxication, and withdrawal?
A. Caffeine.
B. Cannabis.
C. Tobacco.
D. Hallucinogen.
E. Inhalant.
Substance-Related and Addictive Disorders
Correct Answer: B. Cannabis.
Explanation: Only cannabis has sufficient evidence to support all three categories of substance-related disorders. Cannabis withdrawal and caffeine withdrawal, neither of which was fully recognized in DSM-IV, are now included in
DSM-5. Proposed criteria for caffeine use disorder are provided in the “Conditions for Further Study” chapter in DSM-5 Section III to encourage research in
this area, but there is still insufficient evidence to support this diagnosis. Tobacco has no recognized clinically significant intoxication syndrome. Hallucinogens and inhalants have no consistent evidence of a clinically significant
withdrawal syndrome.
16.1—Appendix / Highlights of Changes From DSM-IV to DSM-5 (p. 815)
16.2 Almost all of the possible physical and behavioral symptom criteria included
in the DSM-IV definitions of substance abuse and substance dependence are included in the DSM-5 definition of substance use disorder. Which of the following
possible criteria included in DSM-IV were intentionally omitted in DSM-5?
A. There is a persistent desire or unsuccessful efforts to cut down or control
substance use.
B. The substance is often taken in larger amounts or over a longer period than
was intended.
Substance-Related and Addictive Disorders—ANSWER GUIDE | 383
C. The recurrent substance use results in a failure to fulfill major role obligations at work, school, or home.
D. There is continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the
substance.
E. There are recurrent substance-related legal problems.
Correct Answer: E. There are recurrent substance-related legal problems.
Explanation: The risk of detection and the legal consequences of the detection
of use of a substance vary widely across and within cultures and geographic
regions and may change over time. Research has shown that the presence of recurrent legal problems does not correlate with the diagnosis of substance
abuse. Therefore, the DSM-5 definition of substance use disorder omits the
DSM-IV substance abuse criterion of “recurrent substance-related legal problems.”
16.2—Appendix / Highlights of Changes From DSM-IV to DSM-5 (p. 815)
16.3 Whereas in DSM-IV, there were 11 recognized substance classes, DSM-5 has
only 10, because certain related substances have been combined into a single
class. Which of the following pairs of drugs falls into a single class in DSM-5?
A. Cocaine and phencyclidine (PCP).
B. Cocaine and methamphetamine.
C. 3,4-Methylenedioxymethamphetamine (MDMA [Ecstasy]) and methamphetamine.
D. Lorazepam and alcohol.
E. Lorazepam and oxycodone.
Correct Answer: B. Cocaine and methamphetamine.
Substance-Related and Addictive Disorders
Explanation: In DSM-5, cocaine and amphetamines are no longer in separate
classes but instead have been combined into a new class, stimulants. PCP is no
longer a distinct class; it is now grouped with the hallucinogens. MDMA is
chemically similar to methamphetamine, but its clinical manifestations are
more similar to those of the hallucinogens, so it is included in that group. Alcohol and opioids remain in their own distinct classes, as do sedatives, hypnotics, and anxiolytics.
16.3—Stimulant Use Disorder / diagnostic criteria (p. 605)
16.4 Tolerance and withdrawal were each considered valid criteria for the diagnosis
of substance dependence in DSM-IV, although neither was required. Which of
the following statements about tolerance and withdrawal in the DSM-5 diagnosis of substance use disorder is true?
384 | Substance-Related and Addictive Disorders—ANSWER GUIDE
A. Tolerance and withdrawal are no longer considered to be valid diagnostic
symptoms of substance use disorder.
B. The definitions of tolerance and withdrawal have been updated because
the previous definitions had poor interrater reliability.
C. The presence of either tolerance or withdrawal is now required to make a
diagnosis of substance use disorder.
D. The presence of either tolerance or withdrawal is now required to make a
substance use disorder diagnosis for some but not all classes of substances.
E. Both tolerance and withdrawal are still listed as possible criteria, but if they
occur during appropriate medically supervised treatment, they may not be
counted toward the diagnosis of a substance use disorder\
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