Substance-Related and Addictive Disorders

 

Learn more about  substance use disorders, addictive disorders, and specific intoxication and withdrawal symptoms. Substance use disorders and additive disorders are often treated with psychotherapy and medications


Substance Use Disorders 

Substance use disorders are characterized by a problematic pattern of substance use leading to clinically significant impairment or distress, as evidenced by the presence of at least two of the following symptoms within a twelve month period:

  • A specific substance is taken in larger amounts or over a longer period of time than was intended.
  • There is a desire or unsuccessful efforts to cut down or control substance use.
  • A significant amount of time is spent in activities to obtain, use or recover from a specific substance.
  • The presence of cravings or a strong desire to use a specific substance.
  • Recurrent substance use resulting in a failure to fulfill obligations are work, school or home.
  • Continued substance abuse despite having recurrent social or interpersonal problems caused or exacerbated by the effects of a specific substance.
  • Important social, work or recreational activities are given up or reduced because of substance abuse.
  • Recurrent substance abuse in situations in which it is physically dangerous. 
  • Substance use is continued despite knowledge of having a recurrent physical or psychological problem that is likely to have been caused or worsened by the specific substance.
  • Tolerance which is defined (a) a need for increased amounts of a substance to become intoxicated or (b) the diminished effect with continued use of the same amount of a specific substance.
  • Withdrawal which is manifested by (a) the characteristic withdrawal symptoms of a specific substance or (b) the substance is taken to relieve or avoid withdrawal symptoms.

*Some substances (such as phencyclidine) do not have well established withdrawal symptoms or signs. 

Alcohol Intoxication 

  • Problematic behavior (such as inappropriate sexual or aggressive behavior).
  • Psychological changes (such as mood lability or impaired judgement).
  • Slurred speech.
  • Incoordination.
  • Unsteady gain.
  • Nystagmus  (involuntary, rapid and repetitive eye movements).
  • Impairment in attention or memory.
  • Stupor or coma.

Alcohol Withdrawal

  • Increased sweating or rapid heart rate.
  • Increased hand tremor.
  • Decreased sleep.
  • Nausea or vomiting.
  • Visual, tactile or auditory hallucinations or illusions.
  • Psychomotor agitation (increased purposeless movements).
  • Anxiety.
  • Generalized tonic-clonic seizures.

*Symptoms may occur within several hours to several days after alcohol use is stopped or reduced after prolonged and heavy usage. 

Caffeine Intoxication 

  • Restlessness.
  • Nervousness.
  • Excitement.
  • Difficulty sleeping.
  • Flushed face.
  • Increased urination.
  • Stomach upset.
  • Muscle twitching.
  • Rambling speech and flow of thought.
  • Increased heart rate or abnormal heart rate.
  • Periods of inexhaustibility.
  • Psychomotor agitation (increased purposeless movements).

*Intoxication occurs after recent consumption of caffeine, usually doses in excess of 250 mg. 

Caffeine Withdrawal 

  • Headache.
  • Feeling tired or drowsy.
  • Depressed mood or irritability.
  • Difficulty concentration.
  • Flu-like symptoms (such as nausea, vomiting or muscle pain).

*Symptoms occur within 24 hours after stopping or reducing caffeine after prolonged daily use.  

Cannabis Intoxication

  • Problematic behaviors or psychological changes (such as impaired motor coordination, anxiety, euphoria, sensation of slowed time, impaired judgement, and social withdrawal)
  • Conjunctival injection (red eye).
  • Increased appetite.
  • Dry mouth.
  • Increased heart rate.

Cannabis Withdrawal 

  • Irritability, aggression or anger.
  • Nervousness or anxiety.
  • Difficulty sleeping or disturbing dreams.
  • Decreased appetite or weight loss.
  • Restlessness.
  • Depressed mood.
  • Physical symptoms, such as abdominal pain, shakiness, tremors, sweating, fever, chill or headache.

*Symptoms occur within approximately one week after stopping or reducing cannabis after prolonged daily or almost daily use for several months.

Phencyclidine (PCP) Intoxication

  • Problematic behavioral changes such as belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment.
  • Within one hour, two or more of the following signs or symptoms become present.
    • Vertical nystagmus (involuntary, rapid and repetitive eye movements from up to down) or horizontal nystagmus (involuntary, rapid and repetitive eye movements from side to side).
    • Elevated blood pressure or increased heart rate.
    • Numbness or decreased response to pain.
    • Ataxia (lack of muscle control during voluntary movements).
    • Dysarthria (slurred or slow speech).
    • Muscle rigidity.
    • Seizures or coma.
    • Hyperacusis (increased sensitivity to sound).

*Withdrawal symptoms are not well established for phencyclidines.

Other Hallucinogen Intoxication (other than phencyclidine)

  • Problematic behavioral or psychological changes (such as increased anxiety or depression, ideas of reference, paranoia, fear of “losing one’s mind”, or impaired judgement).
  • Changes in perception, such as depersonalization, derealization, illusions, hallucinations, and synesthesias.
  • Two or more of the following signs:
    • Dilated pupils.
    • Increased heart rate.
    • Sweating.
    • Heart pounding.
    • Blurred vision.
    • Tremors.
    • Lack of coordination.

Hallucinogen Persisting Perception Disorder 

  • After use of a hallucination is stopped, one of more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen are re-experienced.
  • The re-experienced symptoms cause significant distress or impairment in social, work, or other important areas of life.
  • These symptoms cannot be attributed to any other substance, medication, or other medical or mental condition.

Inhalant Intoxication 

  • Problematic behavioral or psychological changes (such as belligerence, assaultiveness, apathy, or impaired judgment)
  • Two or more of the following signs or symptoms:
    • Dizziness.
    • Nystagmus (involuntary, rapid and repetitive eye movements).
    • Lack of coordination.
    • Slurred speech.
    • Unsteady gait.
    • Lethargy (tiredness or lack of energy).
    • Depressed reflexes.
    • Psychomotor retardation (moving slower).
    • Tremor.
    • Generalized muscle weakness.
    • Blurred vision or double vision.
    • Stupor or coma.
    • Euphoria (a feeling or state of intense happiness and excitement).

Opioid Intoxication 

  • Problematic behavioral or psychological changes (such as intense feelings of happiness followed by feeling down and dissatisfied, increased or decreased body movements, or impaired judgement).
  • Constricted pupils (or dilated pupils due to lack of oxygen in overdose).
  • Drowsiness or coma.
  • Slurred speech.
  • Impaired attention or memory.

Opioid Withdrawal 

  • Three or more of the following signs or symptoms develop within minutes to several days:
    • Dysphoric mood (feeling depressed or dissatisfied).
    • Nausea or vomiting.
    • Muscle aches.
    • Secretion of tears or running nose.
    • Dilated pupils, piloerection (hairs standing up), or sweating.
    • Diarrhea.
    • Yawning.
    • Fever.
    • Difficulty sleeping.

Sedative, Hypnotic, or Anxiolytic Intoxication 

  • Problematic behavioral or psychological changes (such as inappropriate sexual or aggressive behavior, mood lability, or impaired judgment).
  • One or more of the following signs or symptoms:
    • Slurred speech.
    • Lack of coordination.
    • Unsteady gait.
    • Nystagmus (involuntary, rapid and repetitive eye movements).
    • Thoughts problems, such as impairment in attention or memory.
    • Stupor (lack of physical movement) or coma.

Sedative, Hypnotic, or Anxiolytic Withdrawal 

  • Two or more of the following signs or symptoms, develop within several hours to a few days after stopping usage of the sedative, hypnotic or anxiolytic:
    • Autonomic hyperactivity (such as sweating or elevated heart rate).
    • Hand tremor.
    • Difficulty sleeping.
    • Nausea or vomiting.
    • Visual, tactile or auditory hallucinations or illusions.
    • Psychomotor agitation (involuntary purposeless movements).
    • Anxiety.
    • Grand mal seizures.

Stimulant Intoxication 

  • Problematic behavioral or psychological changes (such as intense feelings of happiness, intense feelings of being threatened, anxiety, anger, repetitive physical movements, or impaired judgment).
  • Two or more of the following signs or symptoms:
    • Abnormally increased heart rate or abnormally slowed heart rate.
    • Dilated pupils.
    • Elevated or lowered blood pressure.
    • Sweating or chills.
    • Nausea or vomiting.
    • Weight loss.
    • Psychomotor agitation (increased purposeless movements) or psychomotor retardation (moving slower).
    • Muscle weakness, decreased breathing, chest pain or abnormal heart rhythm.
    • Confusion, seizures, abnormal voluntary movements, abnormal muscle contractions, or coma.

Stimulant Withdrawal 

  • Dysphoric mood and two or more of the following physiological changes, develop within a few hours to several days after cessation or reduction in stimulant use:
    • Fatigue.
    • Vivid, unpleasant dreams.
    • Decreased or increased sleep.
    • Increased appetite.
    • Psychomotor agitation (increased purposeless movements) or psychomotor retardation (moving slower).

Tobacco Withdrawal 

  • After reduction in use or stopping tobacco use, 4 or more of the following signs or symptoms develop within 24 hours:
    • Irritability, frustration or anger.
    • Anxiety.
    • Difficulty concentrating.
    • Increased appetite.
    • Restlessness.
    • Depressed mood.
    • Difficulty sleeping.

Non-Substance-Related Disorders

Gambling Disorder 

  • Recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the presences of at least four of the following in a twelve month period:
    • Need to gamble with increasing amounts of money in order to achieve the desired excitement level.
    • Feeling restless or irritable when attempting to cut down or stop gambling.
    • Has made repeated unsuccessful efforts to cut back, control or stop gambling.
    • Often preoccupied with gambling.
    • Often gambles when feeling distressed, anxious or depressed.
    • After losing money gambling, often returns another day to get even (chasing ones losses).
    • Lies to hide the extent of the gambling.
    • Has jeopardized or lost a significant job, relationship or other opportunity because of gambling.
    • Relies on others to provide money to relieve financial situations caused by gambling.
  • The gambling behavior is not caused by a manic episode.
 

The above criteria are adapted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).