1. North Carolina TASC Clinical Series Training Module Eight: DSM -IV

2. DSM-IV System Axis I: Clinical disorders Axis II: Personality disorders and mental retardation Axis III: General medical conditions relevant to the understanding or management of the mental disorder Axis IV: Psychosocial and environmental problems Axis V: Global Assessment of Functioning (GAF)

3. Diagnosis of Substance Abuse Determination of substance dependence or abuse based on DSM-IV definitions A determination of the presence or absence of physiological dependence as indicated by withdrawal tolerance The present course of dependence

4. Criteria for Dependence A maladaptive pattern of substance use, leading to clinically significant impairment or distress. Manifested by three or more of the following: Tolerance Withdrawal Using increasing amounts Craving or desire to cut down Significant time devoted to using/seeking substances Salience of drug use Use despite harm or consequences

5. Tolerance What effects have you received from the substance? Do you usually get intoxicated and how intoxicated? Has the occurrence changed in the last year or two? What do these drugs cost you per week? How much do you think you spend on drugs per week?

6. Increasing Amounts and Time Devoted How many days per week do you use drugs? What time of day do you usually begin use? Has your pattern of use changed over the last year or two? How often do you use more drugs than “average”?

7. Salience When and why do you think that you use drugs? What situations make you use drugs? Who do you usually use drug with? Have things changed in your life due to your use?

8. Withdrawal/Craving – Desire to Cut Down Have you ever overdosed or experience a blackout? Have you ever had the shakes or DTs? Have you ever had to seek medical treatment in these situations? How has your drug use changed in the past year? Why do you think this happened?

9. Withdrawal/Craving – Desire to Cut Down Have you ever tried to quit or cut down? Have you ever experienced physical or emotional problems? How long did these problems last? How hard was it dealing with these problems? Why do you think you began using again?

10. Use Despite Harm or Consequences Have you ever used drugs knowing that your use was causing you physical or psychological problems? Has anyone complained to you about your drug use? Has your use caused problems with relationships? Home? Work/School? Socially? Legally?

11. Use Despite Harm or Consequences Do you use despite failure to fulfill obligations? Do you use despite recurrent legal problems? Do you use despite recurrent employment, social, or interpersonal problems?

12. Criteria for Abuse A maladaptive pattern of substance use, leading to clinically significant impairment or distress. Manifested by one or more of the following: Recurrent use resulting in failure to fulfill obligations at work, home, or school Recurrent use in situations in which it is physically hazardous Recurrent substance related legal problems Continued use despite persistent or recurrent social or interpersonal problems AND Symptoms have never met the substance dependence criteria

13. Drug Classifications Alcohol Caffeine Cocaine Inhalants Opioids Sedatives Amphetamines Cannabis Hallucinogens Nicotine Phencyclidine

14. Drug Classifications Drug Classes Dependence DIAbuse DI Alcohol303.90305.00 Cocaine304.20305.60 Inhalants304.60305.90 Opioids304.00305.50

15. Course Specifiers Early Full Remission Early Partial Remission Sustained Full Remission Sustained Partial Remission On Agonist Therapy In a Controlled Environment Actively Using Never Met Criteria

16. Congratulations! You now understand DSM-IV