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Over the Hills and Far, Far
away
DSM V, the Brave New World
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Presented by Rick Moldenhauer, MS,
LADC, ICADC, LPCC
Treatment Services Consultant/State OpioidTreatment Authority
P: (651) 431 2474
F: (651) 431 7449
Alcohol and Drug Abuse Division, DHS
PO Box 64977
St Paul, Minnesota 55164-0977
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Notice of Copyright and
Limitations on Use and Liability
"Copyright 2009, State of Minnesota, Department of Human Services"
"This curriculum was written by the Minnesota Department of HumanServices for use in its training regarding pharmacology of drugs of addiction.The curriculum was designed for the specific purposes that may or may notapply to other locations, and may require modifications of content and/or
form before it can be used in other jurisdictions. The Minnesota Departmentof Human Services makes no representations and accepts no liability on itsuse or results. This curriculum is made available free as part of trainingprovided by the Minnesota Department of Human Services and is availablefor personal use by a single requestor for a nominal fee, which covers thecost of making, certifying, compiling and copying the materials. Any use ofthis curriculum for other than personal use requires a licensing agreement
with the department. This curriculum may not be sold, used, or reproducedfor profit or financial gain. Those accessing or copying this document agreeto be bound by the aforementioned limitations on its use. "
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http://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Plus_sign.svg/200px-Plus_sign.svg.png7/29/2019 Changes in DSM V
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For the draft language
www.dsm5.org
Substance-Related Disorder found in:
http://www.dsm5.org/ProposedRevisions/Pa
ges/Substance-RelatedDisorders.aspx
http://www.dsm5.org/http://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/ProposedRevisions/Pages/Substance-RelatedDisorders.aspxhttp://www.dsm5.org/7/29/2019 Changes in DSM V
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History of the Diagnostic and Statistical
Manual of Mental Disorders (DSM)
DSM I.1952
DSM II1968
DSM III..1980 DSM III-R..1987
DSM IV..1994
DSM IV TR2000 DSM Vplanned June 2013
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Substance Related Disorders
Substance Use Disorders;
-Substance Dependency
-Substance Abuse
Substance- Induced Disorders-Substance Intoxication
-Substance Withdrawal
Substance-Induced Mental Health DisorderIncluded Elsewhere
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Specifiers
With Physiological
Dependence: Used
when there is
evidence of toleranceor withdrawal
Without Physiological
Dependence: Used
when there is no
evidence of toleranceor withdrawal.
Substance
dependence is
characterized by apattern of compulsive
use
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Course Specifiers
Course Specifiers is based on length of
time and number of criteria met
Divided into four categories as follows
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Early Full Remission
Early Full Remission
Dependence 1 month 0-11 months
at least 1 month, but less than 12 months, no criteria met
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Early Partial Remission
Early Partial Remission
Dependence 1 month 0-11 months
atleast one month, but less than 12 months, no criteria met
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Sustained Full Remission
Sustained Full Remission
Dependence 1 month 0-11 months+
at least 12 months, no criteria met
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Sustained Partial Remission
Sustained Partial Remission
Dependence 1 month 0-11 months+
one or more, but not full criteria for 12 months or longer
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Additional Course Specifiers
On Agonist Therapy:
Used when client has
no symptoms and is
on anagonist/antagonist
medication (e.g.
methadone,
dexamphetamine)
In a Controlled
Environment:
Used when access is
restricted (e.g.hospital, jail)
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Substance intoxication
Development of a reversible substance-
specific syndrome due to recent ingestion
(or exposure to) a substance
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Major Change!!!!!!!!!
DSM V will remove the segregation
between Abuse and Dependency
diagnosis, and will be replaced by single
term Substance Use Disorder withSeverity and Course Specifiers.
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Substance Use Disorder, DSM V
A. A maladaptive pattern of substance use leading toclinically significant impairment or distress, asmanifested by 2 (or more) of the following, occurringwithin a 12-month period:
1) recurrent substance use resulting in a failure to fulfillmajor role obligations at work, school, or home (e.g.,repeated absences or poor work performance related tosubstance use; substance-related absences,suspensions, or expulsions from school; neglect ofchildren or household)
2) recurrent substance use in situations in which it isphysically hazardous (e.g., driving an automobile oroperating a machine when impaired by substance use)
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Substance Use Disorder, DSM V
3) continued substance use despite having persistent orrecurrent social or interpersonal problems caused orexacerbated by the effects of the substance (e.g.,arguments with spouse about consequences ofintoxication, physical fights)
4) tolerance, as defined by either of the following:
a. a need for markedly increased amounts of thesubstance to achieve intoxication or desired effect
b. markedly diminished effect with continued use ofthe same amount of the substance(Note: Tolerance is not counted for those takingmedications under medical supervision such asanalgesics, antidepressants, ant-anxiety medicationsor beta-blockers.)
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Substance Use Disorder, DSM V
7) there is a persistent desire or unsuccessful
efforts to cut down or control substance use
8) a great deal of time is spent in activities
necessary to obtain the substance, use thesubstance, or recover from its effects
9) important social, occupational, or recreational
activities are given up or reduced because of
substance use
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Substance Use Disorder, DSM V
10) the substance use is continued despite
knowledge of having a persistent or recurrent
physical or psychological problem that is likely to
have been caused or exacerbated by thesubstance
11) Craving or a strong desire or urge to use a
specific substance.
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Caffeine
DSM IV TR:
305.90 Caffeine Intoxication
292.89 Caffeine-Induced Anxiety Disorder
292.85 Caffeine-Induced Sleep Disorder
292.9 Caffeine-Induced Disorder Not
Otherwise Specified
DSM V:
305.90 Caffeine Intoxication
292.89 Caffeine-Induced Anxiety Disorder
292.85 Caffeine-Induced Sleep Disorder
292.9 Caffeine-Induced Disorder Not
Otherwise Specified
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Cannabis
DSM IV TR: 304.30 Cannabis Dependence
304.20 Cannabis Abuse
292.89 Cannabis Intoxication
292.81 Cannabis IntoxicationDelirium
292.11 Cannabis-InducedPsychotic Disorder with Delusions
292.12 Cannabis-InducedPsychotic Disorder withHallucinations
292.89 Cannabis-Induced Anxiety
Disorder 292.9 Cannabis-Related DisorderNot Otherwise Specified
DSM V: Cannabis Use Disorder
Cannabis Withdrawal
292.89 Cannabis Intoxication
292.81 Cannabis IntoxicationDelirium
292.11 Cannabis-InducedPsychotic Disorder with Delusions
292.12 Cannabis-InducedPsychotic Disorder withHallucinations
292.89 Cannabis-Induced Anxiety
Disorder 292.9 Cannabis-Related DisorderNot Otherwise Specified
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Cocaine
DSM IV TR 304.20 Cocaine Dependence
304.60 Cocaine Abuse
292.89 Cocaine Intoxication
292.0 Cocaine Withdrawal
292.81 Cocaine Intoxication Delirium
292.11 Cocaine-Induced Psychotic Disorderwith Delusions
292.12 Cocaine-Induced Psychotic Disorderwith Hallucinations
292.84 Cocaine-Induced Mood Disorder
292.89 Cocaine-Induced Anxiety Disorder
292.89 Cocaine-Induced Sexual Dysfunction
292.85 Cocaine-Induced Sleep Disorder
292.9 Cocaine-Related Disorder Not
Otherwise Specified
DSM IV Cocaine-Use Disorder
292.89 Cocaine Intoxication
292.0 Cocaine Withdrawal
292.81 Cocaine Intoxication Delirium
292.11 Cocaine-Induced Psychotic Disorderwith Delusions
292.12 Cocaine-Induced Psychotic Disorderwith Hallucinations
292.84 Cocaine-Induced Mood Disorder
292.89 Cocaine-Induced Anxiety Disorder
292.89 Cocaine-Induced Sexual Dysfunction
292.85 Cocaine-Induced Sleep Disorder
292.9 Cocaine-Related Disorder NotOtherwise Specified
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Hallucinogens
304.50 Hallucinogen Dependence 305.30 Hallucinogen Abuse
292.89 Hallucinogen Intoxication
292.89 Hallucinogen PersistingPerception Disorder
291.81 Hallucinogen IntoxicationDelirium
292.11 Hallucinogen-InducedPsychotic Disorder with Delusions
292.12 Hallucinogen-InducedPsychotic Disorder with Hallucinations
292.84 Hallucinogen-Induced MoodDisorder
292.89 Hallucinogen-Induced Anxiety
Disorder 292.9 Hallucinogen-Related Disorder
NOS
Hallucinogen-Use Disorder 292.89 Hallucinogen Intoxication
292.89 Hallucinogen PersistingPerception Disorder
291.81 Hallucinogen IntoxicationDelirium
292.11 Hallucinogen-Induced
Psychotic Disorder with Delusions 292.12 Hallucinogen-Induced
Psychotic Disorder with Hallucinations
292.84 Hallucinogen-Induced MoodDisorder
292.89 Hallucinogen-Induced AnxietyDisorder
292.9 Hallucinogen-Related DisorderNOS
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Nicotine
305.1 Nicotine
Dependence
292.0 Nicotine
Withdrawal
292.9 Nicotine-Related
Disorder NOS
Nicotine-Use Disorder
292.0 Nicotine
Withdrawal
292.9 Nicotine-Related Disorder
NOS
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Phencyclidine
304.60 PhencyclidineDependence
305.90 Phencyclidine Abuse
292.89 Phencyclidine Intoxication
292.81 Phencyclidine IntoxicationDelirium
292.11 Phencyclidine-InducedPsychotic Disorder with Delusions
292.12 Phencyclidine-InducedPsychotic Disorder withHallucinations
292.84 Phencyclidine-InducedMood Disorder
292.89 Phencyclidine-InducedAnxiety Disorder
292.9 Phencyclidine-RelatedDisorder NOS
Phencyclidine-Use Disorder 292.89 Phencyclidine Intoxication
292.81 Phencyclidine IntoxicationDelirium
292.11 Phencyclidine-InducedPsychotic Disorder with Delusions
292.12 Phencyclidine-InducedPsychotic Disorder withHallucinations
292.84 Phencyclidine-InducedMood Disorder
292.89 Phencyclidine-InducedAnxiety Disorder
292.9 Phencyclidine-RelatedDisorder NOS
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Polysubstance
304.80 Polysubstance
Dependence
Polysubstance-Use
Disorder
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What does this mean in
Minnesota?
Changes to Rule 25
assessment
Changes to DAANES