Diagnosis
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Podcast Host: Addiction Counselor Exam Review and Counselor Toolbox
Objectives
~ Review the criteria for substance use disorder
~ Discuss substance induced disorders
~ Learn mnemonics to identify signs of intoxication and withdrawal as well as mental health symptoms
Diagnosis and the DSM
~ The Diagnostic and Statistical Manual is created to
~ facilitate communication between and within professions regarding mental health and substance use disorders
~ Improve interrater reliability regarding diagnosis
~ Improve sharing of information about client presentation and needs
ICD-10
~ International Classification of Disease is used for diagnosis (like the DSM)

Diagnosis of Substance Use Disorders
~ The DSM V recognizes 10 separate classes of drugs
~ Alcohol
~ Inhalants
~ Opioids
~ Sedatives
~ Hypnotics/Barbiturates
~ Anxiolytics
~ Stimulants
~ Caffeine
~ Tobacco
~ Cannabis
~ Hallucinogens
~ Other/Unknown substances
SUD Diagnosis
~ Although how each types of drug acts in the brain differs, they all activate the brain’s reward system
~ Two groups of substance disorders
~ Substance use
~ Substance induced
SUD Diagnosis
~ Diagnosis
~ Using in larger amounts or for longer than intended
~ Wanting to cut down or stop but failing
~ Spending increased time getting, using or recovering from use
~ Cravings and urges
~ Neglecting work, school, family, social obligations because of use
~ Continue to use even when it causes problems in relationships
~ Giving up important social, occupational, recreational activities because of use
~ Using in risky situations
~ Continuing to use despite knowing that it is making a physical or psychological problem worse
~ Tolerance
~ Withdrawal

Diagnosis of Substance Use Disorders
~ SUD severity is dependent on how many symptoms are present
~ 2-3 symptoms = Mild
~ 4-5 = Moderate
~ More than 5 severe
~ Qualifiers
~ In early remission
~ In sustained remission
~ On maintenance therapy
~ In a controlled environment

Substance Induced vs. Mental Illness Dx
~ Substance induced means that the current presenting symptoms are likely the result of use of a substance not an underlying (pre-existing) mental disorder
~ Concurrent mental disorders can (and often do) occur
Substance-Induced Disorder Diagnosis
~ Result from effects of the use of a substance
~ Intoxication
~ Withdrawal
~ Anxiety or depressive disorders
~ Bipolar and related disorders
~ Psychotic disorders (hallucinations, delusions)
~ Sleep disorders
~ Sexual dysfunctions
~ Neurocognitive disorders
~ The teeter-totter principle helps predict symptoms in the withdrawal period (Polysubstance complicates things)
Depressants
~ Alcohol, Sedative, Hypnotic, or Anxiolytic Intoxication (SAM'S GIN)
Slurred Speech
Attention impairment
Memory impairment
Stupor or coma or death
Gait unsteady
Incoordination
Nystagmus
Depressants
~ Alcohol, Sedative, Hypnotic, or Anxioloytic Intoxication Withdrawal (PAST NITES)
Psychomotor agitation
Anxiety
Seizures (Grand-Mal)
Transient hallucinations
Nausea or vomiting
Insomnia
Tremor increased (hand)
Excitability-autonomic (Increased HR and BP)
Sweating (diaphoresis)
Stimulants
~ Amphetamine/Cocaine Intoxication (A CODE BLUE)
Agitation or retardation (psychomotor)
Cardiac (tachycardia or bradycardia)
Opening of the pupil
Diaphoresis (or chills)
Encephalopathic-like changes (seizures, confusion, dyskinesias, dystonias, or coma)
Blood pressure (elevated or lowered)
Loss of stomach content
Unstable muscle-associated changes (diaphramatic, cardiac, and skeletal) i.e., muscle weakness, respiratory depression, arrhythmias
Evidence of weight loss

Stimulants
Amphetamine/Cocaine Withdrawal (D-PANTS)
Depression (suicidal)
P -Psychomotor agitation or retardation
A -Appetite increases
N -Nightmares (vivid, unpleasant dreams)
T -Tiredness (fatigue)
S -Sleep (hypersomnia or insomnia)

Cannabis and Hallucinogens
Hallucinogen Intoxication (DISTORT)
Disoriented (blurred) vision
Incoordination
Sweating
Tachycardia
Opening of the pupil
Racing heart (palpitations)
Tremor
Cannabis Intoxication (MEAT)
Mouth dry
Erythamatous conjunctiva
Appetite increased
Tachycardia

Opiates
~ Opioid Intoxication (SAD)
Slurred speech
Pinpoint pupils
Attention (or memory) impairment
Respiratory depression
Euphoria
Drowsiness

~ Withdrawal (ARMY FINDS)
Aches (muscular)
Rhinorrhea (or lacrimation)
Mood-dysphoric (depression)
Yawning
Fever
Insomnia
Nausea/vomiting
Diarrhea
Sweating

Also…pupillary dilation or piloerection (goosebumps)

PCP
~ Phencyclidine Intoxication (MAP STAND)
Muscle rigidity
Acute sense of hearing (hyperacusis)
Pain numbness
Seizures (or coma)
Tachycardia (or hypertension)
Ataxia (loss of control of bodily movements)
Nystagmus – horizontal and vertical
Dysarthria –(problems with articulation)
Depression
~ A Sad Face
~ Appetite change
~ Sleep disturbances
~ Anhedonia
~ Dysphoria
~ Fatigue
~ Agitation/restlessness
~ Concentration difficulties
~ Esteem (low)
Mania/Hypomania
~ DIG FAST
~ Distractibility
~ Indiscretion
~ Grandiosity
~ Flight of ideas
~ Activity increase
~ Sleep deficit
~ Talkativeness
Anxiety
~ GAD
~ WATCHERS
~ Worry
~ Anxiety
~ Tension in muscles
~ Concentration difficulty
~ Hyperarousal (or irritability)
~ Energy loss
~ Restlessness
~ Sleep disturbance
PTSD
~ TRAUMA
~ Traumatic event
~ Re-experience
~ Avoidance
~ Unable to function
~ Month or more of symptoms
~ Arousal increased
Summary
~ Some conditions are substance induced
~ Substance use can also be a condition in it’s own right
~ It is important to be able to differentially diagnose co-occurring disorders.