Subtitle<\/u>:\u00a0 Series on Substance Use Disorder (Part I)<\/p>\n
Case study<\/u>:\u00a0 A 45 year old woman with chronic obstructive pulmonary disease and peripheral neuropathy arrives to seek care in your office or facility.\u00a0 She smokes a half pack of cigarettes per day, drinks one 750 ml bottle of white wine daily, smokes marijuana once daily and uses prescription long acting Morphine for \u201cchronic pain,\u201d lorazepam twice a day for \u201canxiety\u201d, and prescription short acting amphetamine salts for \u201cattention deficit disorder\u201d.\u00a0 She states that she would like to stop smoking, because of her lung problem, but thinks of her alcohol and marijuana use as \u201crecreational\u201d and her prescription drug use as treatment of medical conditions.\u00a0 She emphatically states that she is only \u201caddicted\u201d to tobacco.<\/p>\n
Question:<\/u>\u00a0 Is she addicted to something else?<\/p>\n
Answer:<\/u>\u00a0 Maybe?<\/p>\n
The words drug abuse<\/em> and drug addiction<\/em> carry a significant stigma in our society, which results in individuals who are using substances in dysfunctional ways strongly denying that they are addicted or abuse drugs.\u00a0 This led the American Psychiatric Association to create a new terminology in 2013, as part of the newly released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, affectionately known as DSM-5.<\/p>\n Substance use has a spectrum of labels, as currently standardized by DSM 5.\u00a0 Of note, the terms addiction and abuse<\/em>, which were widely misinterpreted and carried significant stigma, are no longer standard.<\/p>\n The spectrum is:<\/p>\n In DSM 5, Substance Use Disorders include:<\/p>\n These different substances are grouped together in the overarching category of all SUDs, they all share a similar common pathway in disruptions in the stimulus\/response, reward, habit centers of the brain (shared also with compulsive gambling, and eating disorders).\u00a0 In spite of the final common pathway, different SUDs have critically different underlying biochemical, sociological, legal, psychological and sociological etiologies and pathways, such that they are often addressed by different staff, in different, separate settings.<\/p>\n In DSM-5, the diagnosis of SUD is based on the presence of at least 2 of 11 criteria; these can be divided into four clusters or groups, as follows:<\/p>\n Group 1:\u00a0 Impaired Control<\/p>\n Group 2:\u00a0 Social Impairment<\/p>\n Group 3:\u00a0 Risky use<\/p>\n Group 4:\u00a0 Pharmacologic Dependence<\/p>\n The number of criteria determine the severity of the SUD:<\/p>\n 2-3:\u00a0 Mild SUD<\/p>\n 4-5:\u00a0 Moderate SUD<\/p>\n 6 or more:\u00a0 Severe SUD<\/p>\n This categorization system seems complicated, at first, but it is the bedrock for diagnosis of all the individual Substance Use Disorders.<\/p>\n All of us in the medical profession need to be aware of our use of language and educate out patients on this use of language.\u00a0 It is not as easy as it seems.\u00a0 For example, the American Society of Addiction Medicine (ASAM) has not changed its name (would it change to ASSUDM?), and their reference book \u00a0is Addition Medicine<\/em>, published in 2016.\u00a0 In fact, they have their own standard \u201cshort\u201d definition of addiction which is different from the DSM-5 terminology, which starts out as follows:<\/p>\n \u201cAddiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.\u00a0 Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.\u00a0 This is reflected in an individual pathologically pursuing reward and\/or relief by substance use and other behaviors.\u201d\u00a0 (See ASAM website for full definition.)<\/p>\n If ASAM hasn\u2019t changed their language yet, we in the non-SUD world can be forgiven, perhaps, taking a few years to become facile with the new words and their uses.<\/p>\n Next in series:\u00a0 Part II:\u00a0 Alternative Facts on Alcohol Detox<\/p>\n Author: Robert Moore, MD, Chief Medical Officer, Partnership HealthPlan of California<\/p>\n","protected":false},"excerpt":{"rendered":" Subtitle:\u00a0 Series on Substance Use Disorder (Part I)<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1942","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n\n
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