Psychiatric Comorbidities

Question 1

What is the diagnostic criteria for substance use disorder

Answer 1

Don’t overthink this. There are a LOT of option here, you only need 2 within a year. Basically anything linked to abusing something = SUD

2 or more w/in 12 months:
• Used in larger amounts OR over longer periods of time
• Desire or unsuccessful attempts to cut back
• Great deal of time spent obtaining, using, recovering
• Cravings or strong desire or urge to use
• Recurrent use results in failure to fulfill major obligations
• Continued use despite recurrent social/interpersonal
problems caused or exacerbated by effects
- Give up or reduce important social, occupational or
recreational activities
• Recurrent use in physically hazardous situations
• Continued use despite knowledge of persistent or recurrent
physical or psychological problems
• Tolerance (inc amount to get same intoxication, dec effect
with same amount)
• Withdrawal (characteristic withdrawal syndrome, substance
taken to relieve or avoid withdrawal symptoms)

Question 2

When diagnosing someone with SUD, what three situation require us to record an extra note about the patient?

Answer 2

• In Early Remission (no criteria met for 3-12 mon)
• In Sustained Remission (no criteria >12 mon; exception = cravings)
• In a Controlled Environment (access to substance restricted)

Question 3

What are the levels of severity for SUD?

Answer 3

• Mild (2-3 sxs)
• Moderate (4-5 sxs)
• Severe (6+ sxs)

Question 4

Comorbid vs. substance induced

Answer 4

Comorbid is a disease or process that was around before your substance abuse or that is unrelated.

Substance induced is some physiologic effect secondary to abusing a substance.

Question 5

What were the parameters of the NESARC (2001-2002)?

Answer 5

• National Epidemiological Survey on Alcohol and
Related Conditions
• Comorbidity SUD & independent mood/anxiety DOs
• Face-to-face survey of 43K adult respondents
• Civilian, non-institutionalized, US residing

Question 6

What were the results of the NESARC?

Answer 6

Prevalence (%) of Co-occurring SUD (12 mon) and Independent Mood or Anxiety Disorders:
• Mood/Anxiety DO among SUDs = 20/18
• Mood/Anxiety DO among ETOH DO in Tx = 40/33
• Mood/Anxiety DO among Drug DO in Tx = 60/43
• SUDs among Mood/Anxiety DOs = 20/15
• SUDs among Mood/Anxiety DO in Tx = 20/16

Question 7

There are 6 stages of change in SUD. What are they?

Answer 7

Pre-contemplation – “I don’t have a problem, YOU have a problem!” In this stage, offer education; counseling generally results in minimal change

Contemplation – “I might have a problem.” Focus on non-judgmental motivational interviewing and explore ambivalence, costs/benefits, continue to engage

Preparation – “I have a problem and I’m ready to change.” Imminent plan to change; time for action! Refer to appropriate treatment; set change date

Action – working their change in active treatment

Maintenance – maintaining sobriety, periodic inquiry/support

Relapse – normal part of recovery cycle; helpful to anticipate