Core feature: Continued use of substances despite significant problems.
- Brain changes: Long-term alterations in brain circuits lead to cravings and relapses even after detoxification.
Diagnostic criteria (4 groups):
1. Impaired control – inability to regulate use, taking larger amounts, unsuccessful attempts to cut down, craving.
- Social impairment – failure to meet responsibilities, interpersonal problems, withdrawal from activities.
- Risky use – using in hazardous situations, continuing despite physical/psychological harm.
- Pharmacological criteria – tolerance (needing more for effect) and withdrawal (symptoms when stopping).
Severity levels:
Mild = 2–3 symptoms
Moderate = 4–5 symptoms
Severe = 6+ symptoms
Specifiers: early remission, sustained remission, on maintenance therapy, in a controlled environment.
Diagnosis: Must specify the exact substance (e.g., heroin, cocaine, methamphetamine) rather than using generic labels.
SUBSTANCE USE DISORDER
Reversible syndrome caused by recent ingestion.
- Leads to behavioral/psychological changes (e.g., mood swings, impaired judgment).
- Symptoms must not be due to another medical condition or mental disorder.
- Common signs: disturbances in perception, attention, thinking, judgment, psychomotor behavior.
Example:
Juan drinks too much alcohol at a party.
He becomes loud, aggressive, and has poor coordination.
This is alcohol intoxication.
substance intoxication
Syndrome caused by stopping or reducing prolonged heavy use.
- Involves behavioral changes plus physiological/cognitive symptoms.
- Causes distress or impairment in functioning.
- Often linked with substance use disorder, but not always.
Features: Distress, cognitive and physical symptoms (e.g., sweating, tremors, anxiety, irritability).
Example:
Maria, a long-term smoker, suddenly quits.
- She experiences irritability, cravings, and difficulty concentrating.
This is nicotine withdrawal.
substance withdrawal
Explanation: Mental health conditions directly caused by substance use.
Features: Can mimic psychiatric disorders (e.g., psychosis, depression, anxiety).
Example:
Pedro uses methamphetamine heavily.
- He starts experiencing paranoia and hallucinations.
This is methamphetamine-induced psychotic disorder
Substance/Medication-Induced Mental Disorders
Factors That Affect Intoxication & Withdrawal
Route of use: Faster methods (like smoking or injecting) cause stronger intoxication and higher risk of withdrawal.
Duration of drug action:
Short-acting drugs → stronger but shorter withdrawal.
Long-acting drugs → milder but longer withdrawal.
Multiple substances: If more than one drug is used, each intoxication/withdrawal must be diagnosed separately.
Development & Course
Intoxication often starts in the teen years.
Withdrawal can happen at any age if someone uses enough of a drug for long enough.
Young adults (18–24) have the highest rates of substance use.
Lab Tests
Blood/urine tests can confirm recent use.
But: A positive test doesn’t prove addiction, and a negative test doesn’t rule it out.
Tests can help identify unknown substances or show tolerance (when someone functions normally despite high levels).
Recording & Coding
Clinicians use ICD-10-CM codes to record diagnoses.
Codes combine both the substance use disorder and the substance-induced disorder.
Example:
F15.120 → methamphetamine intoxication with mild meth use disorder.
F19.920 → intoxication from an unknown substance.
These are mental health problems caused directly by substances or medications.
- They are different from substance use disorders (which are about addiction and continued use despite harm).
They can be triggered by:
1. Drugs of abuse (like alcohol, cocaine, opioids).
2. Prescription or over-the-counter medications.
3. Toxins (like carbon monoxide or insecticides).
🧩 Key Features
- To diagnose a substance/medication-induced mental disorder:
- Symptoms look like a real mental disorder (e.g., depression, psychosis, anxiety).
- Timing matters → symptoms start during or soon after intoxication, withdrawal, or medication use.
- The substance/medication is capable of causing those symptoms.
- It’s not better explained by an independent mental disorder (e.g., depression that existed before drug use).
- Symptoms cause distress or problems in daily life.
- They don’t occur only during delirium (confused/agitated states).
⚡ Common Patterns
Sedating drugs (alcohol, sedatives):
- Intoxication → depression.
- Withdrawal → anxiety.
- Stimulating drugs (cocaine, amphetamines):
- Intoxication → psychosis, anxiety.
- Withdrawal → depression.
- Both types can cause sleep and sexual problems.
💊 Medication-Induced Disorders
Some medications can cause psychiatric side effects:
- Steroids → mood swings, depression, anxiety.
- Antihypertensives → depression or anxiety.
- Anticholinergics → temporary psychosis.
- Anesthetics/antihistamines → cognitive problems.
📈 Course & Duration
Usually temporary → symptoms fade within about 1 month after stopping the substance/medication.
Exceptions:
- Alcohol-related neurocognitive disorder.
- Hallucinogen persisting perception disorder (“flashbacks”).
- Risk increases with higher quantity and frequency of use.
- People with preexisting mental disorders may experience worsening symptoms when using substances or certain medications.
🧪 Why It Matters
Symptoms can look identical to independent mental disorders (like schizophrenia or major depression).
- But the cause, treatment, and prognosis are different.
- Recognizing whether it’s substance/medication-induced prevents misdiagnosis and ensures proper treatment.
📝 Recording
Diagnoses combine the substance and the mental disorder.
Example: Cocaine-induced psychotic disorder with severe cocaine use disorder.
If no substance use disorder is present (e.g., one-time medication reaction), only the induced disorder is recorded.
Example: Corticosteroid-induced depressive disorder.
Substance/Medication-Induced Mental Disorders
means having a problematic pattern of drinking that causes distress or problems in daily life.
Diagnosis requires at least 2 symptoms within a 12-month period.
🧩 Key Symptoms
Some of the main signs include:
- Drinking more or longer than intended.
-Wanting to cut down but not being able to.
-Spending lots of time drinking or recovering from drinking.
-Strong cravings.
-Problems at work, school, or home due to drinking.
-Continuing to drink despite relationship or health problems.
-Giving up important activities because of alcohol.
-Drinking in risky situations (e.g., driving).
-Needing more alcohol to feel the effect (tolerance).
-Feeling sick or shaky when not drinking (withdrawal).
📊 Severity Levels
Mild: 2–3 symptoms.
Moderate: 4–5 symptoms.
Severe: 6+ symptoms.
Remission can be:
Early remission → no symptoms for 3–12 months (except cravings).
Sustained remission → no symptoms for 12+ months (except cravings).
⚡ Associated Problems
Physical: liver disease, ulcers, heart problems, nerve damage, memory issues (like Wernicke-Korsakoff syndrome).
-Psychological: depression, anxiety, sleep problems.
-Social: fights, neglecting responsibilities, accidents, crime.
-Suicide risk is higher, especially during intoxication or alcohol-induced depression.
📈 Development & Course
First intoxication usually happens in the mid-teens.
-Disorder often develops in the late teens to 20s.
-Course involves cycles of remission and relapse.
-Older adults can develop severe problems at lower drinking levels due to body changes.
🧪 Diagnostic Markers
Doctors may use:
Blood alcohol concentration (BAC) → shows tolerance if someone isn’t intoxicated at high levels.
Lab tests (like GGT, CDT, liver function tests) → detect heavy drinking.
Physical signs: tremors, insomnia, stomach issues, sexual dysfunction.
Differential Diagnosis
AUD vs. Alcohol Intoxication/Withdrawal/Induced Disorders:
- AUD = long-term pattern of problematic drinking (loss of control, social impairment, risky use, tolerance/withdrawal).
- Intoxication/Withdrawal/Induced Disorders = short-term psychiatric syndromes caused by heavy use.
Important: Many people drink heavily at times, but less than 20% develop AUD.
alcohol use disorder
the immediate effects of drinking too much alcohol.
It’s diagnosed when behavioral or psychological changes (like aggression, poor judgment, mood swings) appear during or soon after drinking.
🧩 Key Symptoms
To diagnose intoxication, at least one of these signs must be present:
- Slurred speech
- Poor coordination
- Unsteady walking
- Rapid, jerky eye movements (nystagmus)
- Memory or attention problems
- Stupor or coma
⚡ Diagnostic Features
Symptoms must not be explained by another medical condition or another drug.
- Intoxication can range from mild (talkativeness, feeling good) to severe (coma, even death at very high blood alcohol levels).
- Blackouts (amnesia for events while intoxicated) can occur at high levels.
📈 Associated Risks
Violence and accidents are more likely during intoxication.
- Suicide risk increases—each drink raises suicide attempt risk by about 30%.
- At very high blood alcohol levels (300–400 mg/dL), breathing and pulse can stop in people without tolerance.
🧪 Diagnostic Markers
Observed behavior + smell of alcohol on breath.
- Blood or breath alcohol levels confirm intoxication.
-Average body metabolizes about 1 drink per hour.
📊 Prevalence
Most people who drink have been intoxicated at least once.
- In U.S. high school seniors (2018):
- 43% reported being drunk at least once.
-17.5% reported being drunk in the past 30 days.
- Highest rates of intoxication are in ages 18–25.
🌍 Risk Factors
Temperament: impulsivity, sensation-seeking.
- Environment: peer pressure, stress, cultural norms (e.g., college parties, holidays).
- Gender: women generally reach higher blood alcohol levels than men with the same amount of alcohol.
🔍 Differential Diagnosis
Must be distinguished from:
- Medical conditions (like diabetic ketoacidosis).
- Other sedative drug intoxication (benzodiazepines, antihistamines).
- Alcohol-induced mental disorders (e.g., depression during intoxication).
substance intoxification
happens when someone who has been drinking heavily for a long time suddenly stops or reduces their intake.
-The body reacts because it has become dependent on alcohol.
🧩 Key Symptoms
At least two or more of these must appear within hours to a few days:
- Sweating or rapid heartbeat
- Hand tremors
- Insomnia
- Nausea or vomiting
- Hallucinations or illusions (seeing/hearing things that aren’t there)
- Agitation
- Anxiety
- Seizures (tonic-clonic type)
⚡ Diagnostic Features
Symptoms usually start 4–12 hours after stopping alcohol.
- Peak intensity: Day 2.
- Symptoms improve by Day 4–5, but mild anxiety and sleep problems can last 3–6 months.
- Severe cases can include delirium tremens (DTs) → confusion, hallucinations, and medical complications.
- Less than 10% of people in withdrawal develop DTs; seizures occur in fewer than 3%.
📊 Prevalence
About 50% of middle-class individuals with AUD experience withdrawal at some point.
-Rates are higher (80%+) among hospitalized or homeless individuals with AUD.
- Severe complications (DTs, seizures) are rare (<10%).
📈 Development & Course
Withdrawal episodes last 4–5 days.
- More common in older adults and those with long-term heavy drinking.
Risk increases with:
- Daily heavy drinking (8+ drinks/day).
- Past withdrawal episodes.
- Other medical conditions.
- Family history of withdrawal.
- Use of other depressant drugs (like sedatives).
🧪 Diagnostic Markers
Signs like autonomic hyperactivity (sweating, rapid pulse) plus a history of heavy drinking strongly suggest withdrawal.
⚠️ Functional Consequences
Withdrawal symptoms often push people to drink again to relieve discomfort, fueling relapse.
- Severe withdrawal may require hospital detox, leading to lost work time and higher medical costs.
- Overall, withdrawal signals greater impairment and worse prognosis in Alcohol Use Disorder.
Alcohol Withdrawal
These are mental health problems caused directly by alcohol use (during severe intoxication or withdrawal).
They mimic independent psychiatric disorders but are triggered by alcohol.
Examples include:
- Alcohol-induced psychotic disorder (hallucinations, delusions).
- Alcohol-induced bipolar disorder (mood swings).
- Alcohol-induced depressive disorder.
- Alcohol-induced anxiety disorder.
- Alcohol-induced sleep disorder.
- Alcohol-induced sexual dysfunction.
- Alcohol-induced neurocognitive disorder (memory/thinking problems).
🧩 Key Features
Symptoms look just like independent mental disorders, but the timing is tied to alcohol use.
They must:
- Develop during severe intoxication or withdrawal.
- Cause significant distress or impairment.
-Not be better explained by a preexisting mental disorder.
- If symptoms last more than 1 month after stopping alcohol, it’s more likely an independent disorder.
⚡ Severity & Risks
Can be as serious as independent disorders (e.g., suicide attempts).
- Usually short-lived → improve within days to weeks after stopping alcohol.
- Exception: Alcohol-induced neurocognitive disorder (like Wernicke-Korsakoff syndrome) can persist long-term.
📊 Prevalence
Depression: About 40% of people with Alcohol Use Disorder experience major depressive episodes, but only 1/3–1/2 are independent (the rest are alcohol-induced).
- Sleep & anxiety disorders: Similar rates to depression.
-Psychotic episodes: Less common (<5% of people with Alcohol Use Disorder).
📈 Development & Course
Symptoms last as long as severe intoxication or withdrawal continues.
Once alcohol use stops, most alcohol-induced disorders fade within a month.
Independent disorders (like schizophrenia or bipolar disorder) last much longer and usually require ongoing treatment.
Alcohol-Induced Mental Disorders
This diagnosis is used when someone shows alcohol-related symptoms that cause real problems in daily life (work, relationships, health, etc.).
However, the symptoms don’t fully match the criteria for any specific alcohol-related disorder (like Alcohol Use Disorder, Alcohol Intoxication, Alcohol Withdrawal, or Alcohol-Induced Mental Disorders).
🧩 Key Points
It’s a “catch-all” category for alcohol-related problems that are clinically significant but don’t fit neatly into another diagnosis.
Example:
- Someone has distressing alcohol-related sleep problems but doesn’t meet full criteria for alcohol-induced sleep disorder.
- Or someone shows impairment linked to alcohol but doesn’t meet enough criteria for Alcohol Use Disorder.
⚡ Why It’s Important
Ensures that clinically significant issues are recognized and treated, even if they don’t fit a specific label.
Prevents overlooking alcohol-related problems that still impact functioning.
Unspecified Alcohol-Related Disorder (F10.99):
happens when someone consumes a high dose of caffeine (usually more than 250 mg, about 2–3 strong cups of coffee).
- It’s diagnosed when 5 or more symptoms appear shortly after caffeine use.
🧩 Key Symptoms
Common signs include:
- Restlessness, nervousness, excitement
- Insomnia (trouble sleeping)
- Flushed face, sweating
- Frequent urination (diuresis)
- Stomach upset
- Muscle twitching
- Rambling speech or racing thoughts
- Fast or irregular heartbeat (tachycardia/arrhythmia)
- Feeling “wired” or unable to stop moving (psychomotor agitation)
⚡ Diagnostic Features
Symptoms must cause distress or impairment (e.g., trouble at work, school, or socially).
- They can’t be explained by another medical condition or mental disorder.
- Mild symptoms (like restlessness or insomnia) can occur even at lower doses (200 mg) in sensitive people.
- Very high doses (5–10 grams) can be lethal.
📊 Prevalence
About 7% of people in the U.S. may experience caffeine intoxication symptoms with impairment.
- Emergency visits related to energy drinks doubled between 2007–2011, especially among adolescents and young adults.
📈 Development & Course
Symptoms usually fade within a day (since caffeine’s half-life is 4–6 hours).
- Older adults often react more strongly (sleep problems, hyperarousal).
- Children and teens are at higher risk due to low body weight and lack of tolerance.
🧪 Risk Factors
More likely in people who:
- Rarely use caffeine but suddenly consume a lot.
- Recently increased intake.
- Take medications (like oral contraceptives) that slow caffeine elimination.
- Genetics also play a role in sensitivity.
⚠️ Consequences
Can cause serious impairment in daily functioning.
Extremely high doses → seizures, respiratory failure, even death.
Heavy use may worsen anxiety, depression, sleep problems, or eating disorders.
Caffeine Intoxication
happens when someone who regularly consumes caffeine (coffee, tea, soda, energy drinks, chocolate, etc.) suddenly stops or reduces intake.
- The body reacts because it has become dependent on caffeine.
🧩 Key Symptoms
At least three or more of these appear within 24 hours of stopping caffeine:
- Headache (most common and often severe)
- Fatigue or drowsiness
- Irritability, depressed mood, or feeling “off”
- Trouble concentrating
- Flu-like symptoms (nausea, vomiting, muscle pain/stiffness)
⚡ Diagnostic Features
Symptoms must cause distress or impairment (e.g., missing work, social withdrawal).
- They can’t be explained by another medical condition (like migraines or viral illness).
- Headache is the hallmark symptom, but withdrawal can occur without it.
📊 Prevalence
Over 85% of adults and children in the U.S. consume caffeine regularly.
- About 50% of people experience headaches when abstaining.
- In one study, 70% of people trying to quit caffeine reported withdrawal symptoms, and 24% had symptoms severe enough to impair daily functioning.
📈 Development & Course
Symptoms start 12–24 hours after the last dose.
- Peak: 1–2 days.
- Duration: 2–9 days, though headaches can last up to 3 weeks.
- Symptoms usually disappear quickly if caffeine is reintroduced (even small amounts).
🧪 Risk Factors
Higher risk with heavier daily use.
- Situations where caffeine is restricted (medical procedures, pregnancy, hospitalization, fasting, travel) can trigger withdrawal.
- Genetics may play a role, but no specific genes identified yet.
- People with eating disorders, alcohol/substance use disorders, or smokers often consume more caffeine and may be more vulnerable.
⚠️ Functional Consequences
Can cause serious impairment: missing work, staying in bed, canceling plans, or struggling with childcare.
- Withdrawal headaches are often described as “the worst ever.”
- Cognitive and motor performance may decline temporarily.
Caffeine Withdrawal
These are mental health problems triggered directly by caffeine use.
- They resemble independent psychiatric conditions but are caused by caffeine.
Examples:
- Caffeine-Induced Anxiety Disorder → excessive caffeine can cause panic-like symptoms, nervousness, or anxiety severe enough to need clinical attention.
- Caffeine-Induced Sleep Disorder → insomnia or disrupted sleep patterns caused by caffeine.
Important: These are diagnosed instead of caffeine intoxication or withdrawal only when the symptoms are severe enough to require independent treatment.
🧩 Key Features
Symptoms look like real mental disorders but are tied to caffeine use.
- Must cause clinically significant distress or impairment.
- If symptoms last more than 1 month after stopping caffeine, it’s more likely an independent disorder, not caffeine-induced.
📊 Prevalence & Risks
Anxiety and sleep problems are the most common caffeine-induced mental disorders.
- Risk increases with high caffeine intake (energy drinks, multiple cups of coffee).
- People with preexisting mental health conditions may experience worsening symptoms when consuming caffeine.
Caffeine-Induced Mental Disorders
Used when caffeine causes clinically significant problems but doesn’t fit neatly into any specific diagnosis.
Example: Someone experiences distressing caffeine-related symptoms but doesn’t meet full criteria for intoxication, withdrawal, or induced anxiety/sleep disorder.
Unspecified Caffeine-Related Disorder (F15.99)
the short-term effects of recent cannabis use.
It’s diagnosed when cannabis use leads to problematic behavioral or psychological changes (like impaired coordination, euphoria, anxiety, slowed time perception, poor judgment, or social withdrawal).
🧩 Key Symptoms
At least two or more of these must appear within 2 hours of use:
- Red eyes (conjunctival injection)
- Increased appetite (“the munchies”)
- Dry mouth
- Fast heartbeat (tachycardia)
⚡ Diagnostic Features
Intoxication usually starts with a “high” → euphoria, laughter, relaxation.
- Can also cause sedation, memory problems, distorted perceptions, slowed reaction time, and impaired motor skills.
- Sometimes anxiety, dysphoria, or social withdrawal occur.
- Effects last 3–4 hours when smoked, longer when eaten.
- Because THC is fat-soluble, effects can occasionally persist or reappear for 12–24 hours.
- Synthetic cannabinoids (like Spice/K2) can cause similar effects but at high doses may trigger hallucinations or psychosis.
📊 Prevalence
Most cannabis users will experience intoxication at some point.
- Prevalence of intoxication episodes is roughly equal to the prevalence of cannabis use itself.
⚠️ Functional Consequences
Intoxication can impair:
- Work or school performance
- Social interactions
-Driving and reaction time → accidents
- Judgment → risky behaviors (like unprotected sex)
In rare cases, intoxication can trigger psychosis.
🔍 Differential Diagnosis
Must be distinguished from:
- Alcohol intoxication (which decreases appetite and increases aggression).
- Sedative intoxication (similar motor impairment but different signs like nystagmus).
- Hallucinogen intoxication (similar perceptual changes but more intense).
If hallucinations occur without intact reality testing, it may be diagnosed as a substance-induced psychotic disorder instead.
Cannabis Intoxication
means having a problematic pattern of cannabis use that causes distress or problems in daily life.
- Diagnosis requires at least 2 symptoms within a 12-month period.
🧩 Key Symptoms
Some of the main signs include:
- Using more cannabis than intended or for longer than planned.
- Wanting to cut down but not being able to.
-Spending lots of time getting, using, or recovering from cannabis.
- Strong cravings.
- Problems at work, school, or home due to use.
- Continuing use despite relationship or health problems.
- Giving up important activities.
- Using in risky situations (e.g., driving).
- Needing more cannabis to feel the effect (tolerance).
- Feeling sick or irritable when not using (withdrawal).
📊 Severity Levels
Mild: 2–3 symptoms.
Moderate: 4–5 symptoms.
Severe: 6+ symptoms.
Remission can be:
Early remission → no symptoms for 3–12 months (except cravings).
Sustained remission → no symptoms for 12+ months (except cravings).
⚡ Diagnostic Features
Cannabis is used in many forms: smoking (joints, blunts, bongs), vaping, dabbing, edibles, oils, and synthetic cannabinoids (like Spice/K2).
- Potency varies widely, with modern products often much stronger than in the past.
- Regular use can lead to tolerance and withdrawal, making quitting difficult.
- Severe cases involve continued use despite major problems in life.
📈 Prevalence
Cannabis is the most widely used illicit psychoactive substance in the U.S.
Past-year prevalence:
Youth (12–17): ~3%
Adults (18+): ~2.5%
Highest rates: ages 18–29 (~7%).
More common in men than women.
- Globally, cannabis use disorder rates have increased over the past decades.
🧪 Associated Features
People often use cannabis to cope with mood, insomnia, pain, or stress.
- Chronic use can cause lack of motivation (sometimes called “amotivational syndrome”).
- Signs of use: red eyes, cannabis odor, yellow fingertips, chronic cough, food cravings.
⚠️ Consequences
Cognitive impairment (memory, attention, decision-making).
- Accidents (especially driving).
- Poor school/work performance.
- Relationship problems.
- Increased risk of mental health issues (depression, anxiety, psychosis).
- Cannabinoid hyperemesis syndrome → cyclic vomiting from heavy use.
- Respiratory and cardiovascular problems from smoking/vaping.
🔍 Differential Diagnosis
Not all cannabis use is problematic.
- 20–30% of users develop symptoms consistent with CUD.
Must distinguish CUD from:
- Cannabis intoxication (short-term effects).
- Cannabis withdrawal (symptoms after stopping).
- Cannabis-induced mental disorders (like anxiety or psychosis).
📊 Comorbidity
Often co-occurs with other substance use disorders (alcohol, tobacco, cocaine, opioids).
Strongly linked to mental health disorders (depression, bipolar disorder, PTSD, schizophrenia).
Cannabis use during adolescence increases risk of psychosis later
Cannabis Use Disorder
happens when someone who has been using cannabis heavily and regularly (usually daily for months) suddenly stops or reduces use.
- The body reacts because it has become dependent on cannabis.
🧩 Key Symptoms
At least three or more of these appear within about a week of stopping:
- Irritability, anger, or aggression
- Nervousness or anxiety
- Sleep problems (insomnia, disturbing dreams)
- Decreased appetite or weight loss
- Restlessness
- Depressed mood
- Physical discomfort (abdominal pain, tremors, sweating, fever, chills, headache)
⚡ Diagnostic Features
Symptoms cause distress or impairment in daily life.
- They can’t be explained by another medical condition or mental disorder.
- Emotional and behavioral symptoms (like irritability, anxiety, sleep problems) are more common than physical ones.
- Withdrawal often leads people to use cannabis again to relieve symptoms, making quitting difficult.
📊 Prevalence
Withdrawal symptoms occur in 35–95% of regular users who try to quit.
- About 12% of adult regular users in the general population meet full criteria for cannabis withdrawal.
- Rates are higher among heavy users and those in treatment (up to 95%).
- Women may experience more severe withdrawal symptoms than men.
📈 Development & Course
- Symptoms start 24–48 hours after stopping.
- Peak: 2–5 days.
- Usually resolve within 1–2 weeks, though sleep problems can last longer.
- Severity depends on how much and how often cannabis was used.
⚠️ Functional Consequences
Withdrawal symptoms often cause relapse or difficulty quitting.
Sleep problems are the most common trigger for relapse.
Some people turn to other substances (like tranquilizers) to ease withdrawal.
🔍 Differential Diagnosis
Symptoms can resemble:
- Tobacco or alcohol withdrawal
-Depression or anxiety disorders
- Medical conditions (like migraines or viral illness)
- Careful evaluation is needed to confirm cannabis withdrawal as the cause.
📊 Comorbidity
Commonly overlaps with:
- Depression
- Anxiety disorders
- Antisocial personality disorder
Often occurs alongside Cannabis Use Disorder.
Cannabis Withdrawal
that causes clinically significant distress or impairment in life.
- Diagnosis requires at least 2 symptoms within a 12-month period.
🧩 Key Symptoms
Using more than intended or for longer periods.
- Unsuccessful attempts to cut down.
- Spending lots of time obtaining, using, or recovering.
- Cravings.
- Problems at work, school, or home.
- Continued use despite relationship or health issues.
- Giving up important activities.
- Using in risky situations (e.g., driving).
- Continued use despite knowing it worsens problems.
- Tolerance (needing more for the same effect).
Note: Withdrawal is not well established for most hallucinogens, though MDMA/ecstasy may show withdrawal-like symptoms.
⚡ Diagnostic Features
Includes substances like LSD, psilocybin (“magic mushrooms”), DMT, mescaline, MDMA/ecstasy, salvia divinorum, and jimsonweed.
- These drugs alter perception, mood, and cognition.
- Methods of use: oral (most common), smoking (DMT, salvia), or rarely snorting/injecting (MDMA).
Duration varies: LSD/MDMA → long-lasting; DMT/salvia → short-acting.
Tolerance develops with repeated use.
📊 Prevalence
Rare overall: about 0.1% of U.S. population (2018 data).
- Higher in young adults (18–25) and in treatment populations.
- Among heavy ecstasy users, 70%+ may meet criteria for hallucinogen use disorder.
- Most cases are concentrated in ages 18–29.
📈 Risk Factors
Temperamental: sensation-seeking, risk-taking.
- Environmental: urban residence, peer drug use, higher income, lower education.
- Genetic: heritability estimated between 26–79%.
- Cultural: ritual use in Indigenous traditions (peyote, ayahuasca, psilocybin).
⚠️ Functional Consequences
Short-term intoxication effects: hallucinations, hyperthermia, tachyarrhythmias, restlessness, impaired coordination.
-Long-term/repeated use:
- Neurotoxic effects of MDMA → memory problems, serotonin dysfunction, sleep disturbance.
- Serious medical risks → renal failure, seizures, cardiac complications, liver damage.
- Social/occupational impairment due to time spent using or recovering.
🔍 Differential Diagnosis
Must be distinguished from:
Other substance use disorders (e.g., stimulants, alcohol).
Independent psychiatric disorders (schizophrenia, depression, bipolar).
Important to determine if symptoms existed before drug use or are directly drug-induced.
📊 Comorbidity
Commonly co-occurs with:
Cocaine and stimulant use disorders
Tobacco use disorder
Personality disorders
PTSD and panic attacks
problematic pattern of hallucinogen use (excluding PCP
These are mental health problems directly triggered by cannabis use (during intoxication or withdrawal).
They mimic independent psychiatric conditions but are caused by cannabis.
Examples include:
- Cannabis-Induced Psychotic Disorder → hallucinations, delusions.
- Cannabis-Induced Anxiety Disorder → panic, intense anxiety.
- Cannabis-Induced Sleep Disorder → insomnia or disrupted sleep.
🧩 Key Features
Diagnosed instead of cannabis intoxication or withdrawal when symptoms are severe enough to need independent clinical attention.
Symptoms must:
- Occur during or soon after cannabis use.
- Cause clinically significant distress or impairment.
- Not be better explained by another mental disorder.
If hallucinations occur without intact reality testing, it may be diagnosed as a substance-induced psychotic disorder instead.
📈 Development & Course
Symptoms last as long as severe intoxication or withdrawal continues.
- Most cannabis-induced mental disorders are short-lived → usually resolve within days to weeks after stopping cannabis.
- Exception: Cannabis-induced psychosis can sometimes persist longer and may increase risk for chronic psychotic disorders.
⚠️ Why It Matters
These disorders can look identical to independent conditions (like schizophrenia or generalized anxiety disorder).
- Correct diagnosis is crucial because:
- Cannabis-induced disorders often improve quickly once cannabis use stops.
Independent disorders usually require long-term treatment.
Cannabis-Induced Mental Disorders
a problematic pattern of using PCP or similar dissociative drugs (like ketamine, cyclohexamine, dizocilpine) that causes clinically significant distress or impairment.
- Diagnosis requires at least 2 symptoms within a 12-month period.
🧩 Key Symptoms
Using more PCP than intended or for longer periods.
- Unsuccessful attempts to cut down.
- Spending lots of time obtaining, using, or recovering from PCP.
- Cravings.
- Problems at work, school, or home due to use.
- Continued use despite social or relationship problems.
- Giving up important activities.
- Using in risky situations (e.g., driving).
- Continued use despite health or psychological problems.
- Tolerance (needing more for the same effect).
Note: Withdrawal symptoms are not established in humans.
📊 Severity Levels
Mild: 2–3 symptoms.
Moderate: 4–5 symptoms.
Severe: 6+ symptoms.
Remission can be:
Early remission → no symptoms for 3–12 months (except cravings).
Sustained remission → no symptoms for 12+ months (except cravings).
⚡ Diagnostic Features
PCP and related drugs were originally developed as dissociative anesthetics.
Effects: feelings of detachment from mind/body, hallucinations, derealization, analgesia, euphoria, unusual thought content.
High doses → stupor, coma, or violent behavior.
- PCP can stay in the body for 8+ days, and psychotic episodes may last weeks.
- Ketamine has medical uses (e.g., treatment-resistant depression), but misuse can lead to dependence.
📈 Prevalence
PCP use disorder is rare.
- Hallucinogen use disorder overall (including PCP) affects about 0.1% of people age 12+.
- More common among men (62% of treatment admissions for PCP were male).
⚠️ Functional Consequences
Physical injuries from accidents, fights, or falls.
Chronic use → cognitive impairment, urinary and intestinal problems, chest pain, palpitations, respiratory depression, sleep disorders, depression.
Violent behavior can occur during intoxication.
🔍 Differential Diagnosis
Must be distinguished from:
- Phencyclidine intoxication (short-term effects).
- Phencyclidine-induced mental disorders (like psychosis).
- Independent psychiatric disorders (schizophrenia, depression, conduct disorder).
- PCP is sometimes mixed with other drugs (like cannabis or cocaine), complicating diagnosis.
📊 Comorbidity
Often co-occurs with:
- Conduct disorder (in adolescents).
- Antisocial personality disorder.
- Other substance use disorders (alcohol, cocaine, amphetamines).
Phencyclidine Use Disorder (PCP Use Disorder)
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LESSON 187
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LESSON 268
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LESSON 3104
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LESSON 499
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LESSON 5 BIPOLAR54
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PPT 6 (FINALS)29
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ANXIETY42
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DISORDER NEURO- ANXIETY4
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OCD41
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PERSONALITY DISORDER65
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DISSOCIATIVE DISORDER48
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EATING DISORDER76
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SOMATIC58
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TRAUMA46
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IMPULSE41
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SLEEP WAKE DISORDERS73
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SLEEP WAKE BY MAAM ARIANNE31
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SUBSTANCE USE DISORDER32
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PARAPHILIC12
