even as a doctor i'm telling you this
because i see addicts every day so
unfortunately people look at addicts as
bothersome or annoying or you're selfish
and they don't want to interact with
them when in reality kyle they are
suffering us suffering right i promise
you that they're suffering right and i
can also promise you that they don't
want to be that way
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these are the criteria set forth by the
dsm-5 it's our most recent edition of
diagnostics now just a note in the dsm-4
we used to have abuse and dependence but
that's gone now it's just
substance use disorder and in this
particular case it's opiate use disorder
so this is how we look at it there are
11 criteria and over the course of 12
months over the course of one year i
want people to think about
how many of these criteria they they
might hit because that's going to really
sort of
delineate whether it's a mild moderate
or severe issue or if you have an issue
at all right okay so you have 11. let's
go through the 11 okay so the first
thing is this if you're using a
substance and you are getting involved
in a hazardous or dangerous circumstance
somehow putting yourself at risk by
using that substance that's the first
criteria that could be
getting into a car when you're using
that could be experiencing an overdose
something dangerous happens so did
something ever dangerous happen because
of that substance that's number one okay
the next one is social life did your
social life change
based on this substance all right so pay
attention to your social life am i with
a different peer group is something
changing am i more isolative did
something happen did my social life
change the number three
is neglect am i neglecting a duty in my
life because of this substance
that could be your job it could be your
role as a parent it could be your role
as a spouse am i neglecting some sort of
daily duty because of this is that
something's taking over so much that i'm
neglecting something in my life right
and then uh we have withdrawal have you
ever experienced withdrawal and we
talked about withdrawal withdrawal means
you don't take the substance for a
certain amount of time and you
experience physical symptoms so have you
ever experienced withdrawal
the next one is tolerance have you ever
experienced tolerance which basically
means
wow i'm noticing that i have to take
more of this to get the same effect so
my experiencing some sort of tolerance
right
am i taking more and more and more
the the next one is uh the length of
time right so
do you notice that you're spending a lot
of your time
looking for this substance or using that
substance okay
uh the next one is have you ever tried
to quit and you couldn't it's a very
simple one have you ever said you know
what i'm done with this and then that
doesn't really work out for you so if
you tried to quit it doesn't work that's
one another one is
have you experienced
physical or emotional ramifications from
this substance so have you gotten
physically sick
have you not been taking care of
yourself or have you like behaviorally
been erratic or impulsive has your mood
changed because of this substance does
it do does the physical and emotional
components have to be negative or can it
be
i would say affecting your life in a
negative way somehow like moody
irritable
you know something like that right um
the next thing is activities so
are you skipping
activities that you normally would have
done
pleasurable things have you changed your
activities
to do the substance
right so instead of i used to do chest
tournaments i don't do that anymore
because i'm using yeah so are you
substituting activities that you used to
like
to use the substance did you actually
participate in chess tournaments never
okay i don't know i don't know why that
was that was an obscure example i
thought clearly he must have done chess
tournaments at some point i don't know
why they jumped into my mind those
actors
i see so many people just nailing it in
chess and then their life gets derailed
okay all right you usually play in a
pickup basketball game but you're
skipping that activity there and you are
using i understand you are using
opiates right
and the other one is craving do you find
that you're
craving this are you
are you thinking about it are you like
thinking about that next fix right um
and then and then time if we didn't talk
about time are you spending just more
and more time using the substance just
over time so i think that's all 11. and
here's how it works if you have two of
any of those that i just listed
over the course of 12 months
then you have a substance use disorder
however if you if you have two or three
it's considered a mild substance use
disorder if you have four or five it's
considered a moderate substance use
disorder and if you have six or above it
is a severe substance use disorder so
that hopefully clarifies how doctors and
addiction specialists will diagnose a
substance use disorder based on that
criteria and
when you say you have to have at least
two over 12 months does it it only has
to occur once over those 12 months
because of that substance
something is happening so even if you're
saying wow i'm using this substance and
i tried to quit and i can't
and i noticed i'm really moody so that's
two right so my behavior has changed and
i tried to quit so i have a mild
substance use disorder wow
for me that seems like a very
low standard like it would be pretty
easy to get that diagnosis
because
you get a prescription for percocet you
start taking it and you're like yeah i'm
a little moody at the end of the day
when it's wearing off and i'm not
playing volleyball anymore because i
just rather stay home and take percocets
mild substances right but think about it
honestly if you're taking percocet and
you're not playing volleyball anymore
because you're taking a substance that's
a problem yeah like it's it's somehow
taking over your life right now if
you're not playing volleyball because
your shoulder hurts and that's why you
got the percocet it doesn't count that
doesn't count okay no directly related
to this option got it i got it okay that
was very very enlightening thank you
anything else that we need to know from
the dsm no i think that's so that's
really how
we're all going to communicate as far as
clinicians when we say
this individual has opioid use disorder
moderate i love it so then i talk to
someone else and then okay so he's
meeting this many criteria got it so it
levels the playing field when we talk
very clear i like it thanks dr sportelli
we're going to keep this conversation
going in our next episode
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