Substance-Related Disorders
Substance Dependence
The Diagnostic Features were updated to indicate that varied degrees of tolerance may develop to the different central nervous system effects of a substance, that tolerance may develop to phencyclidine, and that a past history of tolerance or withdrawal is associated with a worse clinical course (i.e., earlier onset, higher levels of substance intake, and greater numbers of substance-related problems).
Familial Pattern for Dependence/Abuse/Intoxication/Withdrawal
The text was updated to clarify that individuals who may be at higher risk for Alcohol Dependence because of a family history of Alcohol Dependence do not necessarily have a higher risk of developing Dependence on other substances.
Substance-Induced Disorders
Examples were added to help clarify when it is appropriate to diagnose Substance Intoxication or Substance Withdrawal versus a Substance-Induced Disorder With Onset During Intoxication or With Onset During Withdrawal.
Alcohol-Related Disorders
The "Associated Features" section (e.g., risk of alcohol-related accidents, comorbidity with other disorders) was updated. A discussion of the laboratory test carbohydrate deficient transferrin (CDT), a widely-used state marker for heavy drinking, was added. In the "Specific Culture, Age, and Gender Features" section, text concerning the low rates of Dependence in Asians and the clinical course in women was expanded. Text regarding the prevalence of alcohol use, prevalence of alcohol-related complications, and the prevalence of Alcohol Dependence was expanded and updated.
Amphetamine-Related Disorders
Text regarding the prevalence of amphetamine use across different age groups and the prevalence of Dependence was expanded and updated.
Caffeine-Related Disorders
Specific Age Features was expanded to include information about the increased sensitivity of the elderly to the effects of caffeine. A "Prevalence" section was added that describes patterns of caffeine use, and the "Course" section has been expanded and updated.
Cannabis-Related Disorders
Updated information regarding mechanisms of action was added to the introductory section. The text for Cannabis Dependence was updated to clarify that evidence of physiological dependence is seen in chronic users and may be associated with more severe cannabis-related problems. Text regarding the prevalence of cannabis use across different age groups and the prevalence of Dependence was expanded and updated. A discussion regarding whether cannabis use is a precursor to other drug use (i.e., its role as a “gateway drug”) was added to the "Course" section.
Cocaine-Related Disorders
The complications of severe Cocaine Intoxication were updated and expanded, and Specific Culture and Gender Features were also updated. Text regarding the prevalence of cocaine use across different age groups and the prevalence of Dependence and Abuse was expanded and updated.
Hallucinogen-Related Disorders
A discussion of the physiological changes associated with intoxication (e.g., increases in blood glucose) was added. Text regarding the prevalence of hallucinogen use across different age groups and the prevalence of Dependence and Abuse was expanded and updated.
Inhalant-Related Disorders
Additional information was added to the sections on Associated Laboratory Findings (e.g., urine assay for a metabolite of toluene) and Associated Physical Examination and General Medical Conditions (e.g., an expanded list of respiratory complications and possible association between benzene and acute myelocytic leukemia). Text regarding the prevalence of different types of inhalant use among different age and other demographic groups was added.
Nicotine-Related Disorders
Specific Culture, Age, and Gender Features were updated (e.g., data about increased nicotine blood levels in African-Americans were added). Text regarding the prevalence of smoking and other tobacco use in various groups and the prevalence of Nicotine Dependence was updated. The "Course" section was also revised based on new data.
Opioid-Related Disorders
Text regarding hepatitis screening tests was added to Associated Laboratory Findings, and death rates from medical complications were added to Associated General Medical Conditions. Specific Gender Features (i.e., gender ratio), and Course (i.e., remission rates) were updated. Text regarding the prevalence of different patterns of opioid use among different age and other demographic groups was updated and expanded.
Phencyclidine-Related Disorders
Text regarding the prevalence of different patterns of phencyclidine use among different age groups was updated and expanded.
Sedative, Hypnotic, and Anxiolytic-Related Disorders
Text regarding patterns of use among different age groups and the prevalence of Dependence and Abuse was updated.
Polysubstance Dependence
Examples were added to clarify the appropriate use of this category.