Gangguan Stimulant

8/13/2019 Gangguan Stimulant

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Stimulant-Related Disorders

Stimulant Use Disorder

Stimulant Intoxication

Stimulant Withdrawal

Other Stimulant-Induced Disorders

Unspecified Stimulant-Related Disorder

Stimulant Use Disorder

Diagnostic Criteria

A. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to

clinically significant impairment or distress, as manifested by at least two of the

following, occurring within a 12-month period:

1. The stimulant is often taen in larger amounts or o!er a longer period than was it ended.

2. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use.

". A great deal of time is spent in acti!ities necessary to obtain the stimulant, use the

stimulant, or reco!er from its effects.

#. Cra!ing, or a strong desire or urge to use the stimulant.

$. %ecurrent stimulant use resulting in a failure to fulfill ma&or role obligations at wor,

school, or home.

'. Continued stimulant use despite ha!ing persistent or recurrent social or interpersonal

problems caused or e(acerbated by the effects of the stimulant.

). *mportant social, occupational, or recreational acti!ities are gi!en up or reduced because of

stimulant use.

+. %ecurrent stimulant use in situations in which it is physically haardous.

. timulant use is continued despite nowledge of ha!ing a persistent or recurrent ***

physical or psychological problem that is liely to ha!e been caused or e(acerbatedby the stimulant.

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1/. Tolerance, as defined by either of the following:

a. A need for maredly increased amounts of the stimulant to achie!e into(ication or

desired effect.

b. A maredly diminished effect with continued use of the same amount of the

stimulant. 0ote: This criterion is not considered to be met for those taing stimulant

medications solely under appropriate medical super!ision, such as medications for

attention-deficithyperacti!ity disorder or narcolepsy.

11. ithdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for the stimulant 3refer to Criteria A and 4 of

the criteria set for stimulant withdrawal, p. $'5.

b. The stimulant 3or a closely related substance5 is taen to relie!e or a!oid with drawal

symptoms.

0ote: This criterion is not considered to be met for those taing stimulant medical tions

solely under appropriate medical super!ision, such as medications for attenttion-

deficithyperacti!ity disorder or narcolepsy.

pecify if:

In early remission: After full criteria for stimulant use disorder were pre!iously met none of

the criteria for stimulant use disorder ha!e been met for at least " months but for less than 12

months 3with the e(ception that Criterion A#, 6Cra!ing, or a strong desire or urge to use the

stimulant,6 may be met5.

In sustained remission: After full criteria for stimulant use disorder were pre!iously met,

none of the criteria for stimulant use disorder ha!e been met at any time during a period of 12

months or longer 3with the e(ception that Criterion A#, 6Cra!ing, or a strong desire or urge to

use the stimulant,6 may be met5.

pecify if:

In a controlled environment: This additional specifier is used if the indi!idual is in anen!ironment where access to stimulants is restricted.

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Coding ased on current severity: 0ote for *CD-1/-C7 codes: *f an amphetamine in-

to(ication, amphetamine withdrawal, or another amphetamine-induced mental disorder is

also present, do not use the codes below for amphetamine use disorder. *nstead, the co-

morbid amphetamine use disorder is indicated in the #th character of the amphetamine-

induced disorder code 3see the coding note for amphetamine into(ication, amphetamine

withdrawal, or a specific amphetamine-induced mental disorder5. 8or e(ample, if there is

comorbid amphetamine-type or other stimulant-induced depressi!e disorder and amphet-

amine-type or other stimulant use disorder, only the amphetamine-type or other stimulant-

induced depressi!e disorder code is gi!en, with the #th character indicating whether the

comorbid amphetamine-type or other stimulant use disorder is mild, moderate, or se!ere9

81$.1# for mild amphetamine-type or other stimulant use disorder with amphetamine-type or

other stimulant-induced depressi!e disorder or 81$.2# for a moderate or se!ere am- *

phetamine-type or other stimulant use disorder with amphetamine-type or other stimulant-

induced depressi!e disorder. imilarly, if there is comorbid cocaine-induced depressi!e

disorder and cocaine use disorder, only the cocaine-induced depressi!e disorder code is

gi!en, with the #th character indicating whether the comorbid cocaine use disorder is mid

moderate, or se!ere: 81#.1# for mild cocaine use disorder with cocaine-induced depressi!e

disorder or 81#.2# for a moderate or se!ere cocaine use disorder with cocaine-induced

depressi!e disorder.

pecify current se!erity:

!ild "resence of 2-" symptoms.

#$%&'$ ()*%&*$+Amphetamine-type substance

#$%&,$ ()*&*$+Cocaine

#$%&'$ ()*%&*$+;ther or unspecified stimulant

!oderate : resence of #-$ symptoms.

#$&$ ()*%&.$+Amphetamine-type substance

#$&.$ ()*&.$+Cocaine

#$&$ ()*%&.$+;ther or unspecified stimulant

Severe : resence of ' or more symptoms.

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#$&$ ()*%&.$+Amphetamine-type substance

#$&.$ ()*&.$+Cocaine

#$&$ ()*%&.$+;ther or unspecified stimulant

Specifiers

9*na controlled en!ironment6 applies as a further specifier of remission if the

indi!idual is both in remission and in a controlled en!ironment 3i.e., in early remission in a

controlled en!ironment or in sustained remission in a controlled en!ironment5. owe!er, in all forms of the substance, cocaine is the acti!e ingredient. Cocaine

hydrochloride powder is usually 6snorted6 through the nostrils or dissol!ed in water and

in&ected intra!enously.

*ndi!iduals e(posed to amphetamine-type stimulants or cocaine can de!elop stimulant

use disorder as rapidly as 1 wee, although the onset is not always this rapid. %egardless of

the route of administration, tolerance occurs with repeated use. ithdrawal symptoms,

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particularly hypersomnia, increased appetite, and dysphoria, can occur and can enhance

cra!ing. 7ost indi!iduals with stimulant use disorder ha!e e(perienced tolerance or

withdrawal.

?se patterns and course are similar for disorders in!ol!ing amphetamine-type stimu-

lants and cocaine, as both substances are potent central ner!ous system stimulants with

similar psychoacti!e and sympathomimetic effects. Amphetamine-type stimulants are longer

acting than cocaine and thus are used fewer times per day. ?sage may be chronic or episodic,

with binges punctuated by brief non-use periods. Aggressi!e or !iolent beha!ior is common

when high doses are smoed, ingested, or administered intra!enously. *ntense temporary

an(iety resembling panic disorder or generalied an(iety disorder, as well as paranoid

ideation and psychotic episodes that resemble schiophrenia, is seen with high- dose use.

ithdrawal states are associated with temporary but intense depressi!e symptoms that

can resemble a ma&or depressi!e episode@ the depressi!e symptoms usually resol!e within 1

wee. Tolerance to amphetamine-type stimulants de!elops and leads to escalation of the

dose. Con!ersely, some users of amphetamine-type stimulants de!elop sensitiation,

characteried by enhanced effects.

/ssociated )eatures Supporting Diagnosis

hen in&ected or smoed, stimulants typically produce an instant feeling of well-

being, confidence, and euphoria. Dramatic beha!ioral changes can rapidly de!elop with

stimulant use disorder. Chaotic beha!ior, social isolation, aggressi!e beha!ior, and se(ual

dysfunction can result from long-term stimulant use disorder.

*ndi!iduals with acute into(ication may present with rambling speech, headache, tran-

sient ideas of reference, and tinnitus. There may be paranoid ideation, auditory hallucinations

in a clear sensorium, and tactile hallucinations, which the indi!idual usually recognies as

drug effects. Threats or acting out of aggressi!e beha!ior may occur. Depression, suicidal

ideation, irritability, anhedonia, emotional lability, or disturbances in attention and

concentration commonly occur during withdrawal. 7ental disturbances associated with

cocaine use usually resol!e hours to days after cessation of use but can persist for 1 month.

hysiological changes during stimulant withdrawal are opposite to those of the into(ication

phase, sometimes including bradycardia. Temporary depressi!e symptoms may meet

symptomatic and duration criteria for ma&or depressi!e episode. >istories consistent with

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repeated panic attacs, social an(iety disorder 3social phobia5-lie beha!ior, and generalied

an(iety-lie syndromes are common, as are eating disorders. ;ne e(treme instance of

stimulant to(icity is stimulant-induced psychotic disorder, a disorder that resembles

schiophrenia, with delusions and hallucinations.

*ndi!iduals with stimulant use disorder often de!elop conditioned responses to drug-

related stimuli 3e.g., cra!ing on seeing any white powderlie substance5. These responses

contribute to relapse, are difficult to e(tinguish, and persist after deto(ification.

Depressi!e symptoms with suicidal ideation or beha!ior can occur and are generally

the most serious problems seen during stimulant withdrawal.

0revalence

timulant use disorder amphetamine-type stimulants. ispanics

3/.25, with amphetamine-type stimulant use disorder !irtually absent among African

Americans and Asian Americans and acific *slanders. ast-year nonprescribed use of

prescription stimulants occurred among $- of children through high school, with $-

"$ of college-age persons reporting past-year use.

timulant use disorder cocaine.


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Amen- cans 3/.#5, >ispanics 3/."5, whites 3/.25, and Asian Americans and acific

*slanders 3/.15. *n contrast, for 12- to 1)-year-olds, rates are similar among >ispanics

3/.25, whites 3/.25, and Asian Americans and acific *slanders 3/.25@ and lower among

African Americans 3/./25@ with cocaine use disorder !irtually absent among 0ati!e

Americans and Alasa 0ati!es.

Development and Course

timulant use disorders occur throughout all le!els of society and are more common

among indi!iduals ages 12-2$ years compared with indi!iduals 2' years and older. 8irst

regular use among indi!iduals in treatment occurs, on a!erage, at appro(imately age 2" years.

8or methamphetamine primary treatment admissions, the a!erage age is "1 years.

ome indi!iduals begin stimulant use to control weight or to impro!e performance

in ,school, wor, or athletics. This includes obtaining medications such as methylphenidate or

amphetamine salts prescribed to others for the treatment of attention deficithyperacti!y

disorder. timulant use disorder can de!elop rapidly with intra!enous or smoed

administration@ among primary admissions for amphetamine-type stimulant use, ''

reported smoing, 1+ reported in&ecting, and 1/ reported snorting.

Ris1 and 0rognostic )actors

amperamental. Comorbid bipolar disorder, schiophrenia, antisocial personality

disorder and other substance use disorders are ris factors for de!eloping stimulant use

disorder aid for relapse to cocaine use in treatment samples. Also, impulsi!ity and similar

personality arts may affect treatment outcomes. Childhood conduct disorder and adult

antisocial personality disorder are associated with the later de!elopment of stimulant-related

disorders.


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suspensions, employment suspension5. Despite small !ariations, cocaine and other stimulant

ale disorder diagnostic criteria perform e=ually across gender and raceethnicity groups.

americans Appro(imately '' of indi!iduals admitted for primary

methamphetamineamphetamine related disorders are non->ispanic white, followed by 21

of >ispanic origin, " Asian and acific *slander, and " non->ispanic blac.

Diagnostic !ar1ers

4enoylecgonine, a metabolite of cocaine, typically remains in the urine for 1-" days

after a single dose and may be present for )-12 days in indi!iduals using repeated high doses.

midly ele!ated li!er function tests can be present in cocaine in&ectors or users with

concomitant alcohol use. There are no neurobiological marers of diagnostic utility.

Disconsituation of chronic cocaine use may be associated with electroencephalographic

changes, suggesting persistent abnormalities@ alterations in secretion patterns of prolactin@

and down regulation of dopamine receptors.

hort-half-life amphetamine-type stimulants 37D7A B",#-methylenedio(y-0-

methylamphetamine5, methamphetamine5 can be detected for 1-" days, and possibly up to #

days depending on dosage and metabolism. >air samples can be used to detect presence of

amphetamine type stimulants for up to / days. ;ther laboratory findings, as well as physicalfindings and other medical conditions 3e.g., weight loss, malnutrition@ poor hygiene5, art

similar for both cocaine and amphetamine-type stimulant use disorder.

)unctional Conse2uences of Stimulant Use Disorder

arious medical conditions may occur depending on the route of administration.

*ntranasal users often de!elop sinusitis, irritation, bleeding of the nasal mucosa, and a

perforated nasal septum. *ndi!iduals who smoe the drugs are at increased ris for respiratory

problems 3egg., coughing, bronchitis, and pneumonitis5. *n&ectors ha!e puncture mars and

6tracs,6 most commonly on their forearms. %is of >* infection increases with fre=uent

intra!enous in&ections and unsafe se(ual acti!ity. ;ther se(ually transmitted diseases

hepatitis, and tuberculosis and other lung infections are also seen. eight loss and mal-

nutrition are common.

Chest pain may be a common symptom during stimulant into(ication. 7yocardial in-

farction, palpitations and arrhythmias, sudden death from respiratory or cardiac arrest and

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stroe ha!e been associated with stimulant use among young and otherwise healthy

indi!iduals. eiures can occur with stimulant use. neumothora( can result from

forming alsal!a-lie maneu!ers done to better absorb inhaled smoe. Traumatic in&uries

due to !iolent beha!ior are common among indi!iduals trafficing drugs. Cocaine use

associated with irregularities in placental blood flow, abruptio placentae, premature labor and

deli!ery, and an increased pre!alence of infants with !ery low birth weights. *ndi!iduals with

stimulant use disorder may become in!ol!ed in theft, prostitution, drug dealing in order to

ac=uire drugs or money for drugs.

0eurocogniti!e impairment is common among methamphetamine users. ;ral heal

problems include 6meth mouth6 with gum disease, tooth decay, and mouth sores relater9 to

the to(ic effects of smoing the drug and to bru(ism while into(icated. Ad!erse pu*monary

effects appear to be less common for amphetamine-type stimulants because they are smoed

fewer times per day.


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Comoridity

timulant-related disorders often co-occur with other substance use disorders,

especially those in!ol!ing substances with sedati!e properties, which are often taen to

reduce insomnia, ner!ousness, and other unpleasant side effects. Cocaine users often use

alcohol, while amphetamine-type stimulant users often use cannabis. timulant use disorder

may :e associated with posttraumatic stress disorder, antisocial personality disorder, attention

deficithyperacti!ity disorder, and gambling disorder. Cardiopulmonary problems ire often

present in indi!iduals seeing treatment for cocaine-related problems, with chest pain being

the most common. 7edical problems occur in response to adulterants used as 9cutting6

agents. Cocaine users who ingest cocaine cut with le!amisole, an antimicrobial and

!eterinary medication, may e(perience agranulocytosis and febrile neutropenia.

Stimulant Intoxication

Diagnostic Criteria

A. %ecent use of an amphetamine-type substance, cocaine, or other stimulant.

4. Clinically significant problematic beha!ioral or psychological changes 3e.g., euphoriaor affecti!e blunting@ changes in sociability@ hyper!igilance@ interpersonal sensiti!ity@

an(iety, tension, or anger@ stereotyped beha!iors@ impaired &udgment5 that de!eloped

during, or shortly after, use of a stimulant.

C. Two 3or more5 of the following signs or symptoms, de!eloping during, or shortly

after, stimulant use:

1. Tachycardia or bradycardia.

2. apillary dilation.

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+. 7uscular weaness, respiratory depression, chest pain, or cardiac arrhythmias.

. Confusion, seiures, dysinesias, dystonias, or coma.

D. The signs or symptoms are not attributable to another medical condition and are not

better e(plained by another mental disorder, including into(ication with another

substance.

specify the specific into(icant 3i e., amphetamine-type substance, cocaine, or other stimulant5.

pecify if:

With perceptual disturances: This specifier may be noted when hallucinations with

intact reality testing or auditory, !isual, or tactile illusions occur in the absence of a de-

actual.

Coding note"The *CD--C7 code is 22.+. The *CD-1/-C7 code depends on

whether be stimulant is an amphetamine, cocaine, or other stimulant@ whether there is a

comorbid amphetamine, cocaine, or other stimulant use disorder@ and whether or not there are

perceptual disturbances.

8or amphetamine, cocaine, or other stimulant into(ication, without perceptual dis-

turbances: *f a mild amphetamine or other stimulant use disorder is comorbid, the *CD1/-C7

code is 81$.12, and if a moderate or se!ere amphetamine or other stimulant use disorder is

comorbid, the *CD-1/-C7 code is 81$.22. *f there is no comorbid amphetamine or other

stimulant use disorder, then the *CD-1/-C7 code is 81$.2. imilarly, if a mild cocaine use

disorder is comorbid, the *CD-1/-C7 code is 81#.12, and if a moderate or se!ere cocaine

use disorder is comorbid, the *CD-1/-C7 code is 81#.22. *f there is no comorbid cocaine

use disorder, then the *CD-1/-C7 code is 81#.2.

8or amphetamine, cocaine, or other stimulant into(ication, with perceptual distur-

bances: *f a mild amphetamine or other stimulant use disorder is comorbid, the *CD-1/- C7

code is 81$.122, and if a moderate or se!ere amphetamine or other stimulant use disorder is

comorbid, the *CD-1/-C7 code is 81$.222. *f there is no comorbid amphetamine or other

stimulant use disorder, then the *CD-1/-C7 code is 81$.22. imilarly, * a mild cocaine use

disorder is comorbid, the *CD-1/-C7 code is 81#.122, and if a moderate or se!ere cocaine

use disorder is comorbid, the *CD-1/-C7 code is 81#.222. 1 there is no comorbid cocaineuse disorder, then the *CD-1/-C7 code is 81#.22.

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Diagnostic )eatures

The essential feature of stimulant into(ication, related to amphetamine-type

stimulants and cocaine, is the presence of clinically significant beha!ioral or psychological

changes that de!elop during, or shortly after, use of stimulants 3Criteria A and 45. Auditory

hallucinations may be prominent, as may paranoid ideation, and these symptoms must be dis-

tinguished from an independent psychotic disorder such as schiophrenia. timulant

into(ication usually begins with a 6high6 feeling and includes one or more of the following:

euphoria with enhanced !igor, gregariousness, hyperacti!ity, restlessness, hyper!igilance,

interpersonal sensiti!ity, talati!eness, an(iety, tension, alertness, grandiosity, stereotyped

and repetiti!e beha!ior, anger, impaired &udgment, and, in the case of chronic into(ication,

affecti!e blunting with fatigue or sadness and social withdrawal. These beha!ioral and

psychological changes are accompanied by two or more of the following signs and symptoms

that de!elop during or shortly after stimulant use: tachycardia or bradycardia@ pupillary

dilation@ ele!ated or lowered blood pressure@ perspiration or chills@ nausea or !omiting@

e!idence of weight loss@ psychomotor agitation or retardation@ muscular weaness,

respiratory depression, chest pain, or cardiac arrhythmias@ and confusion, seiures,

dysinesias, dystonias, or coma 3Criterion C5. *nto(ication, either acute or chronic, is often

associated with impaired social or occupational functioning. e!ere into(ication can lead tocon!ulsions, cardiac arrhythmias, hyperpyre(ia, and death. 8or the diagnosis of stimulant

into(ication to be made, the symptoms must not be attributable to another medical condition

and not better e(plained by another mental disorder 3Criterion D5. hile stimulant

into(ication occurs in indi!iduals with stimulant use disorders, into(ication is not a criterion

for stimulant use disorder, which is confirmed by the presence of two of the 11 diagnostic

criteria for use disorder.


The magnitude and direction of the beha!ioral and physiological changes depend on

many !ariables, including the dose used and the characteristics of the indi!idual using the

substance or the conte(t 3e.g., tolerance, rate of absorption, chronicity of use, conte(t in

which it is taen5. timulant effects such as euphoria, increased pulse and blood pressure, and

psychomotor acti!ity are most commonly seen. Depressant effects such as sadness, brady-

cardia, decreased blood pressure, and decreased psychomotor acti!ity are less common and

generally emerge only with chronic high-dose use.

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Differential Diagnosis

timulant-induced disorders. timulant into(ication is distinguished from the other

stimulant-induced disorders 3e.g., stimulant-induced depressi!e disorder, bipolar disorder,

psychotic disorder, an(iety disorder5 because the se!erity of the into(ication symptoms

e(ceeds that associated with the stimulant-induced disorders, and the symptoms warrant

independent clinical attention. timulant into(ication delirium would be distinguished by a

disturbance in le!el of awareness and change in cognition.


Acute withdrawal symptoms 36a crash65 are often seen after periods of repetiti!e high-

due. use 36runs6 or 6binges65. These periods are characteried by intense and unpleasant

feeling lassitude and depression and increased appetite, generally re=uiring se!eral days of

rest a. recuperation. Depressi!e symptoms with suicidal ideation or beha!ior can occur and

are genorally the most serious problems seen during 6crashing6 or other forms of stimulant

withdrawal. The ma&ority of indi!iduals with stimulant use disorder e(perience a withdraw.

syndrome at some point, and !irtually all indi!iduals with the disorder report tolerance.


timulant use disorder and other stimulant-induced disorders. timulant withdrawal is

distinguished from stimulant use disorder and from the other stimulant-induced dicer ders

3e.g., stimulant-induced into(ication delirium, depressi!e disorder, bipolar disorder psychotic

disorder, an(iety disorder, se(ual dysfunction, sleep disorder5 because symptoms of

withdrawal predominate the clinical presentation and are se!ere enough warrant independent

clinical attention.

Other Stimulant-Induced Disorders

The following stimulant-induced disorders 3which include amphetamine-, cocaine-,

apt other stimulant-induced disorders5 are described in other chapters of the manual with die-

orders with which they share phenomenology 3see the substancemedication inducet mental

disorders in these chapters5: stimulant-induced psychotic disorder 36chiophrenia pectrum

and ;ther sychotic Disorders65@ stimulant-induced bipolar disorder 364ipolar and %elatedDisorders65@ stimulant-induced depressi!e disorder 36Depressi!e Disorders9@ stimulant-

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induced an(iety disorder 36An(iety Disorders65@ stimulant-induced obsessi!e compulsi!e

disorder 36;bsessi!e-Compulsi!e and %elated Disorders65@ stimulant induced sleep disorder

36leep-ae Disorders65@ and stimulant-induced se(ual dysfunction 36e(ual

Dysfunctions65. 8or stimulant into(ication delirium, see the criteria and discussion of

delirium in the chapter 60eurocogniti!e Disorders.6 These stimulant-induced disorder are

diagnosed instead of stimulant into(ication or stimulant withdrawal only when the symptoms

are sufficiently se!ere to warrant independent clinical attention.

Unspecified Stimulant-Related Disorder

This category applies to presentations in which symptoms characteristic of a stimulant

related disorder that cause clinically significant distress or impairment in social, occupe

tional, or other important areas of functioning predominate but do not meet the full criteria.

for any specific stimulant-related disorder or any of the disorders in the substance related and

addicti!e disorders diagnostic class.

Coding note"The *CD--C7 code is 22.. The *CD-1/-C7 code depends on whether the

stimulant is an amphetamine, cocaine, or another stimulant. The *CD-1/-C7 code for an

unspecified amphetamine- or other stimulant-related disorder is 81$.. The *CD-1/- C7

code for an unspecified cocaine-related disorder is 81#..

3oacco-Related Disorders

3oacco Use Disorder

3oacco Withdrawal

Other 3oacco-Induced Disorders

Unspecified 3oacco-Related Disorder

3oacco Use Disorder

Diagnostic Criteria

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A.A problematic pattern of tobacco use leading to clinically significant impairment or

distress, as manifested by at least two of the following, occurring within a 12-month

period:

1. Tobacco is often taen in larger amounts or o!er a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.

". A great deal of time is spent in acti!ities necessary to obtain or use tobacco.

#. Cra!ing, or a strong desire or urge to use tobacco.

$. %ecurrent tobacco use resulting in a failure to fulfill ma&or role obligations at wor, school,

or home 3e.g., interference with wor5.

'. Continued tobacco use despite ha!ing persistent or recurrent social or interpersonal

problems caused or e(acerbated by the effects of tobacco 3e.g., arguments with others

about tobacco use5.


tobacco use.

+. %ecurrent tobacco use in situations in which it is physically haardous 3e.g., smoing in

bed5.

. Tobacco use is continued despite nowledge of ha!ing a persistent or recurrent physical or

psychological problem that is liely to ha!e been caused or e(acerbated by tobacco.

1/.Tolerance, as defined by either of the following:

a. A need for maredly increased amounts of tobacco to achie!e the desired effect.

b. A maredly diminished effect with continued use of the same amount of tobacco.


a. The characteristic withdrawal syndrome for tobacco 3refer to Criteria A and 4 of the

criteria set for tobacco withdrawal5.

b. Tobacco 3or a closely related substance, such as nicotine5 is taen to relie!e or a!oid

withdrawal symptoms.

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pecify if:

In early remission"After full criteria for tobacco use disorder were pre!iously met,

none of the criteria for tobacco use disorder ha!e been met for at least " months but for less

than 12 months 3with the e(ception that Criterion A#, 6Cra!ing, or a strong desire or urge to

use tobacco,6 may be met5.

In sustained remission"After full criteria for tobacco use disorder were pre!iously

met, none of the criteria for tobacco use disorder ha!e been met at any time during a period

of 12 months or longer 3with the e(ception that Criterion A#, 6Cra!ing, or a strong desire or

urge to use tobacco,6 may be met5.

pecify if:

On maintenance therapy"The indi!idual is taing a long-term maintenance medica-

tion, such as nicotine replacement medication, and no criteria for tobacco use disorder ha!e

been met for that class of medication 3e(cept tolerance to, or withdrawal from, the nicotine

replacement medication5.

In a controlled environment"This additional specifier is used if the indi!idual is in

an en!ironment where access to tobacco is restricted.

Coding based on current se!erity: 0ote for *CD-1/-C7 codes: *f a tobacco withdrawal to

tobacco-induced sleep disorder is also present, do not use the codes below for tobacco use

disorder. *nstead, the comorbid tobacco use disorder is indicated in the #th character of the

tobacco-induced disorder code 3see the coding note for tobacco withdrawal or tobacco.

induced sleep disorder5. 8or e(ample, if there is comorbid tobacco-induced sleep disorder and

tobacco use disorder, only the tobacco-induced sleep disorder code is gi!en, with the #th

character indicating whether the comorbid tobacco use disorder is moderate or se!ere:

81).2/+ for moderate or se!ere tobacco use disorder with tobacco-induced sleep disorder. *t

is not permissible to code a comorbid mild tobacco use disorder with a tobacco-induced sleep

disorder.


#$%&* (4'.&$+7ild: resence of 2-" symptoms.

#$%&* ()*'&.$$+7oderate: resence of #-$ symptoms.

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#$%&* ()*'&.$$+e!ere: resence of ' or more symptoms.

Specifiers

6;n maintenance therapy6 applies as a further specifier to indi!iduals being

maintained on other tobacco cessation medication 3e.g., bupropion, !arenicline5 and as a

further specifier of remission if the indi!idual is both in remission and on maintenance

therapy. 6*n a controlled en!ironment6 applies as a further specifier of remission if the


controlled en!ironment or in sustained remission in a controlled en!ironment5.


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smoing around flammable chemicals5 occur at an intermediate pre!alence. Although these

criteria are less often endorsed by tobacco users, if endorsed, they can indicate a more se!ere

disorder.


moing within "/ minutes of waing, smoing daily, smoing more cigarettes per

day, and waing at night to smoe are associated with tobacco use disorder. owe!er, there often is a lag in the

demographic transition such that smoing increases in females at a later time.


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The ma&ority of ?.. adolescents e(periment with tobacco use, and by age 1+ years,

about 2/ smoe at least monthly. 7ost of these indi!iduals become daily tobacco users.

*nitiation of smoing after age 21 years is rare. *n general, some of the tobacco use disorder

criteria symptoms occur soon after beginning tobacco use, and many indi!iduals9 pattern of

use meets current tobacco use disorder criteria by late adolescence. 7ore than +/ of in-

di!iduals who use tobacco attempt to =uit at some time, but '/ relapse within 1 wee and

less than $ remain abstinent for life. >owe!er, most indi!iduals who use tobacco mae

multiple attempts such that one-half of tobacco users e!entually abstain. *ndi!iduals who use

tobacco who do =uit usually do not do so until after age "/ years. Although nondaily

smoing in the ?nited tates was pre!iously rare, it has become more pre!alent in the last

decade, especially among younger indi!iduals who use tobacco.


3emperamental& *ndi!iduals with e(ternaliing personality traits are more liely to

initiate tobacco use. Children with attention-deficithyperacti!ity disorder or conduct

disorder, and adults with depressi!e, bipolar, an(iety, personality, psychotic, or other

substance use disorders, are at higher ris of starting and continuing tobacco use and of to-

bacco use disorder.

5nvironmental. *ndi!iduals with low incomes and low educational le!els are more

liely to initiate tobacco use and are less liely to stop.

6enetic and physiological. Fenetic factors contribute, to the onset of tobacco use,

the continuation of tobacco use, and the de!elopment of tobacco use disorder, with a degree

of heritability e=ui!alent to that obser!ed with other substance use disorders 3i.e., about

$/5. ome of this ris is specific to tobacco, and some is common with the !ulnerability to

de!eloping any substance use disorder.

Culture-Related Diagnostic Issues

Cultures and subcultures !ary widely in their acceptance of the use of tobacco. The

pre!alence of tobacco use declined in the ?nited tates from the 1'/s through the 1/s,

but this decrease has been less e!ident in African American and >ispanic populations. Also.

smoing in de!eloping countries is more pre!alent than in de!eloped nations. The degree to

which these cultural differences are due to income, education, and tobacco control acti!itiesin a country is unclear. 0on->ispanic white smoers appear to be more liely to de!elop

19


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tobacco use disorder than are smoers. ome ethnic differences may be biologically based.

African American males tend to ha!e higher nicotine blood le!els for a gi!er number of

cigarettes, and this might contribute to greater difficulty in =uitting. Also, the speed of

nicotine metabolism is significantly different for whites compared with African Americans

and can !ary by genotypes associated with ethnicities.

Diagnostic !ar1ers

Carbon mono(ide in the breath, and nicotine and its metabolite cotinine in blood,

sali!a, or urine, can be used to measure the e(tent of current tobacco or nicotine use@

howe!er, these are only wealy related to tobacco use disorder.

)unctional Conse2uences of 3oacco Use Disorder

7edical conse=uences of tobacco use often begin when tobacco users are in their #/s

and usually become progressi!ely more debilitating o!er time. ;ne-half of smoers who do

not stop using tobacco will die early from a tobacco-related illness, and smoing-related

morbidity occurs in more than one-half of tobacco users. 7ost medical conditions result from

e(posure to carbon mono(ide, tars, and other non-nicotine components of tobacco The ma&or

predictor of re!ersibility is duration of smoing. econdhand smoe increaseE the ris of

heart disease and cancer by "/. Hong-term use of nicotine medications does not appear to

cause medical harm.

Comoridity

The most common medical diseases from smoing are cardio!ascular illnesses,

chronic obstructi!e pulmonary disease, and cancers. moing also increases perinatal

problems, such as low birth weight and miscarriage. The most common psychiatric

comorbidities are alcoholsubstance, depressi!e, bipolar, an(iety, personality, and attention

deficithyperacti!ity disorders. *n indi!iduals with current tobacco use disorder, the

pre!alence of current alcohol, drug, an(iety, depressi!e, bipolar, and personality disorders

ranges from 22 to "2. 0icotine-dependent smoers are 2.)-+.1 times more liely to ha!e

these disorders than nondependent smoers, ne!er-smoers, or e(-smoers.

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3oacco Withdrawal

.7.&$()1).2/"5

Diagnostic Criteria

A. Daily use of tobacco for at least se!eral wees.

4. Abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed

within 2# hours by four 3or more5 of the following signs or symptoms:

1. *rritability, frustration, or anger.

2. An(iety.

". Difficulty concentrating.

#. *ncreased appetite.

$. %estlessness.

'. Depressed mood.

). *nsomnia.

C. The signs or symptoms in Criterion 4 cause clinically significant distress orimpairment in

social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributed to another medical condition and are not better

e(plained by another mental disorder, including into(ication or withdrawal from another

substance.

Coding note"The *CD--C7 code is 22./. The *CD-1/-C7 code for tobacco withdrawal

is 81).2/". 0ote that the *CD-1/-C7 code indicates the comorbid presence of a moderate or

se!ere tobacco use disorder, reflecting the fact that tobacco withdrawal can only occur at *re

presence of a moderate or se!ere tobacco use disorder. *t is not permissible to code a

comorbid mild tobacco use disorder with tobacco withdrawal.

Diagnostic )eatures

21


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ithdrawal symptoms impair the ability to stop tobacco use. The symptoms after

abstice from tobacco are in large part due to nicotine depri!ation. ymptoms are much re

intense among indi!iduals who smoe cigarettes or use smoeless tobacco than song those

who use nicotine medications. This difference in symptom intensity is liely to the more

rapid onset and higher le!els of nicotine with cigarette smoing. Tobacco withdrawal is

common among daily tobacco users who stop or reduce but can also occur r among nondaily

users. Typically, heart rate decreases by $-12 beats per minute in the first few days after

stopping smoing, and weight increases an a!erage of #-) lb 32-" g5 o!er first year after

stopping smoing. Tobacco withdrawal can produce clinically significant mood changes and

functional impairment.


Cra!ing for sweet or sugary foods and impaired performance on tass re=uiring

!igilance associated with tobacco withdrawal. Abstinence can increase constipation,

coughing, diiness, dreamingnightmares, nausea, and sore throat. moing increases the

metabolism of many medications used to treat mental disorders@ thus, cessation of smoing

can acrease the blood le!els of these medications, and this can produce clinically

significant :outcomes. This effect appears to be due not to nicotine but rather to other

compounds in.

0revalence

Appro(imately $/ of tobacco users who =uit for 2 or more days will ha!e symptoms

that meet criteria for tobacco withdrawal. The most commonly endorsed signs and symptoms

are an(iety, irritability, and difficulty concentrating. The least commonly endorsed symptoms

are depression and insomnia.


Tobacco withdrawal usually begins within 2# hours of stopping or cutting down on

tobacco use, peas at 2-" days after abstinence, and lasts 2-" wees. Tobacco withdrawal

symptoms can occur among adolescent tobacco users, e!en prior to daily tobacco use. ro-

longed symptoms beyond 1 month are uncommon.


22


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3emperamental& moers with depressi!e disorders, bipolar disorders, an(iety disor-

ders, attention-deficithyperacti!ity disorder, and other substance use disorders ha!e more

se!ere withdrawal.

6enetic and physiological. Fenotype can influence the probability of withdrawal upon

abstinence.

Diagnostic !ar1ers

Carbon mono(ide in the breath, and nicotine and its metabolite cotinine in blood,

sali!a, or urine, can be used to measure the e(tent of tobacco or nicotine use but are only

wealy related to tobacco withdrawal.

)unctional Conse2uences of 3oacco Withdrawal

Abstinence from cigarettes can cause clinically significant distress. ithdrawal

impairs the ability to stop or control tobacco use. hether tobacco withdrawal can prompt a

new mental disorder or recurrence of a mental disorder is debatable, but if this occurs, it

would be in a small minority of tobacco users.


The symptoms of tobacco withdrawal o!erlap with those of other substance

withdrawal syndromes 3e.g., alcohol withdrawal@ sedati!e, hypnotic, or an(iolytic

withdrawal@ stimulant withdrawal@ caffeine withdrawal@ opioid withdrawal5@ caffeine

into(ication@ an(iety, depressi!e, bipolar, and sleep disorders@ and medication-induced

aathisia. Admission to smoe-free inpatient units or !oluntary smoing cessation can induce

withdrawal symptoms that mimic, intensify, or disguise other disorders or ad!erse effects of

medications used to treat mental disorders 3e.g., irritability thought to be due to alcohol

withdrawal could be due to tobacco withdrawal5. %eduction in symptoms with the use of

nicotine medications confirms the diagnosis.

Other 3oacco-Induced Disorders

23


24/61

Tobacco-induced sleep disorder is discussed in the chapter 6leep-ae Disorders6

3see 6ubstance7edication-*nduced leep Disorder65.

Unspecified 3oacco-Related Disorder

.7.&7 ()*'&.$7+

This category applies to presentations in which symptoms characteristic of a tobacco related

disorder that cause clinically significant distress or impairment in social, occupational, or

other important areas of functioning predominate but do not meet the full criteria for any

specific tobacco-related disorder or any of the disorders in the substance-related and addicti!e

disorders diagnostic class.

Other (or Un1nown+

Sustance-Related Disorders

Other (or Un1nown+ Sustance Use Disorder

Other (or Un1nown+ Sustance Intoxication

Other (or Un1nown+ Sustance Withdrawal

Other (or Un1nown+ Sustance8Induced Disorders

Unspecified Other (or Un1nown+ Sustance8Related Disorder

Other (or Un1nown+ Sustance Use Disorder

Diagnostic Criteria

A. A problematic pattern of use of an into(icating substance not able to be classified within

the alcohol@ caffeine@ cannabis@ hallucinogen 3phencyclidine and others5@ inhalant@

opioid@ sedati!e, hypnotic, or an(iolytic@ stimulant@ or tobacco categories and leading to

clinically significant impairment or distress, as manifested by at least two of the

following, occurring within a 12-month period:

1. The substance is often taen in larger amounts or o!er a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control use of thesubstance.

24


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". A great deal of time is spent in acti!ities necessary to obtain the substance, use the

substance, or reco!er from its effects.

#. Cra!ing, or a strong desire or urge to use the substance.

$. %ecurrent use of the substance resulting in a failure to fulfill ma&or role obligations

at wor, school, or home.

'. Continued use of the substance despite ha!ing persistent or recurrent social or in-

terpersonal problems caused or e(acerbated by the effects of its use.


use of the substance.

+. %ecurrent use of the substance in situations in which it is physically haardous.

. ?se of the substance is continued despite nowledge of ha!ing a persistent or recurrent

physical or psychological problem that is liely to ha!e been caused or e(acerbated by the

substance.

1/. Tolerance, as defined by either of the following:

a. A need for maredly increased amounts of the substance to achie!e into(ication or

desired effect.

b. A maredly diminished effect with continued use of the same amount of the substance.


a. The characteristic withdrawal syndrome for other 3or unnown5 substance 3refer to

Criteria A and 4 of the criteria sets for other Bor unnownI substance withdrawal, p.

$+"5.

b. The substance 3or a closely related substance5 is taen to relie!e or a!oid withdrawal

symptoms.

pecify if:

*n early remission: After full criteria for other 3or unnown5 substance use disorder were

pre!iously met, none of the criteria for other 3or unnown5 substance use disorder ha!e

25


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been met for at least " months but for less than 12 months 3with the e(ception that Cri-

terion A#, 6Cra!ing, or a strong desire or urge to use the substance,6 may be met5. *n

sustained remission: After full criteria for other 3or unnown5 substance use disorder

were pre!iously met, none of the criteria for other 3or unnown5 substance use disorder

ha!e been met at any time during a period of 12 months or longer 3with the e(ception

that Criterion A#, 6Cra!ing, or a strong desire or urge to use the substance,9 may be met5.

pecify if:

*n a controlled en!ironment: This additional specifier is used if the indi!idual is if air

en!ironment where access to the substance is restricted.

Coding ased on current severity: 0ote for *CD-1/-C7 codes: *f an other 3or unnown5

substance into(ication, other 3or unnown5 substance withdrawal, or another other 3or

unnown substance-induced mental disorder is present, do not use the codes below for other

3or unnown5 substance use disorder. *nstead, the comorbid other 3or unnown5 substance

use disorder is indicated in the #th character of the other 3or unnown5 substance-induced

disorder code 3see the coding note for other 3or unnown5 substance into(ication, other 3or

unnown5 substance withdrawal, or specific other 3or unnown5 substance-induced mental

disorder 8or e(ample, if there is comorbid other 3or unnown5 substance-induced depressi!edisorder and other 3or unnown5 substance use disorder, only the other 3or unnown5

substance- induced depressi!e disorder code is gi!en, with the #th character indicating

whether the comorbid other 3or unnown5 substance use disorder is mild, moderate, or

se!ere: 81.1# for other 3or unnown5 substance use disorder with other 3or unnown5

substance-induced de pressi!e disorder or 81.2# for a moderate or se!ere other 3or

unnown5 substance use disorder with other 3or unnown5 substance-induced depressi!e

disorder.


#$%&7$ ()*7&*$+ 7ild: resence of 2-" symptoms&

#$&7$ ()*7&.$+ 7oderate: resence of #-$ symptoms.

#$&7$ ()*7&.$+e!ere: resence of ' or more symptoms.

Specifiers

26


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6*n a controlled en!ironment6 applies as a further specifier of remission if the


controlled en!ironment or in sustained remission in a controlled en!ironment5.


28/61

characteristic of an unidentified substance that has newly appeared in the indi!idual9s

community.

4ecause of increased access to nitrous o(ide 36laughing gas65, membership in certain

populations is associated with diagnosis of nitrous o(ide use disorder. The role of this gas m

an anesthetic agent leads to misuse by some medical and dental professionals. *ts use as a

propellant for commercial products 3e.g., whipped cream dispensers5 contributes to misuse by

food ser!ice worers. ith recent widespread a!ailability of the substance in 9whippet6

cartridges for use in home whipped cream dispensers, nitrous o(ide misuse by adolescents

and young adults is significant, especially among those who also inhale !olatile

hydrocarbons. ome continuously using indi!iduals, inhaling from as many as 2#/ whippets

per day, may present with serious medical complications and mental conditions, including

myeloneuropathy, spinal cord subacute combined degeneration, peripheral neuropathy, and

psychosis. These conditions are also associated with a diagnosis of nitrous o(ide use disorder.

?se of amyl-, butyl-, and isobutyl nitrite gases has been obser!ed among homose(ual men

and some adolescents, especially those with conduct disorder. 7embership in these

populations may be associated with a diagnosis of amyl-, butyl-, or isobutyl nitrite use dis-

order. >owe!er, it has not been determined that these substances produce a substance use

disorder. Despite tolerance, these gases may not alter beha!ior through central effects, and

they may be used only for their peripheral effects.

ubstance use disorders generally are associated with ele!ated riss of suicide, but

there is no e!idence of uni=ue ris factors for suicide with other 3or unnown5 substance use

disorder.

0revalence

4ased on e(tremely limited data, the pre!alence of other 3or unnown5 substance use

disorder is liely lower than that of use disorders in!ol!ing the nine substance classes in this

chapter.


0o single pattern of de!elopment or course characteries the pharmacologically

!aried other 3or unnown5 substance use disorders. ;ften unnown substance use disorders

will be reclassified when the unnown substance e!entually is identified.

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%is and prognostic factors for other 3or unnown5 substance use disorders are

thought to be similar to those for most substance use disorders and include the presence of

any other substance use disorders, conduct disorder, or antisocial personality disorder in the

indi!idual or the indi!idual9s family@ early onset of substance problems@ easy a!ailability of

the substance in the indi!idual9s en!ironment@ childhood maltreatment or trauma@ and e!-

idence of limited early self-control and beha!ioral disinhibition.

Culture-Related Diagnostic Issues

Certain cultures may be associated with other 3or unnown5 substance use disorders

in!ol!ing specific indigenous substances within the cultural region, such as betel nut.

Diagnostic !ar1ers

?rine, breath, or sali!a tests may correctly identify a commonly used substance

falsely sold as a no!el product. >owe!er, routine clinical tests usually cannot identify truly

unusual or new substances, which may re=uire testing in specialied laboratories.


?se of other or unnown substances without meeting criteria for other 3or unnown.

substance use disorder. ?se of unnown substances is not rare among adolescents, most use

does not meet the diagnostic standard of two or more criteria for other 3or unnown5

substance use disorder in the past year.

ubstance use disorders. ;ther 3or unnown5 substance use disorder may co-occur

with !arious substance use disorders, and the symptoms of the disorders may be similar and

o!erlapping. To disentangle symptom patterns, it is helpful to in=uire about which symptoms

persisted during periods when some of the substances were not being used.

;ther 3or unnown5 substancemedication-induced disorder. This diagnosis should be

differentiated from instances when the indi!idual9s symptoms meet full criteria for ore of the

following disorders, and that disorder is caused by an other or unnown substance delirium,

ma&or or mild neurocogniti!e disorder, psychotic disorder, depressi!e disorder an(iety

disorder, se(ual dysfunction, or sleep disorder.

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;ther medical conditions. *ndi!iduals with substance use disorders, including other

3or unnown5 substance use disorder, may present with symptoms of many medical de-

orders. These disorders also may occur in the absence of other 3or unnown5 substance use

disorder. A history of little or no use of other or unnown substances helps to e(clude. other

3or unnown5 substance use disorder as the source of these problems.

Comoridity

ubstance use disorders, including other 3or unnown5 substance use disorder, are

cot.- monly comorbid with one another, with adolescent conduct disorder and adult antisocial

personality disorder, and with suicidal ideation and suicide attempts.

6angguan Stimulan

6angguan 0enggunaan Stimulan

9eracunan Stimulan

9ecanduan Stimulan

6angguan :ainnya ;ang Diindu1si Oleh Stimulan

6angguan Stimulan ;ang 3ida1 Di1etahui 0enyeanya

6angguan 0enggunaan Stimulan

9riteria Diagnosti1

A.A ola amphetamine &enis at, oain, atau menggunaan stimulan lainnya menyebaban

penurunan linis yang signifian atau stress, sebagaimana terlihat minimal dua dari

beriut ini, yang ter&adi dalam &anga watu 12 bulan:

1. timulan yang sering diambil dalam &umlah besar atau periode yang lebih lama

daripada itu berahir.

2. Ada einginan terus-menerus atau upaya gagal untu mengurangi atau mengontrol

penggunaan stimulan.

3. 4anya watu yang dihabisan dalam egiatan yang diperluan untu memperoleh

stimulan, gunaan stimulan, atau pulih dari efenya.

4. >asrat, atau einginan yang uat atau dorongan untu menggunaan stimulan.

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$. enggunaan stimulan berulang mengaibatan egagalan untu memenuhi ewa&iban

peran utama di tempat er&a, seolah, atau rumah.

6. Han&utan penggunaan stimulan walaupun memilii masalah sosial atau interpersonal

yang persisten atau berulang yang disebaban atau diperburu oleh efe stimulan.

7. Jegiatan sosial, peer&aan, atau rereasi yang penting menyerah atau berurang

arena penggunaan stimulan.

+. enggunaan stimulan berulang dalam situasi di mana secara fisi berbahaya.

. enggunaan stimulan dilan&utan mesipun pengetahuan yang memilii masalah fisi

atau psiologis *** persisten atau berulang yang mungin telah disebaban atau

diperburu oleh stimulan.

10.Toleransi, seperti yang didefinisian oleh salah satu dari beriut :

a. ebuah ebutuhan nyata meningatan &umlah stimulan untu mencapai

intosiasi atau efe yang diinginan.

b. ebuah efe nyata berurang dengan terus menggunaan &umlah yang sama dari

stimulan. Catatan : Jriteria ini tida dianggap harus dipenuhi bagi merea yang

mengambil obat stimulan hanya di bawah pengawasan medis yang tepat , seperti

obat untu defisit perhatian hyperacti!ity disorder atau narolepsi .

11.Jecanduan , seperti yang dituturan oleh salah satu dari beriut :

a. Jarateristi sindrom ecanduan untu stimulan 3lihat Jriteria A dan 4 dari

riteria yang ditetapan untu ecanduan stimulan , hal. $' 5.

b. timulan 3 atau substansi yang terait erat 5 diambil untu menghilangan atau

menghindari ge&ala ecanduan.

Catatan : Jriteria ini tida dianggap harus dipenuhi bagi merea yang mengambil

tions medis stimulan h anya di bawah pengawasan medis yang tepat , seperti obat

untu attenttion defisit hyperacti!ity disorder atau narolepsi.

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Tentuan Kia :

Dalam remisi awal : etelah riteria penuh untu gangguan penggunaan

stimulan sebelumnya bertemu tida ada riteria untu gangguan penggunaan stimulan telah

dipenuhi untu minimal " bulan tetapi urang dari 12 bulan 3 dengan pengecualian bahwa

Jriteria A# , 6 Cra!ing , atau uat einginan atau dorongan untu menggunaan stimulan , 6

dapat dipenuhi 5.

Dalam remisi er1esinamungan: etelah riteria penuh untu gangguan

penggunaan stimulan sebelumnya dipenuhi, tida ada riteria untu gangguan penggunaan

stimulan telah dipenuhi setiap saat selama &anga watu 12 bulan atau lebih 3dengan

pengecualian bahwa Jriteria A#, 6>asrat, atau einginan yang uat atau dorongan untu

menggunaan stimulan, 6dapat dipenuhi5.

Tentuan &ia :

Dalam lingungan yang terendali : *ni specifier tambahan digunaan &ia indi!idu

berada dalam lingungan di mana ases e stimulan dibatasi .

0eng1odean erdasar1an 1eparahan saat ini: Catatan untu ode *CD - 1/ - C7 : Kiaintosiasi amfetamin, amfetamin ecanduan, atau gangguan lain yang disebaban

amfetamin mental yang &uga hadir, tida menggunaan ode di bawah ini untu gangguan

penggunaan amfetamin. ebalinya, gangguan penggunaan amfetamin omorbid ditun&uan

dalam arater e-# amfetamin diindusi ode gangguan 3 lihat catatan coding untu

intosiasi amfetamin, amfetamin ecanduan, atau amfetamin spesifi yang ditimbulan

gangguan mental 5 . 7isalnya, &ia ada omorbiditas &enis amfetamin atau stimulan diindusi

gangguan depresi lainnya dan &enis amfetamin atau gangguan penggunaan stimulan lainnya,

hanya &enis amfetamin atau stimulan diindusi ode gangguan depresi lainnya diberian,

dengan arater e-# yang menun&uan apaah omorbiditas &enis amfetamin atau lainnya

gangguan penggunaan stimulan ringan, sedang, atau berat 81$.1# untu &enis amphetamine

ringan atau gangguan penggunaan stimulan lain dengan stimulan yang disebaban gangguan

depresi amphetamine-type atau lain atau 81$.2# untu au phetamine &enis atau lain

penggunaan stimulan sedang atau berat gangguan dengan &enis amfetamin atau stimulan

gangguan depresi diindusi lainnya. Demiian pula, &ia ada oain omorbiditas diindusi

gangguan depresi dan gangguan penggunaan oain, oain hanya diindusi ode gangguan

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depresi diberian, dengan arater e-# yang menun&uan apaah gangguan penggunaan

oain omorbiditas mid sedang, atau berat 81#.1# untu penggunaan oain ringan

gangguan dengan oain aibat gangguan depresi atau 81#.2# untu penggunaan oain

gangguan sedang atau berat dengan oain gangguan depresi diindusi .

Tentuan tingat eparahan saat ini:

Ringan: Adanya 2-" ge&ala.

#$%


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stimulan seperti 7at. Amfetamin dan stimulan lainnya dapat diperoleh dengan resep

doter untu pengobatan obesitas, gangguan perhatian defisit hiperatif, dan narcolepsy.

Aibatnya, stimulan yang ditentuan dapat dialihan e pasaran ilegal.


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6amaran yang !endu1ung Diagnosis

Jetia disunti atau meroo, stimulan biasanya menghasilan perasaan instan

ese&ahteraan, epercayaan diri, dan euforia. erubahan perilau yang dramatis dapat

dengan cepat berembang pada gangguan penggunaan stimulan. erilau acau, isolasi

sosial, perilau agresif, dan disfungsi sesual dapat disebaban oleh gangguan

penggunaan stimulan &anga pan&ang.

*ndi!idu dengan intosiasi aut dapat datang dengan bicara bertele-tele ,sait

epala, gagasan mengacu transien, dan tinnitus. 7ungin ada einginan membunuh, gila

etautan, halusinasi pendengaran di sensorium &elas, dan halusinasi tatil, indi!idu

biasanya mengaui sebagai efe obat. Ancaman atau bertinda eluar perilau agresif

dapat ter&adi. Depresi, einginan bunuh diri, leas marah, anhedonia, labilitas emosional,

atau gangguan dalam perhatian dan onsentrasi umumnya ter&adi selama ecanduan.

Fangguan mental yang berhubungan dengan penggunaan oain biasanya &am untu

mengatasi hari setelah penghentian penggunaan tetapi dapat bertahan selama 1 bulan.

erubahan fisiologis selama ecanduan stimulan yang berlawanan dengan merea yang

fase eracunan, adang-adang termasu bradiardi.

*ndi!idu dengan gangguan penggunaan stimulan sering mengembangantanggapan terhadap rangsangan terait obat 3misalnya, einginan pada melihat ada bubu

putih seperti substansi5. %espon ini berontribusi untu ambuh, sulit untu

memadaman, dan bertahan setelah detosifiasi.

Fe&ala depresi dengan einginan bunuh diri atau perilau dapat ter&adi dan

biasanya masalah yang paling serius yang terlihat selama ecanduan stimulan.

0revalensi

Fangguan penggunaan stimulan amfetamin &enis stimulan. eriraan pre!alensi 12

bulan &enis amphetamine gangguan penggunaan stimulan di Ameria eriat adalah

/,2 di antara 12-1) tahun dan /,2 di antara indi!idu 1+ tahun dan lebih tua. Tingat

serupa antara lai-lai dewasa dan perempuan 3/,25, tapi di antara 12 sampai 1) tahun

usia, tingat untu perempuan 3/,"5 lebih besar dari pada lai-lai 3/,15.

enggunaan stimulan intra!ena lai-lai terhadap perempuan rasio ":1 atau #:1, tapi

lebih seimbang antara non in&ecting pengguna, dengan lai-lai mewaili $# dari

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penerimaan pengobatan primer. re!alensi dua belas bulan adalah lebih besar di antara

1+ sampai 2 tahun usia 3/,#5 dibandingan dengan #$ hingga '# tahun usia 3/,1 /5.

elama 12 sampai 1) tahun, tingat yang tertinggi di alangan ulit putih dan Afria

Ameria 3/,"5 dibandingan dengan >ispani 3/,15 dan Asia Ameria dan

Jepulauan asifi 3/,/15, dengan &enis amfetamin gangguan penggunaan stimulan

hampir tida ada di antara pendudu asli Ameria. Di antara orang dewasa, tingat yang

tertinggi di alangan pendudu asli Ameria dan Alasa ribumi 3/,'5 dibandingan

dengan ulit putih 3/,25 dan >ispani 3/,25, dengan &enis amfetamin penggunaan

stimulan gangguan hampir tida ada alangan Afria Ameria dan Asia Ameria dan

Jepulauan asifi. Tahun lalu penggunaan stimulan tida teresepan ter&adi di antara $

- dari ana-ana sampai 7A, dengan $ -"$ dari orang usia uliah melaporan

penggunaan tahun lalu.

timulan gangguan penggunaan oain. eriraan pre!alensi 12 bulan gangguan

penggunaan oain di Ameria eriat adalah /,2 di antara 12 untu 1) tahun dan

/," di antara indi!idu 1+ tahun dan lebih tua. perbandingan yang lebih tinggi di antara

lai-lai 3/,#5 dibandingan perempuan 3/,15. perbandingan yang tertinggi di antara

1+ sampai 2 tahun usia 3/,'5 dan terendah di antara #$ hingga '# tahun usia 3/,1 /.5.

Di antara orang dewasa, tingat lebih besar antara pendudu asli Ameria 3/,+5

dibandingan dengan Afria Amenricans 3/,#5, >ispani 3/,"5, putih 3/,25, dan

Asia Ameria dan Jepulauan asifi 3/,15. ebalinya, selama 12 sampai 1)

tahuntingat serupa antara >ispani 3/,25, putih 3/,25, dan Asia Ameria dan

Jepulauan asifi 3/,25, dan lebih rendah di antara Afria Ameria 3/,/25, dengan

gangguan penggunaan oain hampir tida ada di antara pendudu asli Ameria dan

Alasa ribumi.

0er1emangan dan 0er=alanan

Fangguan penggunaan stimulan ter&adi di seluruh lapisan masyaraat dan lebih

sering ter&adi pada orang berusia 12-2$ tahun dibandingan dengan orang 2' tahun dan

lebih tua. ?ntu pertama alinya digunaan rutin antara indi!idu dalam pengobatan

ter&adi, rata-rata, seitar usia 2" tahun. ?ntu methamphetamine penerimaan pengobatan

primer, rata-rata usia adalah "1 tahun.

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4eberapa orang mulai menggunaan stimulan untu mengendalian berat badan

atau untu meningatan iner&a dalam, seolah, beer&a, atau atleti. *ni termasu untu

mendapatan obat seperti methylphenidate atau garam amfetamin diresepan untu

orang lain untu pengobatan gangguan perhatian defisit hyperacti!y. Fangguan

penggunaan stimulan dapat berembang dengan cepat dengan pemberian intra!ena atau

meroo, antara penerimaan utama untu amphetamine penggunaan stimulan &enis, ''

melaporan meroo, 1+ melaporan sunti, dan 1/ dilaporan menghirup.

)a1tor Risi1o dan 0rognosis

Amperamental. Fangguan bipolar penyerta, siofrenia, gangguan epribadianantisosial dan gangguan penggunaan at lainnya adalah fator risio untu

mengembangan stimulan menggunaan bantuan elainan untu ambuh dengan

penggunaan oain dalam sampel pengobatan. Kuga, impulsi!itas dan seni epribadian

yang sama dapat mempengaruhi hasil pengobatan. Ana gangguan perilau dan

gangguan epribadian antisosial dewasa terait dengan perembangan selan&utnya dari

gangguan terait stimulan.

Hingungan. redisi penggunaan oain di alangan rema&a termasu pa&anan

sebelum elahiran oain, pascaelahiran penggunaan oain oleh orang tua, dan

paparan eerasan masyaraat selama Dhood. ?ntu pemuda, terutama perempuan,

fator risio termasu yang tinggal di Hingungan rumah tida stabil, memilii ondisi

e&iwaan, dan bergaul dengan pedagang dan pengguna.

9ultur >erhuungan !asalah Diagnosti1

timulan gangguan penggunaan pembantu aan mempengaruhi semua ras etnis,

sosial eonomi, usia, dan &enis elamin udeta. Diagnosti masalah mungin terait

dengan onseuensi sosial 3misalnya, penahanan, orsing seolah, penghentian er&a5.

7esipun !ariasi ecil, oain dan riteria gangguan stimulan diagnosti lainnya

melauan sama seluruh &enis elamin dan ras elompo etnis. ameria eitar ''

orang mengau untu gangguan primer terait metamfetamin amfetamin non >ispani

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ulit putih, diiuti oleh 21 asal >ispani, " Asia dan Jepulauan asifi, dan " non

>ispani hitam.

0enega11an Diagnosti1

4enoylecgonine, metabolit oain, biasanya tetap dalam urin selama 1-" hari yang

setelah dosis tunggal dan mungin ada selama )-12 hari pada indi!idu yang

menggunaan dosis tinggi berulang. tes fungsi hati peningatan dapat ditemuan in&esi

oain atau pengguna dengan penggunaan alohol secara bersamaan. Tida ada penanda

neurobiologis diagnosti. Disconsituation penggunaan oain ronis dapat diaitan

dengan perubahan eletroensefalografi, menun&uan elainan persisten, perubahan

dalam pola seresi prolatin, dan bawah regulasi reseptor dopamin.

endeatan watu paruh Amphetamine type stimulants 37D7A B",# metilendiosi-

0-methylamphetamine5, metamfetamin5 dapat didetesi selama 1-" hari, dan mungin

sampai # hari tergantung pada dosis dan metabolisme. ampel rambut dapat digunaan

untu mendetesi eberadaan amphetamine tipe stimulan sampai / hari. Temuan lain

laboratorium, serta temuan fisi dan ondisi medis lainnya 3misalnya, penurunan berat

badan, malnutrisi, ebersihan yang buru5, seni sama untu edua oain dan amfetamin

&enis gangguan penggunaan stimulan.

6angguan 9onse1uensi )ungsional 0enggunaan Stimulan

4erbagai ondisi medis dapat ter&adi tergantung pada rute pemaaian. engguna

intranasal sering mengalami sinusitis, iritasi, pendarahan pada muosa hidung, dan

septum hidung berlubang. *ndi!idu peroo obat berada pada peningatan risio untu

masalah pernapasan 3egg., batu, bronitis, dan pneumonitis5. *n&esi ada beberapa tanda

tusuan dan 6&e&a,6 paling sering pada lengan merea. %isio infesi >* meningat

dengan suntian intra!ena yang sering dan ati!itas sesual yang tida aman. enyait

lain menular sesual hepatitis, dan T4C dan infesi paru-paru lainnya &uga terlihat. 4erat

badan dan eurangan gii yang umum.

0yeri dada mungin merupaan ge&ala sering ter&adi selama stimulan eracunan.*nfar mioard, palpitasi dan aritmia, ematian mendada aibat penahanan pernapasan

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atau &antung dan stroe telah diaitan dengan pemaaian stimulan antara indi!idu-

indi!idu muda dan sehat. Je&ang dapat ter&adi dengan penggunaan stimulan.

neumotoras dapat menyebaban pembentuan alsa!a manu!er seperti yang

dilauan untu lebih menyerap asap inhalasi. Hua traumatis aibat perilau eerasan

yang biasa ter&adi antara indi!idu perdagangan naroba. Joain digunaan terait

dengan penyimpangan dalam aliran darah plasenta, solusio plasenta, persalinan prematur

dan melahiran, dan peningatan pre!alensi bayi dengan berat lahir sangat rendah.

;rang dengan gangguan penggunaan stimulan dapat terlibat dalam pencurian, prostitusi,

naroba untu memperoleh obat-obatan atau uang untu obat-obatan.

enurunan neuroognitif biasa ter&adi di antara pengguna metamfetamin. 7asalah

heal oral termasu 6sabu mulut e mulut6 dengan penyait gusi, erusaan gigi, dan

mulut lua relater 9untu efe racun dari obat meroo dan bru(ism saat mabu. anding

Fangguan mental primer. Fangguan yang disebaban stimulan dapat menyerupai

gangguan membai primer 3misalnya, gangguan depresi mayor5 3untu pembahasan

diferensial diagnosis ini, lihat 6timulan Jecanduan65. Fangguan mental aibat efe

stimulan harus dibedaan dari ge&ala siofrenia, depresi dan bipolar perintah@ gangguan

ecemasan umum, dan gangguan pani.

Jeracunan hencyclidine. Jeracunan dengan phencyclidine 36C6 atau 6sebu

bidadari65 atau sintetis 6obat desainer6 seperti mephedrone 3dienal dengan nama yang

berbeda, termasu 6mandi garam65 dapat menyebaban gambaran linis yang serupa dan

hanya dapat dibedaan dari stimulan eracunan oleh adanya oain atau amphetamine

&enis at metabolit dalam urin atau plasma sampel.

timulan eracunan dan ecanduan. timulan eracunan dan ecanduan dibedaan

dari stimulan diindusi gangguan lain 3misalnya, gangguan ecemasan, dengan selama

emabuan5 arena ge&ala pada gangguan yang terahir mendominasi lini. penya&ian

dan cuup parah ge&ala sehingga perlu perhatian linis independen.

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9omoriditas

Fangguan terait timulan sering ter&adi dengan gangguan penggunaan at lainnya,

terutama yang melibatan at dengan sifat obat penenang, yang sering diresepan untu

mengurangi insomnia, gugup, dan efe samping yang tida menyenangan lainnya.

engguna oain sering memaai alohol, amphetamine sementara pengguna stimulan

&enis sering menggunaan gan&a. Fangguan penggunaan stimulan mungin berhubungan

dengan gangguan pasca trauma stres, gangguan epribadian antisosial, urang perhatian

hyperacti!ity disorder, dan gangguan per&udian. Cardiopulmonary masalah

membangitan emarahan sering hadir dalam indi!idu mencari pengobatan untu

masalah terait oain, dengan nyeri dada yang paling umum. 7asalah medis ter&adi

sebagai tanggapan terhadap adulterants digunaan sebagai agen pemotongan. engguna

oain yang menelan oain dipotong dengan le!amisol, obat antimiroba dan hewan,

mungin mengalami agranulositosis dan demam neutropenia.

95R/CU?/? S3I!U:/?

9riteria Diagnosti1

A. penggunaan terbaru dari &enis at amphetamine, oain, atau stimulan lainnya.

4. erubahan perilau atau psiologis bermasalah linis signifian 3misalnya, euforia

atau penumpulan afetif, perubahan sosialisasi, hyper!igilance, sensiti!itas antar

pribadi, cemas, tegang, atau emarahan, perilau stereotip, gangguan penilaian5 yang

berembang selama, atau segera setelah, penggunaan stimulan.

C. Dua 3atau lebih5 dari tanda-tanda atau ge&ala beriut, berembang selama, atau segera

setelah, penggunaan stimulan:

1. Taiardia atau bradiardia.

2. apillary pelebaran

". 7eningat atau menurunan teanan darah.

#. Jeringat atau edinginan.

$. 7ual atau muntah.'. 4uti adanya penurunan berat badan.

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). siomotor gelisah atau retardasi.

+. Jelemahan otot, depresi pernafasan, nyeri dada, atau aritmia &antung.

. Jebingungan, e&ang, disinesia, distonia, atau oma.

D. Tanda-tanda atau ge&ala yang tida disebaban epada ondisi medis lain dan tida

lebih bai di&elasan oleh gangguan mental lainnya, termasu eracunan dengan at

lain.

7enentuan at yang memabuan tertentu 3i e., amphetamine &enis at, oain, atau

stimulan lainnya5.

3entu1an =i1a"

Dengan gangguan persepsi: penspesifiasi ini dapat dicatat etia halusinasi dengan

pengu&ian secara utuh enyataan atau pendengaran, !isual, atau ilusi sentuhan ter&adi pada

tida adanya yang sebenarnya.

0eng1odean Catatan"Jode *CD--C7 adalah 22,+. Jode *CD-1/-C7 tergantung

pada apaah men&adi stimulan adalah amfetamin, oain, atau stimulan lainnya, apaah ada

amfetamin omorbiditas, oain, atau gangguan penggunaan stimulan lainnya, dan apaah

atau tida ada gangguan persepsi.

?ntu amfetamin, oain, atau intosiasi stimulan lainnya, tanpa gangguan persepsi:

Kia amphetamine ringan atau gangguan penggunaan stimulan lainnya adalah penyerta, ode

*CD-1/-C7 adalah 81$.12, dan &ia amfetamin sedang atau berat atau gangguan

penggunaan stimulan lainnya adalah penyerta, ode *CD-1/-C7 adalah 81$.22. Kia tida

ada amfetamin omorbiditas atau gangguan penggunaan stimulan lainnya, maa ode *CD-

1/-C7 adalah 81$.2. Demiian pula, &ia gangguan penggunaan oain ringan

omorbiditas, ode *CD-1/-C7 adalah 81#.12, dan &ia gangguan penggunaan oain

sedang atau berat adalah omorbiditas, ode *CD-1/-C7 adalah 81#.22. Kia tida ada

gangguan penggunaan oain omorbiditas, maa ode *CD-1/-C7 adalah 81#.2.

?ntu amfetamin, oain, atau eracunan stimulan lainnya, dengan gangguan persepsi:

Kia amphetamine ringan atau gangguan penggunaan stimulan lainnya adalah penyerta, ode

*CD-1/-C7 adalah 81$.122, dan &ia amfetamin sedang atau berat atau gangguan

penggunaan stimulan lainnya adalah penyerta, ode *CD-1/-C7 adalah 81$.222. Kia tida

ada amfetamin penyerta atau gangguan penggunaan stimulan lainnya, maa ode *CD-1/-

C7 adalah 81$.22. Demiian pula, saya gangguan penggunaan oain ringan penyerta,

ode *CD-1/-C7 adalah 81#.122, dan &ia gangguan penggunaan oain sedang atau berat

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adalah penyerta, ode *CD-1/-C7 adalah 81#.222. 1 tida ada gangguan penggunaan oain

penyerta, maa ode *CD-1/-C7 adalah 81#.22.

6amaran Diagnosti1

Fambaran penting dari stimulan eracunan, terait dengan amfetamin dan oain

&enis stimulan, adalah adanya perubahan perilau atau psiologis yang bermana secara linis

yang berembang selama, atau segera setelah, penggunaan stimulan 3Jriteria A dan 45.

>alusinasi pendengaran mungin menon&ol, seperti mungin paranoid einginan bunuh, dan

ge&ala-ge&ala ini harus dibedaan dari gangguan psioti independen seperti siofrenia.

timulan eracunan biasanya dimulai dengan 6tingginya6 perasaan dan mencaup satu atau

lebih hal beriut: euforia dengan meningatan semangat, gregariousness, hiperatif,

egelisahan, hyper!igilance, sensiti!itas interpersonal, banya bicara, cemas, tegang,

ewaspadaan, ebesaran, stereotip dan perilau berulang, marah, gangguan penilaian, dan,

dalam asus eracunan ronis, menumpulan afetif dengan elelahan atau esedihan dan

ecanduan sosial.

erubahan perilau dan psiologis yang disertai dengan dua atau lebih dari tanda-

tanda beriut dan ge&ala yang berembang selama atau segera setelah penggunaan stimulan:

taiardia atau bradiardia, dilatasi pupil, teanan darah tinggi atau diturunan, eringat atau

menggigil, mual atau muntah, buti berat erugian, psiomotor agitasi atau retardasi,

elemahan otot, depresi pernafasan, nyeri dada, atau aritmia &antung, dan ebingungan,

e&ang, disinesia, dystonias, atau oma 3Jriteria C5. Jeracunan, bai aut atau ronis,

sering diaitan dengan gangguan fungsi sosial atau peer&aan. Jeracunan yang parah dapat

menyebaban e&ang-e&ang, aritmia &antung, hiperpiresia, dan ematian. ?ntu diagnosis

intosiasi stimulan yang aan dibuat, ge&ala tida harus disebaban ondisi medis lain dan

tida lebih bai di&elasan oleh gangguan mental lain 3Jriteria D5. ementara stimulan

eracunan ter&adi pada indi!idu dengan gangguan penggunaan stimulan, eracunan buanlah

riteria untu gangguan penggunaan stimulan, yang dionfirmasi oleh ehadiran dua dari

riteria diagnosti untu gangguan penggunaan.

6amaran !endu1ung Diagnosis

4esarnya dan arah perubahan perilau dan fisiologis tergantung pada banya !ariabel,

termasu dosis yang digunaan dan arateristi indi!idu menggunaan at atau ontes3misalnya, toleransi, tingat penyerapan, ronisitas penggunaan, ontes yang diambil 5.


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stimulan seperti euforia, peningatan denyut nadi dan teanan darah, dan ati!itas

psiomotor yang paling sering dilihat.


44/61

4eriut stimulan gangguan diindusi 3termasu amfetamin, oain, gangguan diindusi

stimulan lainnya5 di&elasan dalam bab-bab lain dari manual dengan perintah mati yang

merea berbagi fenomenologi 3lihat inducet gangguan mental bahan obat dalam bab ini5,

stimulan diindusi gangguan psioti 3iofrenia dan Fangguan pectrum psioti

Hainnya65, stimulan diindusi gangguan bipolar 36bipolar dan Fangguan Terait65, stimulan

gangguan depresi diindusi 3gangguan depresif5, stimulan diindusi gangguan ecemasan

3gangguan Jecemasan5, stimulan diindusi obsesif ompulsif 3ompulsif ;bsesif dan

gangguan Terait5, stimulan diindusi gangguan tidur 3 Tidur ae Disorders5, dan stimulan

diindusi disfungsi sesual 3disfungsi sesual5 ?ntu stimulan eracunan delirium , lihat

riteria dan disusi delirium dalam bab 6neuroognitif gangguanM. *ni stimulan gangguan

diindusi didiagnosis buan stimulan intosiasi atau ecanduan stimulan hanya etia ge&ala

yang cuup berat untu men&amin perhatian linis independen.

6angguan Stimulan ;ang 3ida1 >isa Di 3entu1an

Jategori ini berlau untu presentasi di mana ge&ala has dari gangguan terait

stimulan yang menyebaban distress linis signifian atau gangguan dalam bidang sosial,

peer&aan, atau lainnya penting dari fungsi mendominasi tetapi tida memenuhi riteria

penuh. untu setiap gangguan yang berhubungan dengan stimulan tertentu atau salah satu

gangguan dalam substansi terait dan aditif gangguan elas diagnosti.

Coding Catatan: Jode *CD--C7 adalah 22,. Jode *CD-1/-C7 tergantung pada

apaah stimulan adalah amfetamin, oain, atau stimulan lain. *CD-1/-C7 ode untu

gangguan yang tida ditentuan stimulan amfetamin atau lainnya terait 81$.. *CD-1/-C7

ode untu gangguan terait oain ditentuan adalah 81#..

6angguan 3ema1au

6angguan 0enggunaan 3ema1au

9ecanduan 3ema1au

6angguan Indu1si 3ema1au :ainnya

6angguan 3ema1au ;ang 3ida1 >isa Di 3entu1an44


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6angguan 0enggunaan 3ema1au

Jriteria diagnosti

A.A ola bermasalah penggunaan tembaau menyebaban erusaan linis signifian atau

stres, seperti yang dituturan oleh setidanya dua dari beriut ini, yang ter&adi dalam

&anga watu 12 bulan:

1. Tembaau sering diambil dalam &umlah besar atau periode yang lebih lama

daripada yang dimasudan.

2. Ada einginan terus-menerus atau upaya gagal untu mengurangi atau mengontrol

penggunaan tembaau.

". 4anya watu yang dihabisan dalam egiatan yang diperluan untu

memperoleh atau menggunaan tembaau.

#. Jeinginan yang uat atau dorongan untu menggunaan tembaau.

$. enggunaan tembaau berulang mengaibatan egagalan untu memenuhi

ewa&iban peran utama di tempat er&a, seolah, atau rumah 3 misalnya, gangguan

er&a 5.

'. enggunaan tembaau terus walaupun memilii masalah sosial atau interpersonal

yang persisten atau berulang yang disebaban atau diperburu oleh dampa

tembaau 3misalnya, argumen dengan orang lain tentang penggunaan tembaau5.

). Jegiatan sosial , peer&aan, atau rereasi yang penting menyerah atau berurang

arena penggunaan tembaau.

+. enggunaan tembaau berulang dalam situasi di mana secara fisi berbahaya

3 misalnya , meroo di tempat tidur 5.

. enggunaan tembaau dilan&utan mesipun pengetahuan yang memilii masalah

fisi atau psiologis persisten atau berulang yang mungin telah disebaban atau

diperburu oleh tembaau.

1/. Tolerance, seperti yang didefinisian oleh salah satu dari beriut:

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A. ebuah ebutuhan nyata peningatan &umlah tembaau untu mencapai efe

yang diinginan.

4. ebuah efe nyata berurang dengan terus menggunaan &umlah yang sama

tembaau .

11. Jecanduan, seperti yang dituturan oleh salah satu dari beriut:

A. Jarateristi sindrom ecanduan untu tembaau 3lihat Jriteria A dan 4 dari

riteria yang ditetapan untu ecanduan tembaau 5.

4. Tembaau 3 atau substansi yang terait erat , seperti niotin 5 diambil untu

menghilangan atau menghindari ge&ala ecanduan.

3entu1an =i1a"

Dalam remisi awal: etelah riteria penuh untu gangguan penggunaan tembaau

sebelumnya bertemu, tida ada riteria untu gangguan penggunaan tembaau telah dipenuhi

untu minimal " bulan tetapi urang dari 12 bulan 3dengan pengecualian bahwa Jriteria A#,

6Cra!ing, atau einginan yang uat atau dorongan untu menggunaan tembaau, 6dapat

dipenuhi5.

Dalam remisi berelan&utan: etelah riteria penuh untu gangguan penggunaan

tembaau sebelumnya bertemu, tida ada riteria untu gangguan penggunaan tembaau

telah dipenuhi setiap saat selama &anga watu 12 bulan atau lebih 3dengan pengecualian

bahwa Jriteria A#, 6>asrat, atau einginan yang uat atau dorongan untu menggunaan

tembaau6 dapat dipenuhi5.

Tentuan &ia:

ada terapi pemeliharaan: *ndi!idu adalah mengambil obat perawatan &anga pan&ang,

seperti obat pengganti niotin, dan tida ada riteria untu gangguan penggunaan tembaau

telah terpenuhi untu elas obat-obatan 3ecuali toleransi, atau ecanduan dari, obat

pengganti niotin5 .

Dalam lingungan yang terendali: *ni penspesifiasi tambahan digunaan &ia

indi!idu dalam lingungan di mana ases e tembaau dibatasi.

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engodean berdasaran tingat eparahan saat ini: Catatan untu ode *CD-1/-C7: Kia

ecanduan tembaau untu diindusi gangguan tidur tembaau &uga hadir, tida

menggunaan ode di bawah ini untu gangguan penggunaan tembaau. ebalinya,

gangguan penggunaan tembaau omorbid ditun&uan dalam arater e-# tembaau

diindusi ode gangguan 3lihat catatan coding untu ecanduan tembaau atau tembaau.

Fangguan tidur yang diindusi5. 7isalnya, &ia ada tembaau yang disebaban gangguan

tidur dan gangguan omorbid penggunaan tembaau, hanya tembaau diindusi ode

gangguan tidur diberian, dengan arater e-# yang menun&uan apaah gangguan

penggunaan tembaau omorbiditas yang sedang atau berat: 81).2/+ untu tembaau sedang

atau berat menggunaan gangguan dengan gangguan tidur yang disebaban tembaau. >al

ini tida diperbolehan untu ode gangguan penggunaan tembaau ringan omorbiditas

dengan gangguan tidur yang disebaban tembaau.

3entu1an ting1at 1eparahan saat ini"

#$%


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efe yang lebih intens tembaau pertama ali digunaan pada siang hari. enghentian

penggunaan tembaau dapat menghasilan ge&ala ecanduan yang didefinisian dengan bai.

4anya orang dengan gangguan penggunaan tembaau penggunaan tembaau untu

mengurangi atau menghindari ge&ala ecanduan 3misalnya, setelah berada dalam situasi di

mana penggunaan dibatasi5. 4anya orang yang menggunaan tembaau mengalami ge&ala

fisi yang terait tembaau atau penyait dan terus meroo. ebagian besar laporan

einginan etia merea tida meroo selama beberapa &am. 7eluangan watu yang

berlebihan menggunaan tembaau dapat ditun&uan dengan rantai meroo 3yaitu,

meroo satu batang roo silih berganti tanpa &eda5. Jarena sumber tembaau yang mudah

dan secara legal tersedia, dan arena eracunan niotin yang sangat langa, menghabisan

banya watu berusaha untu mendapatan roo atau pulih dari efenya &arang. 7elepasan

ati!itas sosial, peer&aan, atau rereasi yang penting dapat ter&adi bila seseorang pergi

etempat egiatan yang membatasi penggunaan roo. enggunaan roo &arang seali

menyebaban egagalan untu memenuhi peran besar ewa&ibannya 3misalnya, gangguan

er&a, gangguan ewa&iban rumah5, tapi masalah sosial atau interpersonal yang terus menerus

3misalnya, memilii argumen dengan orang lain tentang penggunaan tembaau, menghindari

situasi sosial arena etidasetu&uan orang lain atas penggunaan tembaau5 atau penggunaan

yang tida membahayaan secara fisi 3misalnya, meroo di tempat tidur, meroo di

seitar bahan imia mudah terbaar5 ter&adi pada semua pre!alensi menengah. 7esipun

riteria ini &arang diduung oleh pengguna tembaau, &ia disahan, merea dapat

menun&uan adanya gangguan yang lebih parah.

6amaran ;ang >erhuungan Untu1 mendu1ung Diagnosis

7eroo dalam watu "/ menit setelah bangun, meroo setiap hari, meroo lebih

dari satu batang perhari, dan bangun di malam hari untu meroo yang berhubungan dengan

gangguan penggunaan tembaau. *syarat lingungan yang dapat membangitan einginan

dan ecanduan. enyait yang serius, seperti paru-paru dan aner lainnya, penyait &antung

dan paru, masalah perinatal, batu, sesa napas, dan mempercepat penuaan ulit, sering

ter&adi.

0revalensi

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%oo adalah hasil tembaau yang paling umum digunaan, yang mewaili lebih dari

/ tembaaupenggunaan niotin. Di Ameria eriat, $) orang dewasa tida pernah

peroo, 22 adalah mantan peroo, dan 21 adalah peroo. eitar 2/ peroo

Ameria erit saat ini adalah peroo non harian. re!alensi penggunaan tembaau tanpa

asap urang dari $, dan pre!alensi penggunaan tembaau dalam pipa dan cerutu urang

dari 1.

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