DSM-V  ADDICTION

 

1. Opioids are often taken in larger amounts or over a longer period of time than intended.  

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

3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects

4. Craving, or a strong desire to use opioids 

5. Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home 

6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids 

7. Important social, occupational or recreational activities are given up or reduced because of opioid use

8. Recurrent opioid use in situations in which it is physically hazardous 

9. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids 

10. Tolerance (not for medically supervised opioid use) is either a need for markedly increased amount of opioids to achieve intoxication or desired effect OR markedly diminished effect with continued use of the same amount of an opioid

11. Withdrawal (not for medically supervised opioid use) is either the characteristic opioid withdrawal syndrome OR the same or closely related substance are taken to relieve or avoid withdrawal symptoms

12. SCORE:  Mild=2-3,  Moderate=4-5,  Severe=6 or more                                                          

 

 

DAST 10 (illicits, prescription, and OTC drugs only- questions do not apply to alcohol)

1. Have used drugs other than those required for medical reasons: 

2. Do you abuse more than one drug at a time: 

3. Are you always able to stop using drugs when you want to: 

4. Have you ever had blackouts or flashbacks as a result of drug use: 

5. Do you ever feel bad or guilty about your drug use: 

6. Does your spouse (or parents) ever complain about your involvement with drugs: 

7. Have you neglected your family because of your use of drugs: 

8. Have you engaged in illegal activities in order to obtain drugs: 

9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs: 

10. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding): 

TOTAL:     

Score 0=no problems reported drug abuse, no action needed

Score 1-2= low level problems related to drug abuse:  monitor and reassess

Score 3-5=moderate level problems related to drug abuse:  further investigation

Score 6-10=substantial level of problems related to drug abuse: intensive assessment needed

 

 

 

COWS

 

1. Resting pulse (0=80 or below, 1=81-100, 2=101-120,  4=>120)       

2. Sweating (0=no report of chills or flushing,  1=subjective reports of chills or flushing,  2=flushed or observable moisture on the face,  3=beads of sweat on the brow or face,  4=streams of sweat coming off the face )      

3. Restlessness (0=able to sit still,  1=reports difficulty in sitting still but able to do so,  3=frequent shifting or extraneous movements of legs/arms,  5=unable to sit still for more than a few seconds)      

4. Pupil size (0=pupils pinned or normal size for room light,  1=pupils possibly larger than normal for room light,  2=pupils moderately dilated,  5=pupils so dilated that only the rim of the iris is visible)      

5. Bone or joint aches (new)  0=not present,  1=mild diffuse discomfort, 2=patient reports severe diffuse aching of joints/muscles,  4=patient is rubbing joints or muscles and is unable to sit still because of discomfort      

6. Runny nose or tearing (not cold related)  0=not present,  1=nasal stuffiness or unusually moist eyes,  2=nose running or tearing,  4=nose constantly running or tears streaming down cheeks      

7. GI upset (past 30 min)   0=no GI symptoms,  1=stomach cramps,  2=nausea or loose stool,  3=vomiting or diarrhea,  5=multiple episodes of diarrhea or vomiting      

8. Tremor (observation of outstretched hands)  0=no tremor,  1=tremor can be felt but not observed,  2=slight tremor observable,  4=gross tremor or muscle twitching      

9. Yawning (observation)  0=no yawning,  1=yawning once or twice during assessment,  2=yawning three or more times during assessment,  4=yawning several times/minute      

10. Anxiety or irritability   0=none,  1=patient reports increasing irritability or anxiousness,  2=patient obviously irritable/anxious,  4=patient so irritable or anxious that participation in the assessment is difficult      

11. Gooseflesh skin   0=skin is smooth,  3=piloerection of skin can be felt or hairs standing up on arms,  5=prominent piloerection      

TOTAL SCORE             5-12=mild,  13-24=moderate,  25-36=moderately severe,  >36=severe withdrawal

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Benzodiazepine Severity of Dependence Scale

Answer each question with a 0-3 number:  0=never/almost never,  1=sometimes,  2=often,  3=always/nearly always

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For the past month-

1. Did you think your use of tranquilizers was out of control?

2. Did the prospect of missing a dose make you anxious or worried?

3. Did you worry about your use of tranquilizers?

4. Did you wish you could stop?

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For the next question answer 0-3: 0=not difficult,  1=quite difficult,  2=very difficult,  3=impossible

5. How difficult would you find it to stop or go without your tranquilizers?

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If the score is 7 or more, there is benzodiazepine dependence;  if more than 11 there is severe benzodiazepine dependence.  

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THE SAME QUESTIONS MAY BE USED SUBSTITUTING HEROIN, METHAMPHETAMINE, OR MARIJUANA for "tranquilizers".  The scoring is slightly different- methamphetamine dependence is present if the score is greater or equal to 4.  For heroin, it is 5, and for marijuana, it is 7. 

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