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Mental Health: Substance and Alcohol use Disorders Linda Harvey, MD Consultant Psychiatrist Immigrant, Refugee, and Migrant Health Branch Division of Global Migration and Quarantine Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine Learning Objectives After this session, you should be able to: Implement the DSM-V criteria Understand the basics of diagnosis for substance-use and mental disorders Distinguish the complexities of DUI Clarify the concept of remission Question 1 A 35 year old worker visa applicant is referred to you by the consular section due to a history of marijuana use. What is your goal as a panel physician? A. B. C. D. E. Get paid Determine if the DMS V criteria are met Perform the mental health examination Submit completed DS forms to the consular section Make a classification Goal? Make a classification. Question 2 In order to make a correct classification for this applicant, which of the following is the best answer for what you need to know? A. B. C. D. E. How often he uses marijuana If he meets the DSM V criteria for a substancerelated disorder If there is associated harmful behavior Where he will be employed while in the U.S. If he also drinks Information Needed 1) Evidence of a non-substance related mental disorder? – Are DSM V criteria met for diagnosis? 2) Any substance use? – Controlled Substances Act (CSA) list? – Are DSM V criteria met for substance use or substance-induced disorder? 3) Is associated harmful behavior present? – Current? – Past harmful behavior judged likely to recur? Mental Health Evaluation 1. Review medical/psychiatric history 2. Interview applicant 3. Review laboratory results, if indicated 4. Mental status evaluation THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-5) Question 3 Which of the following is NOT included in the diagnostic criteria for substance-use disorders? A. B. C. D. E. Cravings Tolerance Harmful behavior Using substance when physically hazardous Failure to fulfill obligations at work Substance-use Disorder Criteria Impaired control 1. Use larger amounts over time 2. Desire to reduce use 3. Spend time obtaining, using, or recovering from effects of substance 4. Craving Social impairment 5. Failure to fulfill obligations at work, school, or home 6. Continued use despite problems caused by substance 7. Stops doing activities Risky use 8. Use when physically hazardous 9. Continued use despite problems Pharmacologic 10.Tolerance 11.Withdrawal Severity Mild – 2-3 symptoms met Moderate – 4-5 symptoms met Severe – ≥6 symptoms met Question 4 An applicant reports increasing alcohol use over the past 2 years, needing to drink more to get the desired effect and drinking while driving once. He also says that he wants to drink less. All other history is negative. The applicant should be diagnosed with which of the following? A. B. C. D. Mild substance use disorder Moderate substance use disorder Severe substance use disorder Defer for more information Question 5 An 22 year old female is diagnosed with a substance-use disorder for alcohol use. She was recently arrested for driving with an expired drivers license. All other history is negative. What is her classification? A. B. C. D. Class A Class B Class B Other No Class Alcohol-use: Reminders Alcohol is not on the CSA list – therefore, it is treated the same as a mental disorder: 1. Go through the 11 criteria for diagnosis (DSM5) 2. Does it meet at least two of the criteria? 3. If no – No Class 4. If yes – must look at harmful behavior 5. No harmful behavior – Class B 6. Harmful behavior – Class A Basics of Remission • DSM-5 defines sustained, full remission as a period of at least 12 months during which no substance-use or mental disorderassociated behaviors have occurred. • The panel physician/consultant must use clinical judgment when determining if 12 months is an acceptable period of time to demonstrate sustained, full remission. • The time period should be based on the reliability of the evidence provided Case Discussions Thank you [email protected] http://www.cdc.gov/panelphysicians For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine