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.
/ssociated )eatures Supporting Diagnosis
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.
/ssociated )eatures Supporting Diagnosis
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.
Differential Diagnosis
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.
). *mportant social, occupational, or recreational acti!ities are gi!en up or reduced because of
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.
11. ithdrawal, as manifested by either of the following:
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.
pecify current se!erity:
#$%&* (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
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.
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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.
/ssociated )eatures Supporting Diagnosis
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.
Development and Course
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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 non- daily
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.
Ris1 and 0rognostic )actors
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
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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
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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.
/ssociated )eatures Supporting Diagnosis
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.
Development and Course
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.
Ris1 and 0rognostic )actors
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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.
Differential Diagnosis
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
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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.
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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.
). *mportant social, occupational, or recreational acti!ities are gi!en up or reduced because of
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.
11. ithdrawal, as manifested by either of the following:
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
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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 co- morbid 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.
pecify current se!erity:
#$%&7$ ()*7&*$+ 7ild: resence of 2-" symptoms&
#$&7$ ()*7&.$+ 7oderate: resence of #-$ symptoms.
#$&7$ ()*7&.$+e!ere: resence of ' or more symptoms.
Specifiers
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6*n a 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.
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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.
Development and Course
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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Ris1 and 0rognostic )actors
%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.
Differential Diagnosis
?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 ¨ah 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 ¨ah stimulan untu mencapai
intosiasi atau efe yang diinginan.
b. ebuah efe nyata berurang dengan terus menggunaan ¨ah 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.
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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 ¨ah 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 ¨ah tembaau untu mencapai efe
yang diinginan.
4. ebuah efe nyata berurang dengan terus menggunaan ¨ah 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.