Chapter 1. Overview Of Opioid Use Disorders . 1.1. Diagnosis

1852 WordsApr 27, 20178 Pages
Chapter 1. Overview of Opioid Use Disorders 1.1. Diagnosis and Classification of Substance Use Disorders There has been recent change in the diagnosis of psychoactive substance-related disorders. In the fifth edition of the Diagnostic Statistical Manual Version [APA DSM-5, 2013], both classification and diagnosis requirements have changed moving from the DSM IV-TR to the DSM V. Under DSM IV, diagnosing a substance use disorder (SUD) is performed according to two levels of severity: 1. Substance dependence (reflecting higher severity) and 2. Substance abuse (reflecting a lower severity) [Hasin et al, 2013]. In contrast under DSM-5, “Substance Dependence” is combined into one construct and named “Substance Use Disorders” (SUD)…show more content…
It is important to note that maintaining and sustaining recovery outcomes is the most challenging. Patients who do not meet any of the diagnostic criteria, with the exception of “strong urge to use or craving” for at-least 3 months, are considered to be in early remission. If this period extends to 12 months, patients are considered in sustained remission. In this connection, it is important to identify the type and level of care the patient is receiving, i.e. whether the patient is enrolled in maintenance pharmacotherapy treatment or is living in controlled medical welfare or custodial environment. 1.2. Classification of Opioids Opioids are chemical compounds that exert their pharmacological effect on endogenous opioid receptors in the brain. Endogenously circulating opioids are called endorphins, and those extracted from natural resources like opium are called ca opiates such as morphine. The chemically synthesised opiate analogues are called opioids (the generic term ‘opioids’ is used in this thesis, herein) [UNODC 1961; UNODC 1971]. 1.3. Epidemiology Globally, substance use is estimated as ‘1 in 20’ in the general population (5% among those aged 15-64 years; UNODC, 2015). While ‘1 in 10’ of the users develop SUD (0.59- 0.6% of the population), only 1 in 6 are able to access treatment globally. These prevalence rates remain stable, but the landscape of substance use has changed in period between 2009 and 2013. During this period, there

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