Substance-Induced Disorders

Assessment of Substance-Induced Disorders

The diagnosis of substance-induced disorders often involves obtaining an extensive psychosocial, and sometimes medical, history by a qualified mental health and medical professional. Psychosocial factors relevant to the disorders may be obtained by a variety of professionals, such as psychologists, psychiatrists, [Page 875]physicians, licensed or certified addiction counselors, or licensed clinical social workers, although the specific qualifications required to make diagnoses may vary by state. For some disorders, such as persisting dementia or persisting amnestic disorder, more specialized training is required to make the diagnosis because it not only is based on the psychosocial interview but may also require specialized physical and neurological examinations (e.g., brain imaging procedures), neuropsychological testing to document deficits in memory and other cognitive abilities, and assessment of functional outcomes. Thus, for some of the substance-induced disorders, the diagnosis is made after extensive evaluation by an interdisciplinary team of professionals, each of whom is specialized to evaluate a specific aspect of the disorder in question. It can often be difficult to assess individuals with substance-induced disorders because there may be strong incentives for them to underreport or deny substance use. It is also the case that because some substances can cause deficits in cognitive abilities such as memory, individuals with long histories ofuse may simply be unable to accurately remember the details of prior use. This is particularly true for substance-induced dementia or amnestic disorder, where memory deficits are required in order to make these diagnoses. Even when sufficient symptoms are present to make a diagnosis, it is often difficult to clearly establish a link between the symptoms and the substance use. For example, in the case of an individual with a history of heavy methampheta-mine use and psychotic episodes, it is not always clear whether the methamphetamine use preceded the psychotic episode or, alternatively, if the methamphetamine was used in an attempt to cope with the preexisting psychotic symptoms. In these instances, history of substance use onset and offset in relation to symptom onset and offset is crucial in determining whether the disorder is substance induced or not. This temporal relationship is especially difficult to determine when mental symptoms continue after intoxication and withdrawal, and clinical judgment is needed to determine whether a substance-induced persisting disorder should be diagnosed or whether a primary mental disorder should be diagnosed.

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