This category applies to presentations in which symptoms characteristic of a disruptive, impulse-control, and conduct disorder that cause clinically significant distress or impair- ment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the disruptive, impulse-control, and con- duct disorders diagnostic class. The unspecified disruptive, impulse-control, and conduct disorder category is used in situations in which the clinician chooses not to specify the rea- son that the criteria are not met for a specific disruptive. impulse-control, and conduct dis- order, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).
The substanoe—related disorders encompass 10 separate classes of drugs: alco- sedatives, hypnotics, and anxiolytics; stimulants (amphetamine-type substances, cocaine, and other stimulants); tobacco; and other (or unknown) substances. These 10 classes are not fully distinct. All drugs that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviors and the pro- duction of memories. They produce such an intense activation of the reward system that normal activities may be neglected. Instead of achieving reward system activation through adaptive behaviors, drugs of abuse directly activate the reward pathways. The pharmacological mechanisms by which each class of drugs produces reward are different, but the drugs typically activate the system and produce feelings of pleasure, often re- ferred to as a ”high.” Furthermore, individuals with lower levels of self-control, which may reﬂect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.
In addition to the substance-related disorders, this chapter also includes gambling dis- order, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders. Other excessive behavioral patterns, such as Internet gaming, have also been described, but the research on these and other behavioral syndromes is less clear. Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as ”sex addiction,” “exercise addiction,” or "shopping addiction,” are not included because at this time there is insufficient peer-re- viewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.
The substance-related disorders are divided into two groups: substance use disorders and substance-induced disorders. The following conditions may be classified as sub- stance-induced: intoxication, withdrawal, and other substance/ medication-induced men- tal disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dys- functions, delirium, and neurocognitive disorders).
The current section begins with a general discussion of criteria sets for a substance use disorder, substance intoxication and withdrawal, and other substance/medication- induced mental disorders, at least some of which are applicable across classes of sub- stances. Reﬂecting some unique aspects of the 10 substance classes relevant to this chapter, the remainder of the chapter is organized by the class of substance and describes their unique aspects. To facilitate differential diagnosis, the text and criteria for the remaining substance/medication-induced mental disorders are included with disorders with which they share phenomenology (e.g., substance/medication-induced depressive disorder is in the chapter "Depressive Disorders”). The broad diagnostic categories associated with each specific group of substances are shown in Table 1.