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Addiction disorders
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Addiction disorders

Contributors: Shea A. Nagle MPH, Abhijeet Waghray MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

Addiction and substance use disorders are characterized by diminishing control over seeking a rewarding stimulus despite negative personal and interpersonal consequences. Eventually, the initial reward may no longer be experienced as pleasurable. This is usually accompanied by craving for the stimulus, needing a higher dose to maintain effects (ie, tolerance), and withdrawal symptoms on abstinence.

Addiction commonly involves a substance:
Addiction can also involve an activity or behavior not related to substance use. Some common excessive behavior patterns include gambling, internet gaming, shopping, sex, eating, and exercise. With the exception of gambling, behavioral addiction disorders lack diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Some of these repetitive behaviors overlap with impulse disorders and obsessive-compulsive disorder (OCD), in which a person loses voluntary control over specific activities. It is thus important to consider these disorders in a differential diagnosis.

Disordered substance use is associated with increasing amounts of time spent in obtaining, taking, and recovering from the substance at the expense of time otherwise spent in other activities; unsuccessful efforts to decrease the substance use; and continuation despite recognizing its harmful effects. For many substances of abuse, genetic susceptibility is likely.

Studies support an increased association of addiction disorders among patients with comorbid schizophrenia, bipolar disorder, depression, and personality disorders (particularly antisocial and borderline personality disorders). The course is variable and dependent on many factors including the particular substance of abuse. Patients with comorbid psychiatric diagnoses ("dual diagnoses") often have more prolonged courses, perhaps due to inadequate diagnosis and treatment of the comorbidity.

Patients with these disorders may have an increased risk of various general medical conditions.

Codes

ICD10CM:
F10.20 – Alcohol dependence, uncomplicated
F11.20 – Opioid dependence, uncomplicated
F12.20 – Cannabis dependence, uncomplicated
F13.20 – Sedative, hypnotic or anxiolytic dependence, uncomplicated
F14.20 – Cocaine dependence, uncomplicated
F16.20 – Hallucinogen dependence, uncomplicated

SNOMEDCT:
32709003 – Addiction

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Bipolar disorder – May be comorbid with substance use disorders or excessive behavior patterns (sex, shopping, etc); may be associated with a manic episode.
  • Impulse disorders – Excessive behaviors may be a symptom.
  • Obsessive-compulsive disorder – Excessive and repetitive behaviors may be a symptom.
  • Neurocognitive disorders – New behaviors or changes in behaviors may be a symptom.
  • Polysubstance use disorder – Keep in mind that patients may be using multiple substances.
  • Medications – May cause changes in behaviors (eg, dopaminergic medications for Parkinson disease).

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:05/27/2020
Last Updated:09/22/2020
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Addiction disorders
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Addiction disorders : Substance abuse
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