New Jersey

New Jersey


(DMHAS)

Office of Information Systems (OIS)

User’s Reference Manual

NJSAMS 3.2: DSM-5™

Updated 01/11/2016

Reference:-
DSM-5 Diagnostic and Statistical Manual of Mental Disorders” Fifth Edition”,
American Psychiatric Association

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Table of Content

1.0 / INTRODUCTION / 4
1.0.1 / DSM-5™ Overview / 4
1.0.2 / Changes from DSM IV to DSM-5™ / 4
2.0 / Getting Started DSM-5™ / 5
2.0.1 / Counselor/Clinician Information and Credentials / 5
3.0 / Substance Related and Addictive Disorder / 6
3.0.1 / ALCOHOL-RELATED DISORDERS / 7 to 11
3.0.2 / CAFFEINE-RELATED DISORDERS / 12 to 15
3.0.3 / CANNIBIS-RELATED DISORDERS / 15 to 20
3.0.4 / HALLUCINOGEN-RELATED DISORDERS / 21 to 30
3.0.5 / INHALENT-RELATED DISORDERS / 30 to 34
3.0.6 / OPIOID-RELATED DISORDERS / 34 to 39
3.0.7 / SEDATIVE, HYPNOTIC OR ANXIOLYTIC-RELATED DISORDERS / 40 to 45
3.0.8 / STIMULANT-RELATED DISORDERS / 46 to 51
3.0.9 / TOBACCO-RELATED DISORDERS / 52 to 55
3.0.10 / OTHER (or Unknown) SUBSTANCE-RELATED DISORDERS / 55 to 60
4.0 / NON-SUBSTANCE-RELATED DISORDERS / 60
4.0.1 / GAMBLING DISORDER / 60 to 61
5.0 / CO-OCCURRING DISORDERS / 62
6.0 / DIAGNOSTIC SUMMARY / 63
7.0 / SAMPLE REPORT / 64
8.0 / DSM-5 RE-EVALUATION / 65

1.0INTRODUCTION

The purpose of DSM-5™User’s Reference is to provide a training for the part of Substance Related and Addictive Disorder referred from “DSM-5 Diagnostic and Statistical Manual of Mental Disorders” Fifth Edition” and in addition, it includes “Co-occurring Mental Health and Diagnostic Summary.
This version of DSM-5™in NJSAMS is mainly for Addiction Services and does not suffice for overall training on all aspects/covered in “DSM-5 Diagnostic and Statistical Manual of Mental Disorders” Fifth Edition”. This version of DSM-5 is to replace current DSM IV in NJSAMS.

1.0.1DSM-5™ Overview

DSM is a tool for clinicians intended to serve as a practical, functional, and flexible guide for organizing information that can aid in the accurate diagnosis and treatment of mental and additive disorders. The categories of substance abuse and substance dependence from DSM IV have been eliminated and replaced with an overarching new category of substance use disorders with the specific substance used defining the specific disorders in DSM-5™ ™.

1.0.2Changes from DSM-IVto DSM-5™

DSM-5 does not separate the diagnoses of substance abuse and dependence as in DSM-IV. Rather, criteria are provided for substance use disorder, accompanied by criteria for intoxication,withdrawal, sub- stance/medication-induceddisorders, and unspecifiedsubstance-induced disorders, where relevant. The DSM-5 substance use disorder criteria are nearly identical to the DSM-IV substance abuse and dependence criteria combined into a single list, with two exceptions.The DSM-IV recurrent legal problems criterion for substance abuse has been deleted from DSM-5, and a new criterion, craving or a strong desire or urgeto use a substance has been added. In addition,the threshold for substance use disorder diagnosis in DSM-5 is set at two or more criteria, in contrast to a threshold of one or more criteria fora diagnosis of DSM-IV substance abuse and three or more for DSM-IV substance dependence. Cannabis withdrawal is new for DSM-5, as is caffeinewithdrawal (which was in DSM-IV Appendix B, “Criteria Sets and Axes Provided for Further Study”). Of note, the criteria for DSM-5 tobacco use disorder are the same as those for other substance use disorders. By contrast, DSM-IV did not have a category for tobacco abuse, so the criteria in DSM-5 that are from DSM-IV abuse are new for tobacco in DSM-5.

The DSM- IV specifierfor a physiological subtype has been eliminated in DSM-5, as has the DSM-IV diagnosis of polysubstance dependence. Early remission from a DSM-5 substance use disorder is definedas at least

3 but less than 12 months without substance use disorder criteria (except craving), and sustained re- mission is definedas at least 12 months without criteria (except craving). Additionalnew DSM-5 specifiersinclude “in a controlled environment” and “on maintenance therapy” as the situationwarrants.
The phrase “general medical condition”is replaced in DSM-5 with “another medical condition”where relevant across all disorders.

2.0Getting started DSM-5™

DSM-5™ is mandatory for all clients to continue substance abuse service evaluation (LEVEL OF CARE INDEX – LOCI) for level of care services.

The steps to get the link (or) to continue DSM-5™ in New Jersey Substance Abuse Monitoring System (NJSAMS)

  1. DASIE Registration
  2. Immediate Need Assessment (INP – mandatory for all clients)
  3. UNCOPE – optional
  4. Income Eligibility (IE) and Program Eligibility (PE) for those who are consent to collect income information
  5. Addiction Severity Index (Version 5) – optional unless and otherwise funding entity asks as requirement
  6. BioPsychoSocial – optional
  7. DSM-5™ – mandatory

2.0.1Counselor/ClinicianInformation and Credentials
Screen S-1

All indicated by red asterisks shown in the screen shot above is required field.
Date of Diagnosis is required to enter and date cannot be prior to DASIE Registration date and cannot be future date. Counselor Nameis required. Credentials must select from the dropdown list and multiple credentials can be selected. Credentials listed in dropdown are as follows:-

  1. APN
  2. CADC
  3. CADC intern
  4. LAC
  5. LCADC
  6. LCSW
  7. Licensed Psychologist
  8. LMFT
  9. LPC
  10. LSW
  11. MD
  12. Psychiatrist

If the counselor’s credential is CADC or CADC intern or LSW or LAC, the Supervisor Nametext box is appeared to enter supervisor name and credential must select from the dropdown list. Multiple credentials are allowed and credentials listed in the dropdown are as follows:-

  1. APN
  2. LCADC
  3. LCSW
  4. Licensed Psychologist
  5. LMFT
  6. LPC
  7. MD
  8. Psychiatrist

Note: Supervisor Name and Supervisor Credentials are visible only if CADC or CADC intern or LSW or LAC is selected from “Credentials” list.

Regulations check box: is required to check to acknowledge the regulation disclaimer mentioned in the screenshot above, thereby has to check the check box provided. If not check the user cannot proceed any further.

If all required information is entered, the landing page which shows Disorders, Co-occurring and Diagnostic Summary (shown in below screen shot) will be enabled to start.In order to provide diagnose a substance abuse treatment at least one Substance-Related Disorder must be entered.

3.0Substance-Related and Addictive Disorders

Screen S-2 Landing Page

3.0.1Alcohol-Related Disorder
Alcohol-Related Disorder consists of five components:-

  1. Alcohol Use Disorder
  2. Alcohol Intoxication
  3. Alcohol Withdrawal
  4. Other Alcohol-Induced Disorders
  5. Unspecified Alcohol-Related Disorders

a. Alcohol Use Disorder
Screen S-3

Mouse-over to “green square” icon for explanation of the label for radio button. Click on “Criteria” button to select the Criteria as shown in screen S-3:-
Pop-up Screen S-4

Click on “Save”button in Screen S-4, after selectingthe criteria then click on “Close”.

On closing the Criteria pop-up screen S-4, Severity is automatically computed based on thenumber of symptoms selected.

Basic Rules:

1. If 2-3 symptoms are selected, then Severity is Mild.

2.If 4-6 symptoms are selected, then Severity is Medium.

3.If more than 6 symptoms are selected, then Severity is Severe

4. “Specifiers” section is enabled only if there is a diagnosis.

5. Special Notations is always enabled and is optional.
Maximum characters to enter are limited to 500.

6.None of the options in this section are mandatory

b. Alcohol Intoxication
Screen S-5

Click on “Criteria” button to select Criteria as shown in pop-up screen S-6.
Pop-up Screen S-6

Click on “Save” after select the criteria then “Close”.

On closing the Criteria pop-up screen S-6, based on the number of symptoms selected

1. Check box "Meets Criteria for Alcohol Intoxication Diagnosis?” is checked, if A, B, one or more
of C and D are all selected in pop-up screen S-6.

2. “Specifiers” options are automatically computed as given below:

a.Alcohol use disorder is Mild + “Meets Criteria for Alcohol Intoxication Diagnosis?”is
checked,then “With use disorder, mild 303.00 (F10.129)”, shown in Screen S-5, will be
checked.

b. Alcohol use disorder is Moderate or Severe + “Meets Criteria for Alcohol Intoxication
Diagnosis?”is checked, then “With use disorder, moderate or severe 303.00
(F10.229)”, shown in Screen S-5, will be checked.

c. No Alcohol Use disorder diagnosis + “Meets Criteria for Alcohol Intoxication Diagnosis?” is
checked, then “Without use disorder 303.00 (F10.929)”, shown in Screen S-5, will be
checked.

  1. Special Notations is always enabled and is optional. Maximum characters to enter are limited to 500
  2. None of the options in this section are mandatory.

b. Alcohol Withdrawal

Screen S-7

Click on “Criteria” button to select Criteria as shown in pop-up screen S-8.

Pop-up Screen S-8

Click on “Save” after select the criteria then “Close”.

Basic Rules:

1. “Specifiers” can only be manually selected before (or) after selecting the criteria

2. Special Notations is always enabled and is optional.
Maximum characters to enter are limited to 500.

3.None of the options in this section are mandatory

d. Other Alcohol-Induced Disorders

Screen S-9

Basic Rules:

  1. This section only has an option to enter the code in “Special Notations” area
  2. “Special Notation” is always enabled and is optional.
    Maximum characters to enter are limited to 500.
  3. None of the options in this section are mandatory

e. Unspecified Alcohol-Related Disorders

Screen S-10

Pop-up Screen S-11


Click on “Save” then “Close” the pop-up screen

Basic Rules

  1. There is only one Criterion and if the user selects, saves and closes the pop up screen S-11, the check box “Unspecified Alcohol-Related Disorder 291.9(F10.99)” shown in Screen S-10 should be checked automatically.
  2. Comments can be entered in “Special Notations”. Maximum characters to enter are limited to 500.
  3. None of the options in this section are mandatory

“Save” button in S-10

After entering all valid data, hit “Save” to save the Alcohol-Related Disorder information. If there are no errors, “Saved Successfully” message will be displayed.

In case of errors, an appropriate error message will be displayed.

3.0.2Caffeine Related Disorders

Alcohol-Related Disorder consists of four components:-

a. Caffeine Intoxication
b. Caffeine Withdrawal
c. Other Caffeine -Induced Disorders
d. Unspecified Caffeine -Related Disorders

a. Caffeine Intoxication
Screen S-12

Click on “Criteria” button to select criteria shown in Pop-up screen S-13

Pop-up Screen S-13


Click “Save” after selecting criteria and then “Close”

On closing the Criteria Pop-up Screen S-13,the check box shown in Screen S-12 for "Caffeine Intoxication 305.90 (F15.929)”will be checked if A, five or more of B, C and D are selected.

Basic Rules:
1. Comments can be entered in “Special Notations”. Maximum characters to enter are limited to 500.
2.None of the options in this section are mandatory

b. Caffeine withdrawal
Screen S-14

Click on “Criteria” button to select criteria shown in Pop-up Screen S-15
Pop-up Screen S-15

Click “Save” after selecting criteria and then “Close”

On closing the Criteria Pop-up Screen S-15, based on the number of symptoms selected the check box shown in Screen S-14 for "Caffeine Intoxication 292.0 (F15.93)”if A, three or more of B, C and D are all selected.

Basic Rules:
1. Comments can be entered in “Special Notations”. Maximum characters to enter are limited to 500.
2.None of the options in this section are mandatory

c. Other Caffeine -Induced Disorders

Screen S-16

Basic Rules:

1. This section only has an option to enter the code in “Special Notations” area

2. “Special Notation” is always enabled and is optional.
Maximum characters to enter are limited to 500.

3. None of the options in this section are mandatory

d. Unspecified Caffeine -Related Disorders

Screen S-17

Click on “Criteria” button to select criteria shown in Pop-up Screen S-18

Pop-up Screen S-18

Click on “Save” then “Close” the pop-up screen

Basic Rules

  1. There is only one Criterion and if the user selects, saves and closes the pop up screen S-17, the check box “Unspecified Alcohol-Related Disorder 292.9(F15.99)” shown in Screen S-17 should be checked automatically.
  2. Comments can be entered in “Special Notations”. Maximum characters to enter are limited to 500.
  3. None of the options in this section are mandatory

“Save” button in Screen S-17
After entering all valid data, hit “Save” to save the Caffeine -Related Disorder information. If there are no errors, “Saved Successfully” message will be displayed.

In case of errors, an appropriate error message will be displayed.

3.0.3Cannabis Related Disorders
a.Cannabis Use Disorder
b. Cannabis Intoxication
c. Cannabis Withdrawal
d. Other Cannabis -Induced Disorders
e. Unspecified Cannabis -Related Disorders

a. Cannabis Use Disorder
Screen S-19

Mouse-over to “green square” icon for explanation of the label for radio button. Click on “Criteria” button to select the Criteria as shown in screen S-19.

Pop-up Screen S-20

Click on “Save” button in Pop-up Screen S-20, after selecting the criteria then click on “Close”.

On closing the Criteria pop-up screen, Severity is automatically computed based on the number of symptoms selected.

Basic Rules
1.If 2-3 symptoms are selected, then Severity is Mild.
2. If 4-6 symptoms are selected, then Severity is Medium.
3. If more than 6 symptoms are selected, then Severity is Severe.
4. “Specifiers” section is greyedout initially until the current severity is computed and enable only if
there is a diagnosis.
5. Special Notations is always enabled and is optional. Maximum characters to enter are limited to 500.
6. None of the options in this section are mandatory.

b. Cannabis Intoxication

Screen S-21

Click on “Criteria” button to select Criteria as shown in pop-up screen S-21.

Pop-up Screen S-22

Click on “Save” button in Pop-up Screen S-22, after selecting the criteria then click on “Close”.

Basic Rules:

  1. Check box "Meets Criteria for Cannabis Intoxication Diagnosis?” is checked if A, B, Two or more of C and D are all selected.
  2. Specifiers:

a. Specify if: Manually select if the client has Perceptual Disturbances or not by selecting
theappropriate option.
b. If “Without perceptual disturbances 291.81 (F10.239)” is selected, then one of the
options under“Without perceptual disturbances” is automatically selected based on the
severity of Cannabisuse disorder.
c. If “With perceptual disturbances 291.81 (F10.232)” is selected, then one of the options
under“Without perceptual disturbances” is automatically selected based on the severity
of Cannabisuse disorder.

  1. Special Notations is always enabled and is optional. Maximum characters to enter are limited to 500.
  2. None of the options in this section are mandatory.

c. Cannabis Withdrawal
Screen S-23

Click on “Criteria” button to select criteria. Select from “Criteria” as shown in pop-up screen S-24
On closing the Criteria pop-up screen S-24 (shown on the next page), based on the number of symptoms selected the check box "Cannabis Withdrawal 292.0 (F12.288)” is checked if A, three or more of B, C and D are all selected.

Basic Rules:

  1. Comments can be entered in “Special Notations”. Maximum characters to enter are limited to 500.
  2. None of the options in this section are mandatory.

Pop-up Screen S-24

Click on “Save” button in Pop-up Screen S-24, after selecting the criteria then click on “Close”.

d. Other Cannabis -Induced Disorders
Screen S-25

Basic Rules:

  1. This section only has an option to enter the code in “Special Notations” area
  2. “Special Notation” is always enabled and is optional.
    Maximum characters to enter are limited to 500.
  3. None of the options in this section are mandatory

e. Unspecified Cannabis -Related Disorders

Screen S-26

Pop-up Screen S-27

Click on “Save” button in Pop-up Screen S-27, then “Close”.

Basic Rules

  1. There is only one Criterion and if the user selects, saves and closes the pop up screen S-27, the check box “Unspecified Alcohol-Related Disorder 292.9(F12.99)” shown in Screen S-26 should be checked automatically.
  2. Comments can be entered in “Special Notations”. Maximum characters to enter are limited to 500.
  3. None of the options in this section are mandatory

“Save” button in Screen S-26
After entering all valid data, hit “Save” to save the Caffeine -Related Disorder information. If there are no errors, “Saved Successfully” message will be displayed.

In case of errors, an appropriate error message will be displayed.

3.0.4 Hallucinogen Related Disorders

a. Phencyclidine Use Disorder
b. Other Hallucinogen Use Disorder
c. Phencyclidine Intoxication
d.Other Hallucinogen Intoxication
e. Hallucinogen Persisting Perception Disorder
f. Other Phencyclidine -Induced Disorders
g. Other Hallucinogen-Induced Disorders
h. Unspecified Phencyclidine -Related Disorders
i. Unspecified Hallucinogen -Related Disorders

a. Phencyclidine Use Disorder
Screen S-28

Mouse-over to “green square” icon for explanation of the label for radio button. Click on “Criteria” button to select the Criteria as shown in screen S-28:-

Pop-up Screen S-29

Click on “Save” button in Pop-up Screen S-20, after selecting the criteria then click on “Close”.

On closing the Criteria pop-up screen, Severity is automatically computed based on the number of symptoms selected.

Basic Rules:

1. If 2-3 symptoms are selected, then Severity is Mild.
2.If 4-6 symptoms are selected, then Severity is Medium.
3.If more than 6 symptoms are selected, then Severity is Severe.
4.“Specifiers” section is enabled only if there is a diagnosis.
5.Special Notations is always enabled and is optional.
Maximum characters to enter are limited to 500.
6.None of the options in this section are mandatory.

b. Other Hallucinogen Use Disorder
Screen S-30

Mouse-over to “green square” icon for explanation of the label for radio button. Click on “Criteria” button to select the Criteria as shown in screen S-30:-

Pop-up Screen S-31


Click on “Save” button in Pop-up Screen S-20, after selecting the criteria then click on “Close”.

On closing the Criteria pop-up screen, Severity is automatically computed based on the number of symptoms selected.

Basic Rules:
1.If 2-3 symptoms are selected, then Severity is Mild.
2. If 4-6 symptoms are selected, then Severity is Medium.
3. If more than 6 symptoms are selected, then Severity is Severe.
4. Specify or add the Hallucinogen name by typing in the text box provided
5. “Specifiers” section is greyedout initially until the current severity is computed and enable only if
there is a diagnosis.
6. Special Notations is always enabled and is optional. Maximum characters to enter are limited to 500.
7. None of the options in this section are mandatory.

c. Phencyclidine Intoxication
Screen S-32

Pop-up Screen S-33

Click on “Save” button in Pop-up Screen S-33, after selecting the criteria then click on “Close”.

On closing the Criteria pop-up screen S-33, based on the number of symptoms selected, the check box "Meets Criteria for Phencyclidine IntoxicationDiagnosis?” is checked if A, B, two or more of C and D are all selected.
Basic Rules