Substances

1. Intoxication

   Annotations:

   • Includes: recent ingestion; clinically significant  problematic behavior or psychological changes 1 or more of these symptomsThese can not be better explained by another medical condition or intoxication with another substance
   1. slurred speech
   2. Incoordination
   3. Unsteady gait
   4. Nystagmus
   5. Impairment in attention or memory
   6. stupor or coma
2. Withdrawal

   Annotations:

   • cessation of use that has been heavy and prolonged two or more of the following within several hours to a few days after cessation
   1. Autonomic hyperactivity
   2. increased hand tremor
   3. insomnia
   4. nausea or vomiting
   5. transient visual, tactile, or auditory hallucinations or illusions
   6. psychomotor agitation
   7. anxiety
   8. generalized tonic-clonic seizures

1. Intoxication

   Annotations:

   • 5 or more
   1. restlessness
   2. nervousness
   3. excitement
   4. insomnia
   5. flushed face
   6. diuresis
   7. GI disturbance
   8. muscle twitching
   9. rambling
   10. tachycardia or arrhythmia
   11. periods of inexhaustability
   12. psychomotor agitation
2. Withdrawal
   1. headache
   2. fatigue
   3. dysphoric mood
   4. difficulty concentrating
   5. Flu-like symptoms

1. intoxication

   Annotations:

   • 2 or more symptoms within 2 hours of use
   1. conjunctival injection
   2. increased appetite
   3. dry mouth
   4. tachycardia
2. withdrawal

   Annotations:

   • 3 or more symptoms within a week
   1. irritability, anger or aggression
   2. nervousness or anxiety
   3. sleep difficulty
   4. decreased appetite
   5. restlessness
   6. depressed mood
   7. abdominal pain, shakiness, sweating, fever, chills, or headache

Annotations:

• Hallucinogens are unique among the substances because they typically have no withdrawal symptoms; HOWEVER, there is hallucinogen persisting perception disorder in which 1 or more perceptual symptoms of the intoxication cause significant distress after cessation

1. Phencyclidine (PCP, ketamine)
   1. intoxication

      Annotations:

      • within 1 hour, 2 or more symptoms
      1. vertical or horizontal nystagmus
      2. hypertension or tachycardia
      3. numbness
      4. ataxia
      5. dysarthria

         Annotations:

         • stuttering
      6. muscle rigidity
      7. seizures or coma
      8. hyperacusis

         Annotations:

         • heightened hearing
2. Other hallucinogens
   1. Intoxication

      Annotations:

      • 2 or more
      1. pupillary dilation
      2. tachycardia
      3. sweating
      4. palpitations
      5. blurring of vision
      6. tremors
      7. incoordination

1. intoxication only

   Annotations:

   • 2 or more
   1. dizziness
   2. nystagmus
   3. incoordination
   4. slurred speech
   5. unsteady gait
   6. lethargy
   7. depressed reflexes
   8. psychomotor retardation
   9. tremor
   10. generalized muscle weakness
   11. blurred vision or diplopia
   12. stupor or coma
   13. Euphoria

1. intoxication
   1. pupillary constriction AND

      Annotations:

      • 1 or more
      1. drowsiness or coma
      2. slurred speech
      3. impairment in attention or memory
2. withdrawal

   Annotations:

   • 3 or more developing within minutes to days after cessation or administration of an antagonist
   1. dysphoric mood
   2. nausea or vomiting
   3. muscle aches
   4. lacrimation or rhinorrhea
   5. pupillary dilation or sweating
   6. diarrhea
   7. yawning
   8. fever
   9. insomnia

1. intoxication

   Annotations:

   • 1 or more
   1. slurred speech
   2. incoordination
   3. unsteady gait
   4. nystagmus
   5. impairment in cognition
   6. stupor or coma
2. withdrawal

   Annotations:

   • 2 or more
   1. autonomic hyperactivity
   2. hand tremor
   3. insomnia
   4. nausea or vomiting
   5. transient hallucinations or illusions
   6. psychomotor agitation
   7. anxiety
   8. grand mal seizures

1. intoxication

   Annotations:

   • 2 or more
   1. tachycardia
   2. pupillary dilation
   3. elevated or lowered blood pressure
   4. perspiration or chills
   5. nausea or vomiting
   6. evidence of weight loss
   7. psychomotor agitation or retardation
   8. muscular weaknesses or respiratory depression
   9. confusion, seizures, or coma
2. withdrawal
   1. dysphoric mood AND

      Annotations:

      • 2 or more
      1. fatigue
      2. vivid, unpleasant dreams
      3. insomnia or hypersomnia
      4. increased appetite
      5. psychomotor retardation or agitation

1. withdrawal only

   Annotations:

   • in 24 hours, 4 or more:
   1. irritability, frustration, or anger
   2. anxiety
   3. difficulty concentrating
   4. increased appetite
   5. restlessness
   6. depressed mood
   7. insomnia