Contents
1. Overview and Definition of Substance Abuse 5
1.1 Overview 5
1.2 Definition of the Condition 5
1.3 Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision (DSM-IV-TR) Classification 6
1.3.1 DSM-IV-TR Substance Abuse 6
1.3.2 DSM- IV-TR Substance Dependence 6
1.4 World Health Organisation: International Classification of Diseases 10th Edition (ICD-10) Classification 7
1.4.1 Acute intoxication 8
1.4.2 Harmful use 8
1.4.3 Dependence syndrome 8
1.4.4 Withdrawal State 9
1.4.5 Psychotic Disorder 10

2. Epidemiology 11

3. Aetiology 13
3.1 Aetiology 13
3.2 Neurobiology of misuse 13

4. Diagnosis 14
4.1 Clinical Features 14
4.2 The Mental State Examination 14
4.3 Physical Examination 15
4.4 Investigations 15
4.5 Clinical Features of Withdrawal 16

5. Differential Diagnosis and Comorbidity 17
5.1 Differential Diagnosis 17
5.2 Comorbidity 17

6. Treatment 19
6.1 Pharmacological Treatment Options for Opioid Dependence 19
6.1.1 Clinical Assessment and Assessment of Dependency 19
6.1.2 Opioid Maintenance Treatment 20
6.1.3 Withdrawal/Detoxification 21
6.1.4 Ultra- rapid withdrawal 21
6.1.5 Relapse Prevention 21
6.2 Psychological treatment for Substance Abuse 21
6.3 Rehabilitation 22
7. Prognosis (Main Prognostic Factors) 23

8. Information Gathering at the In Person Assessment 24
8.1 Assessing the Claimant 24
8.1.1 Informal Observation 24
8.1.2 Physical Assessment 25
8.1.3 Mental State Examination 25

9. Analysis of Effect on Functional Ability 27
9.1 Indicators of Ability/Disability 27
9.2 Ability/Disability Profile 29

10. Summary of Scheme Criteria 30
Appendix A - Opioids 31
Appendix B - Cannabinoids 32
Appendix C - Sedative Hypnotics 33
Appendix D - Cocaine 34
Appendix E - MDMA (Ecstasy) 35
Appendix F - Other Stimulant drugs 36
Appendix G - Hallucinogens 38
Appendix H - Volatile Solvents 39
Appendix I - Dissociative Substances 40
Appendix J - Other Substances 42
Appendix K - Neurobiology of drug misuse and dependence 43
Appendix L - Vernacular Names for Commonly Misused Substances 44
L.1 Opioids 44
L.2 Cocaine 44
L.3 Other Stimulant Drugs 44
L.4 Dissociative Substances 44
L.5 Gamma Hydroxy Butyrate (GHB) 45
11. References and Bibliography 46