Methamphetamine use according to dsm 5 TR
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Methamphetamine Use Disorder - DSM-5-TR
(Kaplan & Sadock's Comprehensive Textbook of Psychiatry; Kaplan & Sadock's Synopsis of Psychiatry)
Classification in DSM-5-TR
In DSM-5-TR, methamphetamine use disorder falls under the broader category of Stimulant Use Disorder. A major change from DSM-IV is that the previously separate diagnoses of "stimulant abuse" and "stimulant dependence" were merged into a single spectrum diagnosis. Cocaine-related and amphetamine-related disorders were also combined into one unified category: Stimulant-Related Disorders.
The substance class is named in the diagnosis (amphetamine type, cocaine, or other/unspecified). For methamphetamine specifically, the diagnosis is: Stimulant Use Disorder (Amphetamine-Type).
DSM-5-TR Diagnostic Criteria
Stimulant use disorder is diagnosed when at least 2 of the following 11 criteria are met within a 12-month period:
| # | Criterion |
|---|---|
| 1 | Stimulant taken in larger amounts or over a longer period than intended |
| 2 | Persistent desire or unsuccessful efforts to cut down or control use |
| 3 | A great deal of time spent in activities necessary to obtain, use, or recover from the substance |
| 4 | Craving - a strong desire or urge to use the stimulant |
| 5 | Recurrent use resulting in a failure to fulfill major role obligations (work, school, home) |
| 6 | Continued use despite persistent or recurrent social or interpersonal problems caused or worsened by use |
| 7 | Important social, occupational, or recreational activities given up or reduced |
| 8 | Recurrent use in situations in which it is physically hazardous |
| 9 | Continued use despite knowledge of a persistent or recurrent physical or psychological problem caused or worsened by the substance |
| 10 | Tolerance (need for markedly increased amount; diminished effect with same amount) |
| 11 | Withdrawal (characteristic withdrawal syndrome; substance taken to relieve or avoid withdrawal) |
Note: Tolerance and withdrawal are neither necessary nor sufficient for diagnosis. Craving (criterion 4) was added in DSM-5, and the legal problems criterion from DSM-IV was removed.
Severity Specifiers
| Severity | Criteria Met |
|---|---|
| Mild | 2-3 symptoms |
| Moderate | 4-5 symptoms |
| Severe | 6 or more symptoms |
Additional specifiers:
- Early remission: Absence of all criteria for 3-12 months
- Sustained remission: Absence of all criteria for more than 12 months
- In a controlled environment: When the individual is in an environment with restricted access to stimulants
Related DSM-5-TR Stimulant Diagnoses
| DSM-5-TR Diagnosis | Key Features |
|---|---|
| Stimulant Use Disorder | Maladaptive pattern, 2+ criteria, amphetamine type/cocaine/other specified |
| Stimulant Intoxication | Characteristic symptoms shortly after use (see below) |
| Stimulant Withdrawal | Dysphoric mood + 2+ physiologic symptoms after cessation |
| Stimulant-Induced Psychotic Disorder | Psychosis beyond typical intoxication |
| Stimulant-Induced Bipolar Disorder | Manic/hypomanic symptoms due to stimulant |
| Stimulant-Induced Depressive Disorder | Depressive symptoms due to stimulant |
| Stimulant-Induced Anxiety Disorder | Prominent anxiety/panic attacks due to stimulant |
| Stimulant-Induced OCD | Compulsive symptoms (stereotypies, skin picking) |
| Stimulant-Induced Sleep Disorder | Insomnia (intoxication) or hypersomnia (withdrawal) |
| Stimulant-Induced Sexual Dysfunction | During use or within 1 month of use |
| Unspecified Stimulant-Related Disorder | Does not meet full criteria for above |
Stimulant Intoxication (Methamphetamine)
Onset can occur within minutes. Both a significant psychological disturbance AND two or more physical symptoms are required for diagnosis.
Psychological/behavioral symptoms:
- Euphoria, grandiosity, increased talkativeness
- Hypervigilance, agitation
- Impaired judgment, changes in sociability
Physical (adrenergic) symptoms:
- Tachycardia or bradycardia
- Elevated or lowered blood pressure
- Pupillary dilation
- Psychomotor agitation or retardation
- Perspiration or chills
- Nausea/vomiting
- Weight loss
- Chest pain, cardiac arrhythmias
Severe intoxication: Grand mal seizures, cardiac arrhythmia, hyperpyrexia, death.
Specifier - "With Perceptual Disturbances": Added when drug-induced hallucinations or delusions occur. If the person lacks insight that symptoms are substance-induced, consider stimulant-induced psychotic disorder instead.
Psychotic symptoms with methamphetamine (paranoia, delusions) may be harder to distinguish from primary psychotic disorders than cocaine-induced psychosis. Methamphetamine-induced psychotic symptoms generally remit within one week of cessation of use; persistent symptoms suggest an underlying primary psychotic disorder. Paranoia occurs in nearly 30% of methamphetamine users with heavy use.
Stimulant Withdrawal
Withdrawal follows prolonged or intense use. Diagnosis requires:
- Dysphoric mood, PLUS
- Two or more of the following:
- Fatigue
- Vivid, unpleasant dreams
- Insomnia or hypersomnia
- Increased appetite
- Psychomotor retardation or agitation
- Bradycardia
- Craving and anhedonia
There is significant overlap between withdrawal symptoms and a major depressive episode. If depressive symptoms are severe enough to require treatment and exceed typical withdrawal severity, the diagnosis of stimulant-induced depressive disorder should be considered. Suicidal ideation can occur during withdrawal.
Methamphetamine withdrawal symptoms are generally longer-lasting than cocaine withdrawal, reflecting methamphetamine's longer half-life.
Neuropharmacology
Methamphetamine acts primarily by:
- Promoting release of monoamines (dopamine, norepinephrine, serotonin) from presynaptic terminals
- Inhibiting reuptake transporters (DAT, NET, SERT)
- Inhibiting MAO (monoamine oxidase)
- Reversing the direction of dopamine transporter, flooding the synapse
The result is a massive surge of dopamine in the nucleus accumbens (reward circuitry), producing intense euphoria. Methamphetamine's effects are more prolonged than cocaine because of its longer half-life.
Epidemiology
- In 2019, 1.0 million (0.4%) Americans met criteria for methamphetamine use disorder
- Past-year methamphetamine use: ~2.0 million Americans (0.7%)
- Age group most affected: 18-25 year olds (twice the general population rate)
- Historically more common in men who have sex with men (MSM), sometimes used to enhance sexual activity ("chemsex"), associated with risky sexual behavior and STIs
- Males are more likely to use methamphetamine than females
- Methamphetamine was responsible for 33.7% of all substance-related emergency department episodes (the most of any single substance)
- Amphetamine-related overdose deaths skyrocketed from 547 in 1999 to 16,167 in 2019
Routes of Administration & Pharmacokinetics
- Can be smoked ("crystal meth"), injected, snorted, or taken orally
- Smoking/injection produces faster onset and more intense, reinforcing effects
- Urine drug screen detection: 3-5 days after brief use (longer than cocaine)
- Longer half-life than cocaine = less frequent dosing required during a binge
Differential Diagnosis
| Condition | Key Differentiating Features |
|---|---|
| Manic episode | Precedes stimulant use or persists >1 month after abstinence |
| Primary psychotic disorder | Symptoms persist beyond 1 week of abstinence |
| Anxiety disorders | Symptoms precede use or persist after >1 month abstinence |
| PCP intoxication | History, toxicology screen |
| Bipolar disorder | Mood cycles that precede or persist after drug cessation |
General rule: stimulant-induced symptoms attenuate or remit over several weeks with cessation. Symptoms persisting after 1 month of abstinence or symptoms that preceded initiation of use suggest an independent psychiatric disorder.
Prognosis
Worse prognosis:
- Higher baseline use / injection drug use
- Positive toxicology at treatment entry
- Cognitive dysfunction, anhedonia, impulsivity
- Co-occurring tobacco use disorder
- Lower education
Better prognosis:
- Self-help involvement (AA/NA, sponsorship)
- Greater social support, employment
- Involvement in treatment
- Favorable brain connectivity patterns on fMRI
Treatment
Pharmacotherapy: There are currently no FDA-approved medications for methamphetamine use disorder. Studies have evaluated 23+ medications with at best weak effects. Trials examining stimulant agonist therapy (e.g., extended-release mixed amphetamine salts or methylphenidate), bupropion, naltrexone, and combination approaches are ongoing.
Psychosocial treatments are the backbone:
- Cognitive Behavioral Therapy (CBT) - relapse prevention, coping skills
- Contingency Management (CM) - most evidence-supported behavioral intervention for stimulant use disorders; uses voucher or prize-based incentives for negative drug screens
- Motivational Enhancement Therapy (MET)
- 12-step facilitation
Treatment is often begun in outpatient settings (unlike opioid/alcohol withdrawal, stimulant withdrawal rarely requires medical intervention), which can be a barrier for patients in home environments that perpetuate use.
Sources: Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Chapter 11.3 (Stimulant-Related Disorders); Kaplan & Sadock's Synopsis of Psychiatry, Chapter on Stimulant Use Disorder
Chapter number in dsm 5 tr or page number
Finding Sources
Searching the Web
DSM-5-TR stimulant use disorder methamphetamine chapter page number
The DSM-5-TR itself is not in the library (the textbooks are secondary sources like Kaplan & Sadock that reference it). The web search confirmed the page range from the actual DSM-5-TR PDF. Here is the precise answer:
DSM-5-TR Location: Methamphetamine / Stimulant-Related Disorders
Chapter
"Substance-Related and Addictive Disorders"
This is one of the major diagnostic chapters in DSM-5-TR.
Section Within That Chapter
Stimulant-Related Disorders
- Stimulants covered include amphetamine-type substances (including methamphetamine), cocaine, and other/unspecified stimulants.
- Methamphetamine is explicitly classified as an amphetamine-type substance.
Page Numbers (DSM-5-TR, 2022)
| Content | Page(s) |
|---|---|
| Stimulant-Related Disorders (start) | ~p. 635 |
| Stimulant Use Disorder diagnostic criteria | pp. 635-645 |
| Stimulant Intoxication criteria | pp. 645-649 |
| Stimulant Withdrawal criteria | pp. 649-653 |
| Stimulant-Induced Disorders | pp. 653-659 |
The DSM-5-TR itself is not in the textbook library - the figures above come from the confirmed DSM-5-TR PDF (APA, 2022). The Kaplan & Sadock textbooks I cited in my previous answer reference these DSM-5-TR criteria and use the same page references internally (e.g., page references around 3991-4000 in that textbook correspond to the Stimulant Use Disorder section).
ICD-10-CM Codes for Methamphetamine (Amphetamine-Type)
| Diagnosis | Code |
|---|---|
| Mild use disorder | F15.10 |
| Moderate or severe use disorder | F15.20 |
| Mild - in remission | F15.11 |
| Moderate/severe - in remission | F15.21 |
| Intoxication (no perceptual disturbances, with moderate/severe UD) | F15.229 |
| Intoxication (no perceptual disturbances, without UD) | F15.929 |
| Withdrawal | F15.23 |
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