So... how exactly should I be diagnosing polysubstance abuse/dependance? Being in the state hospital for the past three months has made me pretty familiar with the phrase.
From
Summary of Practice-Relevant
Changes to the DSM-IV-TR
Clarification of concept of Polysubstance Dependence
It is not uncommon for clinicians to inappropriately use the term Polysubstance Dependence to refer the heavy drug users who are dependent on a number of different types of substances. Instead, multiple co-morbid diagnoses of Substance Dependence (one for each class that the person is dependent on) should be given. For example, an individual who smokes crack several times a week, injects heroin daily, and smokes several joints a day would receive three diagnoses: Crack Dependence, Heroin Dependence, and Marijuana Dependence and not a diagnosis of Polysubstance Dependence. Polysubstance Dependence should be used only in those clinical situations where the pattern of multiple drug use is such that it fail to meet the criteria for Dependence on any one class of drug. In such settings, the only way to assign a diagnosis of Dependence is to consider all the substances that the person uses taken together as a whole. To clarify the appropriate use of this diagnosis, the text for Polysubstance Dependence was revised to provide examples of situations in which this diagnosis might apply. In making these revisions, however, it became clear that more than one interpretation of how to apply the Polysubstance Dependence rule is possible. One interpretation (operationalized in the Structured Clinical Interview for DSM-IV (SCID) [19]), focuses on periods of indiscriminant use of a variety of different substances. Another interpretation is analogous to the concept of mixed personality disorder, i.e., one or two dependence criteria are met for a single class of drug but full criteria for Dependence are only met when the drug classes are grouped together as a whole. Since both interpretations are covered by the construct of Polysubstance Dependence, the revised text includes elements of both as follows:
For example, a diagnosis of Polysubstance Dependence would apply to an individual who, during the same 12-month period, missed work because of his heavy use of alcohol, continued to use cocaine despite experiencing severe depressions after heavy nights of consumption, and was repeatedly unable to stay within his self-imposed limits regarding his use of codeine. In this instance, although the problems associated with the use of any one substance were not pervasive enough to justify a diagnosis of Dependence, his overall use of substances significantly impaired his functioning and thus warrants a diagnosis of Dependence on the substances as a group. Such a pattern might be observed, for example, in a setting where substance use was highly prevalent, but where the drugs of choice changed frequently. For those situations in which there is a pattern of problems associated with multiple drugs and the criteria are met for more than one specific Substance-Related Disorder (e.g., Cocaine Dependence, Alcohol Dependence, and Cannabis Dependence), each diagnosis should be made.
I'll make sure I change that on the Axis I...
