The use of the term "Organic Brain Syndrome" has fallen out of favor, is not in the DSM IV, and has always been poorly defined. However, I've seen so many of these polysubstance dependence IV drug users that have been out in the sun that come in disheveled, malodorous, skin that looks like beef jerky, with rambling speech + poverty of content, poor working memory, flat affect, poor insight/judgment, and non-specific psychiatric symptoms. They have been substance free and urine tests negative, yet these symptoms seem to persist and are chronic in nature. They do not meet criteria for dementia but you know something bad happened to their brain from all the drug use. Other than reporting the objective findings on my assessment is there anything else on Axis I that I can add to elucidate these prominent findings? I was thinking Cognitive d/o NOS but then DSM IV says to use "Substance related d/o NOS" if cognitive dysfunction is due to a specific or unknown substance?