PsychEd: Educational Psychiatry Podcast PsychEd Shorts 7: Substance Use History
Nov 15, 2025
This insightful discussion delves into taking a substance use history, touching on essential distinctions between physical and psychological dependence. The hosts explore the DSM-5 criteria, highlighting the different classes of substances and the nuances of intoxication and withdrawal. They emphasize the importance of de-escalation techniques, including maintaining personal space and clear communication. A handy TRAPPED mnemonic is introduced to structure historical data collection effectively, alongside tips for building rapport with patients through non-stigmatizing language.
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DSM-5 Reframes Substance Diagnoses
- DSM-5 unified substance diagnoses under 'substance use disorder' to reflect a severity spectrum rather than separate abuse/dependence categories.
- This reframing emphasizes counting criteria across mild to severe presentations.
Two Types Of Dependence
- Distinguish physical dependence (tolerance, withdrawal) from psychological dependence (perceived emotional need to use).
- Both concepts help conceptualize addiction even though 'addiction' is not a formal DSM diagnosis.
Cluster Symptoms To Simplify Diagnosis
- Group substances as depressants, stimulants, and hallucinogens and remember five SUD symptom clusters: loss of control, social impairment, risky use, tolerance, withdrawal.
- Organizing criteria into clusters simplifies diagnosing within the 12-month timeframe.
