Diagnosing a

Substance
InducedDisorder-
Case of Kirk A
Withdrawal
 Alcohol Withdrawal
Criteria
There are 4 conditions to be met
(A-D)

A. Cessation of (or reduction in)

alcohol use that has been
heavy and prolonged. 
 Alcohol Withdrawal Criteria- continued
B. Two (or more) of the following, developing
within several hours to a few days after
Criterion A: 
1. autonomic hyperactivity (e.g., sweating or
pulse rate greater than 100) 
2. increased hand tremor 
3. insomnia 
4. nausea or vomiting 
5. transient visual, tactile, or auditory
hallucinations or illusions 
6. psychomotor agitation 
Withdrawal Criteria-
continued
C. The symptoms in Criterion B cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning. 

D. The symptoms are not due to a general

medical condition and are not better
accounted for by another mental disorder.

Specify if: With Perceptual Disturbances – p.122

 Other Drug Withdrawal
Signs
Note if any other withdrawal signs are apparent.
dysphoric mood
e.g. (1)
(2) nausea or vomiting 
(3) muscle aches 
(4) lacrimation (tears) or rhinorrhea (runny
nose)
(5) pupillary dilation, piloerection (goosebumps)
or sweating 
(6) diarrhea 
(7) yawning 
(8) fever 
(9) Insomnia
Other Drug Withdrawal-
cont’d
Note if any other withdrawal signs are
apparent.
e.g.(B. Dysphoric mood and two (or more) of
the following physiological changes, developing
within a few hours to several days after
Criterion A: 
(1) fatigue 
(2) vivid, unpleasant dreams 
(3) Insomnia or Hypersomnia
(4) increased appetite 
(5) psychomotor agitation or retardation
 Kirk Again

Four days short of the first anniversary of his

accident, Kirk's wife received notice that she
was being transferred to a branch office in the
interior of the state. The transfer forced the
family to move. At the new location, Kirk
found that there were tighter controls on the
prescription of benzodiazepines, and far fewer
physicians and pharmacies. Once they had
settled into their new house, he realized that
he had no choice but to reduce his dose of
diazepam.
Although Kirk intended to taper his usage, he
put off doing so until he was nearly out of
medication. So on a warm summer morning
he found himself sud­denly facing the
prospect of taking only four tablets, whereas
the day before he had had 16. At first, he was
surprised at how little it bothered him. For
several days he experienced insomnia, but he
had expected that. (With no work to go to, he
had had time to read some magazine articles
about the effects of substance use.)
But at 4 a.m. of the third day, Kirk awakened
to a sense of anxiety that bordered on panic.
He felt nauseated and noticed that his pulse
was racing. For two days his agitation
mounted, to such an extent that he had
difficulty sitting still long enough to eat the
supper he had prepared. On the fifth day, his
wife arrived home after work to find him
having a grand mal seizure.
Does Kirk meet the Withdrawal
Criteria?
Complete the handout given in class (or
downloadable off BlackBoard).