You gotta map measuring stick right there. If you're trying to say if your client has early remission, there's the numbers. It's either they have been clean for at least three months but less than 12 months or in sustained remission, no criteria for 12 months or longer, with the exception that Criteria A4 when you look at the 11 criteria for alcohol usage disorder, "Craving," may be met even while they are not exhibiting... casinoslots nz (silence) drink again or never go anywhere near alcohol, you can still have cravings and not have any of the other manifestations of the disorder and not be classified as actively in remission, actively in relapsing, actively, excuse me, I misspoke, not being classified as actively relapsing, you are actively in remission, so pay attention to how you use "Craving" now and alert the other professionals and the legal people around you that when we talk about "Craving," we can talk about "Craving" without the person having alcohol use disorder actively intoxicated or relapsing. Hope I didn't beat that one up too much, but I thought it was kind of important. So this funny little picture that you see here is the hat that my colleague and I wore at the National Conference on Addictive Disorders a couple weeks ago when we were giving a presentation on the importance of trusting your gut as a clinician when you are assessing and treating someone moving forward with process addictions that aren't listed in the book yet.
So if you've got a hoarder sitting in front of you, you will be able to find numbers for that in DSM-5, but what if you have a person who has internet or some kind of gaming, whether it's video gaming or another kind of gaming that is not specific to gambling, what if they've got an internet problem and it has caused massive problems in their life and you notice that there is clinically significant impairment or distress in their life and the lives of their family with the internet, but there's no numbers in the DSM-5. You will be able now to justify, because justification is what it's all about with diagnosing and reimbursement, you'll be able to justify that person's diagnosis by saying that there's clinically significant impairment or distress relating to this person's behavior. So I got some of these hats and I want you to know that it was very cool wearing them in St. Louis, Missouri a couple weeks ago after all the drama that was going on. And not a single soul asked us what the initials on our hat meant. I think they probably thought that we were very important people and my colleague and I got a tickle out of that just walking around with our little Clinically Significant Impairment or Distress hats on. - [Voiceover] The only thing that I really, since you were talking about this clinical significant impairment of, this is Denise E. by the way, of alcohol or drug taking along with process behaviors, so process addictions.
There is an article in Scientific American and the qoute, it said, "Drugs and gambling alter many of the same brain circuits in similar ways, as shown by studies of blood flow and electrical activity in people's brains as they complete computer tasks that mimic casino games." So there are so many similarities between gambling and what happens in one's brain and taking drugs or alcohol and what happens in one's brain, so I just wanted to as long as we were talking about significant impairment or distress, it also alters the chemicals in a person's head and so there's a myriad of effects from either process addictions or chemical addictions. - [Voiceover] Absolutely, because the chemistry that our brains are swimming in, the hormones the dopemine response... - [Voiceover] Serotonin, yeah.
- [Voiceover] The dopaminergic effect is all people are talking about at the National Conference on Addiction Disorders last week, two weeks ago, I just think you're absolutely right on by pointing that what's under the hat of that person is where his addiction is, there's a lot going on in the brain and that's what we're trying to pay more and more attention to. - [Voiceover] I put this together because I just wanted to sort of highlight, for example, the adolescent in the lower left hand corner is sort of blissfully unaware that they have a ball and chain attached to their ankle, which is really typical of a lot of the clients that we see at Quest.