# 158 - 6C4H Disorders due to use of non psychoactive # 6C4H Disorders due to use of non-psychoactive substances Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders 6C44.Z Disorder due to use of sedatives, hypnotics or anxiolytics, unspecified 6C45.Z Disorder due to use of cocaine, unspecified 6C46.Z Disorder due to use of stimulants, including amfetamines, methamfetamine and methcathinone, unspecified 6C47.Z Disorder due to use of synthetic cathinones, unspecified 6C48.Z Disorder due to use of caffeine, unspecified 6C49.Z Disorder due to use of hallucinogens, unspecified 6C4A.Z Disorder due to use of nicotine, unspecified 6C4B.Z Disorder due to use of volatile inhalants, unspecified 6C4C.Z Disorder due to use of MDMA or related drugs, including MDA, unspecified 6C4D.Z Disorder due to use of dissociative drugs, including ketamine and PCP, unspecified 6C4E.Z Disorder due to use of other specified psychoactive substance, including medications, unspecified 6C4F.Z Disorder due to use of multiple specified psychoactive substances, unspecified 6C4G.Z Disorder due to use of unknown or unspecified psychoactive substances, unspecified Disorders due to use of non-psychoactive substances Disorders due to use of non-psychoactive substances are characterized by the pattern and consequences of non-psychoactive substance use. Non-psychoactive substances include laxatives, growth hormone, erythropoietin and non-steroidal anti-inflammatory drugs. They may also include proprietary or over-the-counter medicines and folk remedies. Disorders due to use of non-psychoactive substances do not include disorders related to psychoactive substances such as anabolic steroids, antidepressants, medications with anticholinergic properties (e.g. benztropine), and some antihistamines. These should be classified under 6C4E Disorders due to use of other specified psychoactive substance, including medications. Episode of harmful use of non-psychoactive substances Essential (required) features • An episode of use of a non-psychoactive substance that has caused clinically significant damage to a person’s physical health or mental health is required for diagnosis. • Harm to the health of the individual occurs due to the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration. • The harm to health is not better accounted for by a medical condition not caused by the substance or by another mental disorder. 6C4H Substance-induced mental disorders | Disorders due to use of non-psychoactive substances 6C4H.0 501 Disorders due to substance use or addictive behaviours Note: harm to physical health includes acute health problems resulting from non-psychoactive substance use such as dehydration or dyslipidemia, and exacerbation or decompensation of pre-existing chronic health problems such as hypertension, liver disease or peptic ulceration. Harm may also result from a harmful route of administration (e.g. non-sterile intravenous selfadministration causing infections). Harm to mental health refers to psychological and behavioural symptoms following non-psychoactive substance use (e.g. severe depressive symptoms following dehydration and mineral loss from inappropriate use of laxatives). Additional clinical features • There must be explicit evidence of harm to the individual’s physical or mental health. There must also be a clear causal relationship between the harm to health and the episode of non-psychoactive substance use in question. • Non-psychoactive substance use may occur in the context of other mental disorders (e.g. use of laxatives in anorexia nervosa to reduce body weight, use of anabolic steroids in body dysmorphic disorder to increase muscle mass). An additional diagnosis of episode of harmful psychoactive substance use can be made if the specific episode of nonpsychoactive substance use in question has resulted in clinically significant harm to the individual’s physical or mental health. • A diagnosis of episode of harmful use of non-psychoactive substances often signals an opportunity for intervention, including lower-intensity interventions that can be implemented in a wide range of settings aimed at reducing the likelihood of additional harmful episodes, or of progression to harmful pattern of non-psychoactive substance use. • As more information becomes available indicating that an episode is part of a continuous or recurrent pattern of harmful non-psychoactive substance use, a diagnosis of episode of harmful psychoactive substance use should be changed to harmful pattern of nonpsychoactive substance use. Boundary with normality (threshold) • The diagnosis of episode of harmful use of non-psychoactive substances requires clinically significant harm to the individual’s physical or mental health. Examples of impact on physical or mental health that would not be considered clinically significant include mild hangover, brief episodes of vomiting or transient depressed mood. • An episode of non-psychoactive substance use may also cause social problems that do not constitute clinically significant harm to physical or mental health (e.g. arguments with loved ones). A diagnosis of episode of harmful use of non-psychoactive substances should not be assigned in these circumstances. Substance-induced mental disorders | Disorders due to use of non-psychoactive substances Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Boundaries with other disorders and conditions (differential diagnosis) Boundary with other specified hazardous drug use The category other specified hazardous drug use from Chapter 24 on factors influencing health status or contact with health services may be assigned if the episode of non-psychoactive substance use in question appreciably increases the risk of harmful physical or mental health consequences to an extent that warrants attention and advice from health professionals, but has not resulted in specific identifiable harm to the individual’s physical or mental health. Boundary with harmful pattern of non-psychoactive substance use If the harm to health is a result of a known episodic or continuous pattern of non-psychoactive substance use, harmful pattern of non-psychoactive substance use is the appropriate diagnosis rather than episode of harmful use of non-psychoactive substances. Substance use is generally considered to be following a pattern if there has been at least episodic or intermittent use over a period of at least 12 months, or continuous use over at least 1 month. If harm is caused by use of a non-psychoactive substance but no information is available about the pattern or history of substance use, a diagnosis of episode of harmful use of non-psychoactive substances may be assigned until such time as evidence for a pattern of use is ascertained. Boundary with injury, poisoning or certain other consequences of external causes When use of a non-psychoactive substance results in injury or life-threatening symptoms (e.g. coma, severe cardiac, respiratory symptoms), a diagnosis from the grouping of harmful effects of substances in Chapter 22 on injury, poisoning or certain other consequences of external causes should also be assigned. Harmful pattern of use of non-psychoactive substances Essential (required) features • A pattern of repeated or continuous use of a non-psychoactive substance that has caused clinically significant damage to a person’s physical health or mental health is required for diagnosis. • Harm to the health of the individual occurs due to the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration. • The pattern of use of the relevant substance is evident over a period of at least 12 months if substance use is episodic or at least 1 month if use is continuous. • The harm to health is not better accounted for by a medical condition not caused by the substance or by another mental disorder. Note: harm to physical health includes acute or chronic health problems resulting from a pattern of non-psychoactive substance use such as testicular atrophy, cardiomegaly, and exacerbation 6C4H.1 Substance-induced mental disorders | Disorders due to use of non-psychoactive substances 503 Disorders due to substance use or addictive behaviours or decompensation of pre-existing chronic health problems such as hypertension, liver disease or peptic ulceration. Harm may also result from a harmful route of administration (e.g. nonsterile intravenous self-administration causing infections). Harm to mental health refers to psychological and behavioural symptoms following non-psychoactive substance use (e.g. severe depressive symptoms due to dehydration and mineral loss from inappropriate use of laxatives). Course specifiers Harmful pattern of use of non-psychoactive substances, episodic This category is assigned when all the diagnostic requirements for harmful pattern of use of non-psychoactive substances are met, and there is evidence of a pattern of recurrent episodic or intermittent use of the relevant non-psychoactive substance over a period of at least 12 months that has caused clinically significant harm to a person’s physical or mental health. Harmful pattern of use of non-psychoactive substances, continuous This category is assigned when all the diagnostic requirements for harmful pattern of use of nonpsychoactive substances are met, and there is evidence of a pattern of continuous substance use (daily or almost daily) of the relevant non-psychoactive substance over a period of at least 1 month that has caused clinically significant harm to a person’s physical or mental health. Harmful pattern of use of non-psychoactive substances, unspecified Additional clinical features for harmful pattern of use of nonpsychoactive substances • There must be explicit evidence of harm to the individual’s physical or mental health. There must also be a clear causal relationship between the harm to health and the episode of non-psychoactive substance use in question. • Non-psychoactive substance use may occur in the context of other mental disorders (e.g. use of laxatives in anorexia nervosa to reduce body weight, use of anabolic steroids in body dysmorphic disorder to increase muscle mass). An additional diagnosis of harmful pattern of non-psychoactive substance use can be made if the pattern of non-psychoactive substance use has resulted in clinically significant harm to the individual’s physical or mental health. 6C4H.10 6C4H.11 Substance-induced mental disorders | Disorders due to use of non-psychoactive substances 6C4H.1Z