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ICD-11 Criteria for Disorders due to use of Unknown or Unspecified Psychoactive Substances (6C4G)

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ICD-11 Criteria for Disorders due to use of Unknown or Unspecified Psychoactive Substances (6C4G)

Disorders due to use of unknown or unspecified psychoactive substances are characterised by the pattern and consequences of psychoactive substance use when the specific substance is unknown or unspecified. These categories may be used in clinical situations in which it is clear that the disturbance is due to substance use but the specific class of substance is unknown. Once the relevant substance is identified, the disturbance should be recoded under the appropriate substance class.

6C4G.0    Episode of harmful use of unknown or unspecified psychoactive substances

An episode of use of an unknown or unspecified psychoactive substance that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication or withdrawal; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to substance intoxication or withdrawal on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of use of the unknown or unspecified psychoactive substance.

Exclusions:

  • Harmful pattern of use of unknown or unspecified psychoactive substance (6C4G.1)
  • Unknown or unspecified psychoactive substance dependence (6C4G.2)

6C4G.1    Harmful pattern of use of unknown or unspecified psychoactive substance

A pattern of use of an unknown or unspecified psychoactive substance that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of substance use is evident over a period of at least 12 months if use is episodic or at least one month if use is continuous (i.e., daily or almost daily). Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to substance intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of unknown or unspecified psychoactive substance applies.

Exclusions:  

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Unknown or unspecified psychoactive substance dependence (6C4G.2)

6C4G.10    Harmful pattern of use of unknown or unspecified psychoactive substance, episodic

A pattern of episodic or intermittent use of an unknown or unspecified psychoactive substance that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of episodic substance use is evident over a period of at least 12 months. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to substance intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of unknown or unspecified psychoactive substance applies.

Exclusions:

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Unknown or unspecified psychoactive substance dependence (6C4G.2)

6C4G.11    Harmful pattern of use of unknown or unspecified psychoactive substance, continuous

A pattern of continuous (daily or almost daily) use of an unknown or unspecified psychoactive substance that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of continuous substance use is evident over a period of at least one month. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to substance intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of unknown or unspecified psychoactive substance applies.

Exclusions:

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Unknown or unspecified psychoactive substance dependence (6C4G.2)

6C4G.1Z   Harmful pattern of use of unknown or unspecified psychoactive substance, unspecified

6C4G.2    Unknown or unspecified psychoactive substance dependence

Unknown or unspecified psychoactive substance dependence is a disorder of regulation of use of an unknown or unspecified substance arising from repeated or continuous use of the substance. The characteristic feature is a strong internal drive to use the unknown or unspecified substance, which is manifested by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use the unknown or unspecified substance. The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if use of the unknown or unspecified substance is continuous (daily or almost daily) for at least 3 months.

Exclusions:

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Harmful pattern of use of unknown or unspecified psychoactive substance (6C4G.1)

6C4G.20    Unknown or unspecified psychoactive substance dependence, current use

Current dependence on an unknown or unspecified psychoactive substance, with use of the substance within the past month.

Exclusions:

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Harmful pattern of use of unknown or unspecified psychoactive substance (6C4G.1)

6C4G.21    Unknown or unspecified psychoactive substance dependence, early full remission

After a diagnosis of Unknown or unspecified psychoactive substance dependence, and often following a treatment episode or other intervention (including self-help intervention), the individual has been abstinent from the substance during a period lasting from between 1 and 12 months.

Exclusions:     

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Harmful pattern of use of unknown or unspecified psychoactive substance (6C4G.1)

6C4G.22    Unknown or unspecified psychoactive substance dependence, sustained partial remission

After a diagnosis of Unknown or unspecified psychoactive substance dependence, and often following a treatment episode or other intervention (including self-help intervention), there is a significant reduction in consumption of the substance for more than 12 months, such that even though intermittent or continuing use of the substance has occurred during this period, the definitional requirements for dependence have not been met.

Exclusions:

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Harmful pattern of use of unknown or unspecified psychoactive substance (6C4G.1)

6C4G.23    Unknown or unspecified psychoactive substance dependence, sustained full remission

After a diagnosis of Unknown or unspecified psychoactive substance dependence, sustained full remission, and often following a treatment episode or other intervention (including self-intervention), the person has been abstinent from the substance for 12 months or longer.

Exclusions:

  • Episode of harmful use of unknown or unspecified psychoactive substances (6C4G.0)
  • Harmful pattern of use of unknown or unspecified psychoactive substance (6C4G.1)

6C4G.2Z    Unknown or unspecified psychoactive substance dependence, substance and state of remission unspecified

6C4G.3    Intoxication due to unknown or unspecified psychoactive substance

Intoxication due to unknown or unspecified psychoactive substance is a transient condition that develops during or shortly after the administration of an unknown or unspecified psychoactive substance that is characterised by disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses. This diagnosis should be made only when there is strong evidence that an unidentified substance has been taken and the features cannot be accounted for by another disorder or disease.

Coding Note:     Code aslo the causing condition

6C4G.4    Withdrawal due to unknown or unspecified psychoactive substance

Withdrawal due to unknown or unspecified psychoactive substance is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of an unknown or unspecified substance in individuals who have developed dependence or have used the unknown or unspecified substance for a prolonged period or in large amounts. Withdrawal due to unknown or unspecified psychoactive substance can also occur when prescribed psychoactive medications have been used in standard therapeutic doses. The specific features of the withdrawal state depend on the pharmacological properties of the unknown or unspecified substance.

Coding Note:     Code aslo the causing condition

6C4G.40    Withdrawal due to unknown or unspecified psychoactive substance, uncomplicated

All diagnostic requirements for Withdrawal due to unknown or unspecified psychoactive substance are met and the withdrawal state is not accompanied by perceptual disturbances or seizures.

Coding Note:     Code aslo the causing condition

6C4G.41    Withdrawal due to unknown or unspecified psychoactive substance, with perceptual disturbances

All diagnostic requirements for Withdrawal due to unknown or unspecified psychoactive substance are met and the withdrawal state is accompanied by perceptual disturbances (e.g., visual or tactile hallucinations or illusions) with intact reality testing. There is no evidence of confusion and other diagnostic requirements for Delirium are not met. The withdrawal state is not accompanied by seizures.

Coding Note:     Code aslo the causing condition

6C4G.42    Withdrawal due to unknown or unspecified psychoactive substance, with seizures

All diagnostic requirements for Withdrawal due to unknown or unspecified psychoactive substance are met and the withdrawal state is accompanied by seizures (i.e., generalised tonic-clonic seizures) but not by perceptual disturbances.

Coding Note:     Code aslo the causing condition

6C4G.43    Withdrawal due to unknown or unspecified psychoactive, with perceptual disturbances and seizures

The development of a withdrawal syndrome accompanied by both perceptual disturbances and seizures following cessation or reduction of use of the unknown or unspecified substance.

Coding Note:     Code aslo the causing condition

6C4G.4Z    Withdrawal due to unknown or unspecified psychoactive substance, unspecified

Coding Note:     Code aslo the causing condition

6C4G.5    Delirium induced by unknown or unspecified psychoactive substance

Delirium induced by unknown or unspecified psychoactive substance is characterised by an acute state of disturbed attention and awareness with specific features of delirium that develops during or soon after substance intoxication or withdrawal or during the use of an unknown or unspecified substance. The symptoms are not better explained by a primary mental disorder, by use of or withdrawal from another substance, or by another health condition that is not classified under Mental, behavioural and neurodevelopmental disorders.

Coding Note:     Code aslo the causing condition

6C4G.6    Psychotic disorder induced by unknown or unspecified psychoactive substance

Psychotic disorder induced by unknown or unspecified psychoactive substance is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxication with or withdrawal from an unknown or unspecified psychoactive substance. The symptoms are not better explained by a primary mental disorder (e.g., Schizophrenia, a Mood disorder with psychotic symptoms), as might be the case if the psychotic symptoms preceded the onset of the use of the unknown or unspecified psychoactive substance, if the symptoms persist for a substantial period of time after cessation of the use of the unknown or unspecified psychoactive substance or withdrawal from the unknown or unspecified psychoactive substance, or if there is other evidence of a pre-existing primary mental disorder with psychotic symptoms (e.g., a history of prior episodes not associated with the use of the unknown or unspecified psychoactive substance).

Coding Note:     Code aslo the causing condition

6C4G.7    Certain unknown or unspecified psychoactive substance-induced mental or behavioural disorders

Coding Note:     Code aslo the causing condition

6C4G.70    Mood disorder induced by unknown or unspecified psychoactive substance

Mood disorder induced by unknown or unspecified psychoactive substance is characterised by mood symptoms (e.g., depressed or elevated mood, decreased engagement in pleasurable activities, increased or decreased energy levels) that develop during or soon after intoxication with or withdrawal from a specified psychoactive substance. The symptoms are not better explained by a primary mental disorder (e.g., a Depressive disorder, a Bipolar disorder, Schizoaffective disorder), as might be the case if the mood symptoms preceded the onset of the use of the unknown or unspecified psychoactive substance, if the symptoms persist for a substantial period of time after cessation of the use of the unknown or unspecified psychoactive substance or withdrawal from the unknown or unspecified psychoactive substance, or if there is other evidence of a pre-existing primary mental disorder with mood symptoms (e.g., a history of prior episodes not associated with the use of the unknown or unspecified psychoactive substance).

Coding Note:     Code aslo the causing condition

6C4G.71    Anxiety disorder induced by unknown or unspecified psychoactive substance

Anxiety disorder induced by unknown or unspecified psychoactive substance is characterised by anxiety symptoms (e.g., apprehension or worry, fear, physiological symptoms of excessive autonomic arousal, avoidance behaviour) that develop during or soon after intoxication with or withdrawal from an unknown or unspecified psychoactive substance. The symptoms are not better explained by a primary mental disorder (e.g., an Anxiety and fear-related disorder, a Depressive disorder with prominent anxiety symptoms), as might be the case if the anxiety symptoms preceded the onset of the use of the unknown or unspecified psychoactive substance, if the symptoms persist for a substantial period of time after cessation of the use of the unknown or unspecified psychoactive substance or withdrawal from the unknown or unspecified psychoactive substance, or if there is other evidence of a pre-existing primary mental disorder with anxiety symptoms (e.g., a history of prior episodes not associated with the use of the unknown or unspecified psychoactive substance).

Coding Note:     Code aslo the causing condition

6C4G.72    Obsessive-compulsive or related disorder induced by unknown or unspecified psychoactive substance

Obsessive-compulsive or related disorder induced by unknown or unspecified psychoactive substance is characterised by either repetitive intrusive thoughts or preoccupations, normally associated with anxiety and typically accompanied by repetitive behaviours performed in response, or by recurrent and habitual actions directed at the integument (e.g., hair pulling, skin picking) that develop during or soon after intoxication with or withdrawal from an unknown or unspecified psychoactive substance. The symptoms are not better explained by a primary mental disorder (in particular an Obsessive-compulsive or related disorder), as might be the case if the symptoms preceded the onset of the unknown or unspecified psychoactive substance use, if the symptoms persist for a substantial period of time after cessation of use or withdrawal of the unknown or unspecified psychoactive substance, or if there is other evidence of a pre-existing primary mental disorder with obsessive-compulsive or related symptoms (e.g., a history of prior episodes not associated with the unknown or unspecified psychoactive substance use).

Coding Note:     Code aslo the causing condition

6C4G.73    Impulse control disorder induced by unknown or unspecified psychoactive substance

Impulse control disorder induced by unknown or unspecified psychoactive substance is characterised by persistently repeated behaviours in which there is recurrent failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite longer-term harm either to the individual or to others (e.g., fire setting or stealing without apparent motive, repetitive sexual behaviour, aggressive outbursts) that develop during or soon after intoxication with or withdrawal from an unknown or unspecified psychoactive substance. The symptoms are not better explained by a primary mental disorder (e.g., an Impulse control disorder, a Disorder due to addictive behaviours), as might be the case if the impulse control disturbances preceded the onset of the unknown or unspecified psychoactive substance use, if the symptoms persist for a substantial period of time after cessation of use or withdrawal of the unknown or unspecified psychoactive substance, or if there is other evidence of a pre-existing primary mental disorder with impulse control symptoms (e.g., a history of prior episodes not associated with the unknown or unspecified psychoactive substance use).

Coding Note:     Code aslo the causing condition

6C4G.Y    Other specified disorders due to use of unknown or unspecified psychoactive substances

6C4G.Z    Disorders due to use of unknown or unspecified psychoactive substances, unspecified

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/
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