ICD-11 Criteria for Disorders Due to Use of Nicotine (6C4A)
Disorders due to use of nicotine are characterised by the pattern and
consequences of nicotine use. Nicotine is the active dependence-producing
constituent of the tobacco plant, Nicotiana tabacum. Nicotine is used
overwhelmingly through smoking cigarettes. Increasingly, it is also used in
electronic cigarettes that vaporize nicotine dissolved in a carrier solvent for
inhalation (i.e., “vaping”). Pipe smoking, chewing tobacco and inhaling snuff
are minor forms of use. Nicotine is a highly potent addictive compound and is
the third most common psychoactive substance used worldwide after caffeine and
alcohol. Nicotine Dependence and Nicotine Withdrawal are well described and
Nicotine-Induced Mental Disorders are recognized.
6C4A.0 Episode of Harmful Use of Nicotine
An episode of nicotine use that has caused damage to a person’s physical
or mental health. Harm to health of the individual occurs due to one or more of
the following: (1) direct or secondary toxic effects on body organs and systems;
or (2) a harmful route of administration. This diagnosis should not be made if
the harm is attributed to a known pattern of nicotine use.
Exclusions:
- Nicotine dependence (6C4A.2)
- Harmful pattern of use of nicotine (6C4A.1)
Harmful effects of or exposure to noxious substances, chiefly
nonmedicinal as to source, not elsewhere classified (NE61)
6C4A.1 Harmful Pattern of Use of Nicotine
A pattern of nicotine use that has caused damage to a person’s physical
or mental health. The pattern of nicotine use is evident over a period of at
least 12 months if substance 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) direct or secondary toxic
effects on body organs and systems; or (2) a harmful route of administration.
Exclusions:
- Nicotine dependence (6C4A.2)
- Episode of harmful use of nicotine (6C4A.0)
6C4A.10 Harmful Pattern of Use of Nicotine, Episodic
A pattern of episodic or intermittent nicotine use that has caused
damage to a person’s physical or mental health. The pattern of episodic
nicotine use is evident over a period of at least 12 months. Harm to the health of the individual occurs due to one or more of the following: (1)
direct or secondary toxic effects on body organs and systems; or (2) a harmful
route of administration.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Nicotine dependence (6C4A.2)
6C4A.11 Harmful Pattern of Use of Nicotine, Continuous
A pattern of continuous (daily or almost daily) nicotine use that has
caused damage to a person’s physical or mental health. The pattern of
continuous nicotine 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) direct
or secondary toxic effects on body organs and systems; or (2) a harmful route
of administration.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Nicotine dependence (6C4A.2)
6C4A.1Z Harmful pattern of use of
nicotine, unspecified
6C4A.2 Nicotine dependence
Nicotine dependence is a disorder of regulation of nicotine use arising
from repeated or continuous use of nicotine. The characteristic feature is a
strong internal drive to use nicotine, 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 nicotine.
Physiological features of dependence may also be present, including tolerance
to the effects of nicotine, withdrawal symptoms following cessation or
reduction in use of nicotine, or repeated use of nicotine or pharmacologically
similar substances to prevent or alleviate withdrawal symptoms. The features of
dependence are usually evident over a period of at least 12 months but the
diagnosis may be made if nicotine use is continuous (daily or almost daily) for
at least 3 months.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Harmful pattern of use of nicotine (6C4A.1)
6C4A.20 Nicotine Dependence, Current
Use
Current nicotine dependence with nicotine use
within the past month.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Harmful pattern of use of nicotine (6C4A.1)
6C4A.21 Nicotine dependence, early
full remission
After a diagnosis of nicotine dependence, and often following a
treatment episode or other intervention (including self-help intervention), the
individual has been abstinent from nicotine during a period lasting from
between 1 and 12 months.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Harmful pattern of use of nicotine (6C4A.1)
6C4A.22 Nicotine Dependence, Sustained
Partial Remission
After a diagnosis of nicotine dependence, and often following a
treatment episode or other intervention (including self-help intervention),
there is a significant reduction in nicotine consumption for more than 12
months, such that even though intermittent or continuing nicotine use has
occurred during this period, the definitional requirements for dependence have
not been met.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Harmful pattern of use of nicotine (6C4A.1)
6C4A.23 Nicotine Dependence, Sustained
Full Remission
After a diagnosis of nicotine dependence, and often following a
treatment episode or other intervention (including self-intervention), the
person has been abstinent from nicotine for 12 months or longer.
Exclusions:
- Episode of harmful use of nicotine (6C4A.0)
- Harmful pattern of use of nicotine (6C4A.1)
6C4A.2Z Nicotine dependence,
unspecified
6C4A.3 Nicotine intoxication
Nicotine intoxication is a clinically
significant transient condition that develops during or shortly after the
consumption of nicotine that is characterised by disturbances in consciousness,
cognition, perception, affect, behaviour, or coordination. These disturbances
are caused by the known pharmacological effects of nicotine and their intensity
is closely related to the amount of nicotine consumed. They are time-limited
and abate as nicotine is cleared from the body. Presenting features may include
restlessness, psychomotor agitation, anxiety, cold sweats, headache, insomnia,
palpitations, paresthesias, nausea or vomiting, abdominal cramps, confusion,
bizarre dreams, burning sensations in the mouth, and salivation. In rare
instances, paranoid ideation, perceptual disturbances, convulsions or coma may
occur. Nicotine intoxication occurs more commonly in naïve (non-tolerant) users
or among those taking higher than accustomed doses.
Coding Note: Code
aslo the causing condition
Inclusions:
- Bad trips" due to nicotine
Exclusions:
- Intoxication meaning poisoning (NE61)
- Possession trance disorder (6B63)
6C4A.4 Nicotine Withdrawal
Nicotine withdrawal 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 nicotine (typically used as a constituent of tobacco) in
individuals who have developed Nicotine dependence or have used nicotine for a
prolonged period or in large amounts. Presenting features of Nicotine
withdrawal may include dysphoric or depressed mood, insomnia, irritability,
anger, anxiety, difficulty concentrating, restlessness, bradycardia, increased
appetite, and craving for tobacco (or other nicotine-containing products. Other
physical symptoms may include increased cough and mouth ulceration.
Coding Note: Code
aslo the causing condition
6C4A.Y Other Specified Disorders Due to Use of Nicotine
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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