Cocaine-induced impulse control disorder

Essential (Required) Features:

• The presentation is characterized 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), or by behaviours similar to those seen in Disorders Due to Addictive Behaviours (i.e., excessive gambling or gaming).
• The disturbance in impulse control develops during or soon after intoxication with or withdrawal from cocaine use.
• The intensity or duration of the disturbance in impulse control is substantially in excess of impulse control disturbances that are characteristic of intoxication or withdrawal due to the cocaine.
• The symptoms and behaviours are not better accounted for by another mental disorder such as an Impulse Control Disorder or a Disorder Due to Addictive Behaviours. Evidence supporting a diagnosis of another mental disorder would include an impulse control disturbance preceding the onset of the substance use, the disturbance persisting for a substantial period of time after cessation of cocaine or withdrawal (e.g., 1 month or more), or other evidence of a pre-existing mental disorder with impulse control disturbance (e.g., a history of prior episodes not associated with cocaine use).
• The symptoms and behaviours are not a manifestation of another medical condition.
• The symptoms cause significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

When making a diagnosis of Cocaine-Induced Impulse Control Disorder, an additional diagnosis indicating the related pattern of cocaine use should also be assigned. These include Episode of Harmful Use of Cocaine, Harmful Pattern of Use of Cocaine, and Cocaine Dependence. A diagnosis of Cocaine Intoxication or Cocaine Withdrawal may also be assigned if applicable.

Additional Clinical Features:

• Cocaine-Induced Impulse Control Disorder may present with patterns of symptoms that vary according to the characteristics of the user (e.g., genetics, metabolism, personality factors). Cocaine use in higher amounts or over longer periods of time is more likely to be associated with the development of a Cocaine-Induced Impulse Control Disorder.
• Symptoms of Cocaine-Induced Impulse Control Disorder usually resolve or improve after sustained cessation of cocaine use.
• The duration of Substance Withdrawal for some substances can be protracted. For substances with more protracted withdrawal periods, the onset of symptoms of Substance-Induced Impulse Control Disorder can occur up to several weeks after the cessation of substance use. Substance-Induced Impulse Control Disorder symptoms related to substances with more protracted withdrawal periods may also last for correspondingly longer periods of time.
• In cases in which multiple psychoactive substance are used, it is often challenging to distinguish which substance is the cause of the Substance-Induced Impulse Control Disorder. When the specific etiological substance cannot be determined, a diagnosis of Substance-Induced Impulse Control Disorder Due to Multiple Specified Psychoactive Substances including Medications may assigned. In cases of multiple psychoactive substance use in which more than one specific substance can be identified as a cause of the Substance-Induced Impulse Control Disorder, the corresponding specific Substance-Induced Impulse Control Disorder diagnoses should be given instead.

Boundary with Normality (Threshold):

• Symptoms of Cocaine-Induced Impulse Control Disorders should be differentiated from from transient physiological aftereffects of intoxication (‘hangover effect’). The duration or severity of the symptoms in Cocaine-Induced Impulse Control Disorders must be in excess of ‘hangover effects’ of Cocaine and result in significant distress or impairment of functioning.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Cocaine Intoxication and Cocaine Withdrawal: Mental or behavioural symptoms that occur during Cocaine Intoxication or Cocaine Withdrawal should only be used as a basis for diagnosing a Cocaine-Induced Impulse Control Disorder if the intensity or duration of the symptoms is substantially in excess of those that are characteristic of Cocaine Intoxication or Cocaine Withdrawal and the symptoms are sufficiently severe to warrant specific clinical attention.
• Boundary with Episode of Harmful Use of Cocaine, Harmful Pattern of Use of Cocaine, or Cocaine Dependence: The impact of repeated or continuous use of cocaine characteristic of Harmful Pattern of Use of Cocaine and Cocaine Dependence may include Cocaine-Induced Impulse Control Disorder. Cocaine-Induced Impulse Control Disorders can also be associated with a single episode of cocaine use. In such cases, a Cocaine-Induced Impulse Control Disorder should be diagnosed together with a primary diagnosis of Episode of Harmful Use of Cocaine, Harmful Pattern of Use of Cocaine, or Cocaine Dependence.
• Boundary with mental disorders not induced by cocaine: Cocaine-Induced Impulse Control Disorders are differentiated from mental disorders with similar features that are not induced by cocaine on the basis of their onset, course and clinical features. A diagnosis of Cocaine-Induced Impulse Control Disorder requires evidence from history, physical or mental examination, or laboratory findings of recent cocaine use, intoxication or withdrawal. Most Cocaine-Induced Mental Disorders resolve or improve within several weeks of cessation of cocaine use. Mental disorders not induced by cocaine may precede the onset of cocaine use or may continue to be symptomatic during periods of sustained abstinence. The co-occurrence of cocaine use or withdrawal and onset of symptoms of mental disorders should not be taken as evidence for a presumptive diagnosis of a Cocaine-Induced Impulse Control Disorder. Some people use substances to suppress symptoms of mental disorders (e.g., Schizophrenia and Other Primary Psychotic Disorders, Mood Disorders, Anxiety and Fear-Related Disorders, Personality Disorders) and full symptomatic presentations only emerge upon cessation or reduction in substance use. Furthermore, cocaine use can exacerbate symptoms or precipitate an episode of a pre-existing mental disorder. Finally, cocaine use may be associated with but not aetiologic for new onset of symptoms of a mental disorder. Although a diagnosis of a Cocaine-Induced Impulse Control Disorder should not be assigned under these circumstances, an additional diagnosis of Episode of Harmful Use of Cocaine, Harmful Pattern of Use of Cocaine, or Cocaine Dependence may still be appropriate.