Volatile inhalant withdrawal

Essential (Required) Features:

• The presence of a clinically significant cluster of symptoms, behaviours, and/or physiological features that occurs upon cessation or reduction in the use of volatile inhalants in individuals who have developed dependence on volatile inhalants or have used volatile inhalants for a prolonged period or in large amounts.
• Presenting features of Volatile Inhalant Withdrawal may include insomnia, anxiety, irritability, depressed or dysphoric mood, shakiness, perspiration, nausea, and transient illusions.
• The severity and duration of Volatile Inhalant Withdrawal is related to the type of inhalant used and to the amount, frequency and duration of use of the specific inhalant.
• The symptoms are not better accounted for by another medical condition or another mental disorder.

Additional Clinical Features:

• Volatile Inhalant Withdrawal may be accompanied by persisting features of Volatile Inhalant Intoxication or its medical complications such as encephalopathy, especially when the inhalant used is lead-containing petrol/gasoline.
• Characteristic features of Volatile Inhalant Withdrawal are opposite to the acute pharmacological effects of volatile inhalants.
• Volatile Inhalant Withdrawal symptoms become more severe with repeated episodes of withdrawal (termed ‘kindling’), with aging, or in the presence of comorbid medical conditions.

Boundary with Normality (Threshold):

• Volatile Inhalant Withdrawal should only be diagnosed when symptoms are consistent with those recognized as occurring upon cessation or reduction in use of volatile inhalants. Recent cessation or reduction of use and the presence of various non-specific transient symptoms is not sufficient to make the diagnosis of Volatile Inhalant Withdrawal.
• Withdrawal symptoms should be differentiated from the transient physiological aftereffects of intoxication (‘hangover effect’).
• Some individuals who have previously had Volatile Inhalant Dependence may experience symptoms similar to those of Volatile Inhalant Withdrawal months after the last use of the substance, particularly when the individual encounters stimuli (e.g., drug paraphernalia) and contexts (e.g., location where use was frequent) previously associated with past volatile inhalant use. These symptoms are more transient than those observed during Volatile Inhalant Withdrawal and occur exclusively when in contact with associated stimuli and contexts. A diagnosis of Volatile Inhalant Withdrawal should not be assigned under these circumstances.

Course Features:

• Volatile Inhalant Withdrawal is time-limited. Factors that influence the features and time course of Volatile Inhalant Withdrawal include: (1) the severity of Volatile Inhalant Dependence, if present, (2) the dose, frequency of use, and duration of volatile inhalant use prior to cessation or reduction of that use, (3) the half-life and duration of action of volatile inhalants, and (4) the presence of comorbid medical conditions (e.g., metabolic disturbances).

Culture-Related Features:

• Symptoms of withdrawal depend largely on the psychotropic characteristics of volatile inhalants. However, specific cultures may emphasize certain symptoms of withdrawal over others, making it more difficult to conduct a differential diagnosis. In addition, vernacular terms for withdrawal vary greatly.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Volatile Inhalant Dependence: Many individuals with Volatile Inhalant Dependence develop Volatile Inhalant Withdrawal upon cessation or reduction in the amount of the substance. In such cases, both Volatile Inhalant Dependence and Volatile Inhalant Withdrawal should be diagnosed. However, Volatile Inhalant Withdrawal can be diagnosed in the absence of a diagnosis of Volatile Inhalant Dependence.
• Boundary with Volatile Inhalant Intoxication: The onset of Volatile Inhalant Intoxication occurs immediately or shortly after the consumption of volatile inhalants. In contrast, Volatile Inhalant Withdrawal occurs upon cessation or reduction in the amount of volatile inhalants in the context of Volatile Inhalant Dependence or when volatile inhalants have been taken for a prolonged period or in large amounts. For volatile inhalants, the intoxication and withdrawal syndromes are typically distinct.
• Boundary with other Volatile Inhalant-Induced Mental Disorders: Mental or behavioural symptoms that arise during Volatile Inhalant Withdrawal should only be used as a basis for diagnosing a Volatile Inhalant-Induced Mental Disorder if the intensity or duration of the symptoms is substantially in excess of those that are characteristic of the Volatile Inhalant Withdrawal and the symptoms are sufficiently severe to warrant specific clinical attention. In such cases, if the withdrawal syndrome is ongoing, diagnoses of both Volatile Inhalant Withdrawal and a Volatile Inhalant-Induced Mental Disorder may be assigned.
• Boundary with other mental disorders: Various symptoms associated with Volatile Inhalant Withdrawal overlap with those that are characteristic of other mental disorders (e.g., depressive and anxiety symptoms). Symptoms of Volatile Inhalant Withdrawal occur in specific temporal relationship to the cessation of use of volatile inhalants and diminish with the passage of time. Evidence supporting a mental disorder diagnosis would include the symptoms preceding the onset of volatile inhalant use, the symptoms persisting for a substantial period of time after cessation of volatile inhalants or withdrawal (e.g., 1 month or more, depending on the substance), or other evidence of a pre-existing mental disorder (e.g., a history of prior episodes not associated with volatile inhalant use).
• Boundary with other medical conditions: It may be difficult to distinguish between various symptoms associated with Volatile Inhalant Withdrawal (e.g., nausea, shakiness, perspiration, transient illusions) and those that are characteristic of other medical conditions. Symptoms of Volatile Inhalant Withdrawal occur in specific temporal relationship to the cessation of use of volatile inhalants and diminish with the passage of time.