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.
• Harm to 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.
• 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 health problems resulting from non-psychoactive substance use such as dehydration, 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 self-administration 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 non-psychoactive 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 Non-Psychoactive 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.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Other Specified Hazardous Drug Use: The category Other Specified Hazardous Drug Use from the chapter 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 or respiratory symptoms), a diagnosis from the grouping of Harmful Effects of Substances in the chapter on Injury, Poisoning or Certain Other Consequences of External Causes should also be assigned.