Addictive disorders in ICD-11 beta - Substance Use -

Addictive disorders in ICD-11 beta - Substance Use -
Sang-Kyu Lee, M.D., Ph.D. Hallym University Medical Center Chuncheon Sacred Heart Hosp. 20주년 중독정신의학회 추계학술대회

20주년 중독정신의학회 추계학술대회

Big Changes from ICD-10 to ICD-11 beta

Mental or behavioral disorders
ICD-11 beta Mental or behavioral disorders Disorders due to substance use or addictive behaviors Disorders due to substance use Disorders due to addictive behaviors Gambling disorder ( online, offline ) Gaming disorder ( online, offline ) ICD-10 Mental or behavioral disorders Mental and behavioral disorders due to psychoactive substance use 20주년 중독정신의학회 추계학술대회

Disorders due to substance use and addictive behaviours
Taxonomy of disorders due to substance use and addictive behaviours in the draft ICD-11 Disorders due to substance use and addictive behaviours Harmful (pattern) substance use Substanc dependece Single episode harmful substance use Substance intoxcation Substance withdrawal Substance-induced delirium Sub-Induc Pschotic D Mood D Anxiety D… Harmful addictive Gamblig disorder Gaming disorder Other disorders due to addictive behaviours Disorders due to substance use Disorders due to addictive behaviours Substance use disorders Substance induced disorders 17 Classes of psychoactive substances 20주년 중독정신의학회 추계학술대회

Disorders Due to Substance Use in the ICD-11 beta: some key innovations (1)
4-character codes allows monitoring and reporting not only classes of psychoactive substances involved (as in ICD-10), but also main clinical conditions (ex, 6B82:Alcohol dependence) Introduction of a section "Disorders due to substance use and addictive behaviours" in Chapter 6 Severity qualifiers for (acute) alcohol intoxication Simplified diagnostic guidance for Substance dependence impaired control (onset, amount, context, termination) Craving here increased priority in life over other activities (salience) Continuation of substance use despite problems physiological features (tolerance, withdrawal). 20주년 중독정신의학회 추계학술대회

Substance intoxication
Clinically significant, time‐limited, disturbance of consciousness, cognition, perception, affect, behavior, or coordination that follows the administration of a psychoactive substance. Intoxication is usually related to the dose of the substance that has been taken. Recovery is complete except when intoxication is complicated by injury, the effects of hypoxia, the effects of prolonged hyperactivity or recumbency, or other tissue damage or other complications. 20주년 중독정신의학회 추계학술대회

Substance Intoxication ‐ mild
Mental or behavioural disturbance is recognizable (on the basis of clinical assessment) Result in detectable impairment of psychosocial functioning Intact motor coordination, attention and judgement are needed. There is little or no disturbance in consciousness level. 20주년 중독정신의학회 추계학술대회

Substance Intoxication ‐ moderate
clearly perceptible and recognizable disturbance of consciousness, cognition, perception, affect, behavior, or coordination Results in impairment of psychosocial functioning Require assistance for tasks or medical attention. 20주년 중독정신의학회 추계학술대회

Substance Intoxication ‐ severe
Obvious disturbance of consciousness, cognition, perception, affect, behaviour, or coordination Results in severe impairment of psychosocial functioning to the extent that the person may be not able to cooperate when help is offered and may be not capable of self‐care and/or self protection. Urgent medical attention may be needed. It may not be possible to establish communication with a severely intoxicated person. 20주년 중독정신의학회 추계학술대회

Specified Injury Intentional self‐harm Delirium Seizures
Perceptual distortions Hypomanic or manic symptoms Other psychotic symptoms Depressive symptoms Coma Other medical complications. 20주년 중독정신의학회 추계학술대회

Definition of Substance Dependence in the ICD-11 beta
Chronic disorder of regulation of psychoactive substance use which arising from repeated or continuous use of that substance Central feature is a strong internal drive to use substanace Manifested by impaired ability to control use, increasing priority given to alcohol use over other activities, and persistence of use despite harm and adverse consequences Develop tolerance and withdrawal symptoms Constellation of behaviors suggesting dependence is evident over a period of at least 12 months if use is episodic, or over a period of at least one month if use is continuous (daily or almost daily). 20주년 중독정신의학회 추계학술대회

Diagnostic guidelines for substance dependence ICD-11 vs ICD-10
The diagnosis requires at least two of three central features to be present in the individual at the same time and to occur repeatedly over a period of at least 12 months or continuously over a period of at least one month. The features are: Impaired control over substance use - in terms of the onset, level, circumstances or termination of use, often but not necessarily accompanied by a subjective sensation of urge or craving to use the substance. Substance use becomes an increasing priority in life such that it takes precedence over other interests or enjoyments, daily activities, responsibilities or health or personal care. Substance use takes an increasingly central role in the person’s life and relegates other areas of life to the periphery. Substance use often continues despite the occurrence of problems. Physiological features (indicative of neuroadaptation to the substance) as manifested by: (i) tolerance, (ii) withdrawal symptoms following cessation or reduction in substance use, or (iii) repeated use of the substance (or pharmacologically similar substance) to prevent or alleviate withdrawal symptoms. A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year: (a) a strong desire or sense of compulsion to take the substance; (b) difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use; (c) a physiological withdrawal state (see F1x.3 and F1x.4) when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms; (d) evidence of tolerance, such that increased doses of the psychoactive substances are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users); (e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects; (f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm. 20주년 중독정신의학회 추계학술대회

Disorders Due to Substance Use in the ICD-11 beta : some key innovations (2)
"Harmful use" changed to "Harmful pattern of use" Harm to health of others included in the scope of definition of "harmful use" New diagnostic category "Single episode of harmful use" Episode if use resulting in damage to a person’s health or behaviour leading to harm to the health of other people Substance-induced delirium outside the code of withdrawal syndrome Revised classes of psychoactive substances. 20주년 중독정신의학회 추계학술대회

Harmful pattern of substance use
A pattern of substance use that has caused clinically significant harm to a person’s physical or mental health or in which substance-induced behavior has caused clinically significant harm to the health of other people. The pattern of substance use is evident over a period of at least 12 months if use is episodic and at least one month if use is continuous (daily or almost daily). Harm may be caused by 1) the intoxicating effects of a substance, 2) the direct or secondary toxic effects on body organs and systems, or 3) a harmful route of administration. 20주년 중독정신의학회 추계학술대회

Single episode of harmful substance use
Identifiable episode of use of a substance which has caused damage to a person’s physical or mental health or has resulted in behavior leading to intentional self‐harm or harm to the physical or mental health of others No evidence or information indicating that the harm to health is a result of a sustained pattern of substance use or more than one episode of harmful use within a 12‐month period or at least one month of continuous use of a substance 20주년 중독정신의학회 추계학술대회

Specified Injury Harm to mental health Harm to physical health
Harm to physical and mental health Substance‐induced behavior resulting in intentional self‐harm Substance‐induced behavior resulting in clinically significant harm to health of others. 20주년 중독정신의학회 추계학술대회

Proposed classes of substances in the ICD-11 beta
Mental or behavioral disorders Disorders due to substance use or addictive behaviors Mental and behavioral disorders due to psychoactive substance use Disorders due to substance use Disorders due to use of alcohol F10 Mental and behavioral disorders due to use of alcohol Disorders due to use of cannabis Disorders due to use of synthetic cannabinoids F12 Mental and behavioral disorders due to use of cannabinoids Disorders due to use of opioids F11 Mental and behavioral disorders due to use of opioids Disorders due to use of sedatives, hypnotics or anxiolytics F13 Mental and behavioral disorders due to use of sedatives or hypnotics Disorders due to use of cocaine F14 Mental and behavioral disorders due to use of cocaine Disorders due to use of stimulants including amphetamines, methamphetamine or methcathinone Disorders due to use of synthetic cathinones Disorders due to use of caffeine F15 Mental and behavioral disorders due to use of other stimulants, including caffeine Disorders due to use of hallucinogens F16 Mental and behavioral disorders due to use of hallucinogens Disorders due to use of nicotine F17 Mental and behavioral disorders due to use of tobacco Disorders due to use of volatile inhalants F18 Mental and behavioral disorders due to use of volatile solvents Disorders due to use of MDMA or related drugs, including MDA Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP] Disorders due to use of other specified psychoactive substances F19 Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances Disorders due to unknown or unspecified psychoactive substances Disorders due to use of non-psychoactive substances F55 Abuse of non-dependence-producing substances (Antidepressants, laxatives, Analgesics, Herbal medicine, Vitamines…)

ICD-11 beta 1. Disorders due to use of alcohol
F10.0 Alcohol intoxication F10.1 Harmful use F10.2 Dependence syndrome .20 Currently abstinent .200 Early remission .201 Partial remission .202 Full remission .21 Currently abstinent, but in a protected environment .22 Currently on a clinically supervised or replacement regime [controlled dependence] .23 Currently abstinent, but receiving treatment with aversive or blocking drugs .24 Currently using alcohol [active dependence] .240 Without physical features .241 With physical features .25 Continuous use .26 Episodic use [dipsomania] F10.3 Withdrawal state .30 Uncomplicated .31 With convulsions F10.4 Withdrawal state with delirium .40 Without convulsions .41 With convulsions 1. Disorders due to use of alcohol 6B80 Alcohol intoxication 6B81 Harmful pattern of use of alcohol 6B81.1 Harmful pattern of use of alcohol, episodic 6B81.2 Harmful pattern of use of alcohol, continuous 6B81.Z Harmful pattern of use of alcohol, unspecified 6B82 Alcohol dependence 6B82.1 Alcohol dependence, continuous use 6B82.2 Alcohol dependence, episodic use 6B82.3 Alcohol dependence, early full remission 6B82.4 Alcohol dependence, sustained partial remission 6B82.5 Alcohol dependence, sustained full remission 6B82.Z Alcohol dependence, unspecified 6B83 Alcohol withdrawal 6B83.1 Alcohol withdrawal, uncomplicated 6B83.2 Alcohol withdrawal with perceptual disturbances 6B83.3 Alcohol withdrawal with seizures 6B83.4 Alcohol withdrawal with perceptual disturbances and seizures 6B84 Alcohol-induced delirium 20주년 중독정신의학회 추계학술대회

ICD-11 beta 1. Disorders due to use of alcohol
F10.5 Psychotic disorder .50 Schizophrenia-like .51 Predominantly delusional .52 Predominantly hallucinatory .53 Predominantly polymorphic .54 Predominantly depressive psychotic symptoms .55 Predominantly manic psychotic symptoms .56 Mixed 1. Disorders due to use of alcohol 6B85 Alcohol-induced psychotic disorder 6B85.1 Alcohol-induced psychotic disorder with hallucinations 6B85.2 Alcohol-induced psychotic disorder with delusions 6B85.3 Alcohol-induced psychotic disorder with schizophreniform symptoms 6B85.Z Alcohol-induced psychotic disorder, unspecified 6B86 Alcohol-induced mood disorder 6B86.1 Alcohol-induced mood disorder with depressive symptoms 6B86.2 Alcohol-induced mood disorder with manic symptoms 6B86.3 Alcohol-induced mood disorder with mixed manic and depressive symptoms 6B86.Z Alcohol-induced mood disorder, unspecified 6B87 Alcohol-induced anxiety disorder 6B88 Alcohol-induced sexual dysfunction 6B89 Alcohol-induced sleep disorder 6B8A Single episode of harmful use of alcohol 6B8Y Other specified disorders due to use of alcohol 6B8Z Disorders due to use of alcohol, unspecified F10.6 Amnesic syndrome F10.7 Residual disorders and late-onset psychotic disorder .70 Flashbacks .71 Personality or behavior disorder .72 Residual affective disorder .73 Dementia .74 Other persisting cognitive disorder .75 Late-onset psychotic disorder F10.8 Other mental and behavioral disorders F10.9 Unspecified mental and behavioral disorder 20주년 중독정신의학회 추계학술대회

ICD-11 beta 2. Disorders due to use of cannabis
F12.0 Acute intoxication F12.1 Harmful use F12.2 Dependence syndrome .20 Currently abstinent .200 Early remission .201 Partial remission .202 Full remission .21 Currently abstinent, but in a protected environment .22 Currently on a clinically supervised or replacement regime [controlled dependence] .23 Currently abstinent, but receiving treatment with aversive or blocking drugs .24 Currently using cannabinoids [active dependence] .240 Without physical features .241 With physical features .25 Continuous use .26 Episodic use [dipsomania] F12.3 Withdrawal state .30 Uncomplicated .31 With convulsions F12.4 Withdrawal state with delirium .40 Without convulsions .41 With convulsions ICD-11 beta 2. Disorders due to use of cannabis 6B90 Cannabis intoxication 6B91 Single episode of harmful use of cannabis 6B92 Harmful pattern of use of cannabis 6B92.1 Harmful pattern of use of cannabis, episodic 6B92.2 Harmful pattern of use of cannabis, continuous 6B92.Z Harmful pattern of use of cannabis, unspecified 6B93 Cannabis dependence 6B93.1 Cannabis dependence, current use 6B93.2 Cannabis dependence, early full remission 6B93.3 Cannabis dependence, sustained partial remission 6B93.4 Cannabis dependence, sustained full remission 6B93.Z Cannabis dependence, unspecified 6B94 Cannabis withdrawal 6B95 Cannabis-induced delirium 6B96 Cannabis-induced psychotic disorder 6B97 Cannabis-induced anxiety disorder 6B98 Cannabis-induced sleep disorder 6B9Y Other specified disorders due to use of cannabis 6B9Z Disorders due to use of cannabis, unspecified 20주년 중독정신의학회 추계학술대회

ICD-11 beta 3. Disorders due to use of synthetic cannabinoids
6C00 Synthetic cannabinoid intoxication 6C01 Single episode of harmful use of synthetic cannabinoids 6C02 Harmful pattern f use of synthetic cannabinoids 6C02.1 Harmful pattern of use of synthetic cannabinoids, episodic 6C02.2 Harmful pattern of use of synthetic cannabinoids, continuous 6C02.Y Other specified harmful pattern of use of synthetic cannabinoids 6C02.Z Harmful pattern of use of synthetic cannabinoids, unspecified 6C03 Synthetic cannabinoid dependence 6C03.1 Synthetic cannabinoid dependence, current use 6C03.2 Synthetic cannabinoid dependence, early full remission 6C03.3 Synthetic cannabinoid dependence, sustained partial remission 6C03.4 Synthetic cannabinoid dependence, sustained full remission 6C03.Y Other specified synthetic cannabinoid dependence 6C03.Z Synthetic cannabinoid dependence, unspecified 6C04 Synthetic cannabinoid withdrawal 6C05 Synthetic cannabinoid-induced delirium 6C06 Synthetic cannabinoid-induced psychotic disorder 6C07 Synthetic cannabinoid-induced anxiety disorder 6C08 Synthetic cannabinoid-induced sleep disorder 6C0Y Other specified disorders due to use of synthetic cannabinoids 6C0Z Disorders due to use of synthetic cannabinoids, unspecified

ICD-11 beta 4. Disorders due to use of opioids
6C10 Opioid intoxication 6C11 Single episode of harmful use of opioids 6C12 Harmful pattern of use of opioids 6C12.1 Harmful pattern of use of opioids, episodic 6C12.2 Harmful pattern of use of opioids, continuous 6C12.Z Harmful pattern of use of opioids, unspecified 6C13 Opioid dependence 6C13.1 Opioid dependence, current use 6C13.2 Opioid dependence, early full remission 6C13.3 Opioid dependence, sustained partial remission 6C13.4 Opioid dependence, sustained full remission 6C13.Z Opioid dependence, unspecified 6C14 Opioid withdrawal 6C15 Opioid-induced delirium 6C16 Opioid-induced mood disorder 6C17 Opioid-induced anxiety disorder 6C18 Opioid-induced sexual dysfunction 6C19 Opioid-induced sleep disorder 6C1A Opioid-induced psychotic disorder 6C1Y Other specified disorders due to use of opioids 6C1Z Disorders due to use of opioids, unspecified

ICD-11 beta 5. Disorders due to use of sedatives, hypnotics or anxiolytics 6C20 Sedative, hypnotic or anxiolytic intoxication 6C21 Single episode of harmful use of sedatives, hypnotics or anxiolytics 6C22 Harmful pattern of use of sedatives, hypnotics or anxiolytics 6C23 Sedative, hypnotic or anxiolytic dependence 6C24 Sedative, hypnotic or anxiolytic withdrawal 6C24.1 Sedative, hypnotic or anxiolytic withdrawal, uncomplicated 6C24.2 Sedative, hypnotic or anxiolytic withdrawal, with perceptual disturbances 6C24.3 Sedative, hypnotic or anxiolytic withdrawal, with seizures 6C24.4 Sedative, hypnotic or anxiolytic withdrawal, with perceptual disturbances and seizures 6C24.Z Sedative, hypnotic or anxiolytic withdrawal, unspecified 6C25 Sedative, hypnotic or anxiolytic-induced delirium 6C26 Sedative, hypnotic or anxiolytic-induced psychotic disorder 6C27 Sedative, hypnotic or anxiolytic-induced mood disorder 6C27.1 Sedative, hypnotic or anxiolytic-induced mood disorder with depressive symptoms 6C27.2 Sedative, hypnotic or anxiolytic-induced mood disorder with manic symptoms 6C27.3 Sedative, hypnotic or anxiolytic-induced mood disorder with mixed depressive and manic symptoms 6C27.Z Sedative, hypnotic or anxiolytic-induced mood disorder, unspecified 6C28 Sedative, hypnotic or anxiolytic-induced anxiety disorder 6C29 Sedative, hypnotic or anxiolytic-induced sexual dysfunction 6C2A Sedative, hypnotic or anxiolytic-induced sleep disorder 6E42.24 Amnestic disorder due to use of sedatives, hypnotics or anxiolytics

ICD-11 beta 6. Disorders due to use of cocaine
6C30 Cocaine intoxication 6C31 Single episode of harmful use of cocaine 6C32 Harmful pattern of use of cocaine 6C32.1 Harmful pattern of use of cocaine, episodic 6C32.2 Harmful pattern of use of cocaine, continuous 6C32.Z Harmful pattern of use of cocaine, unspecified 6C33 Cocaine dependence 6C33.1 Cocaine dependence, current use 6C33.2 Cocaine dependence, early full remission 6C33.3 Cocaine dependence, sustained partial remission 6C33.4 Cocaine dependence, sustained full remission 6C33.Z Cocaine dependence, unspecified 6C34 Cocaine withdrawal 6C35 Cocaine-induced delirium 6C36 Cocaine-induced psychotic disorder 6C37 Cocaine-induced mood disorder 6C38 Cocaine-induced anxiety disorder 6C39 Cocaine-induced obsessive-compulsive or related syndrome 6C3A Cocaine-induced sexual dysfunction 6C3B Cocaine-induced sleep disorder

ICD-11 beta 6. Disorders due to use of cocaine 6C30 Cocaine intoxication 6C31 Single episode of harmful use of cocaine 6C32 Harmful pattern of use of cocaine 6C32.1 Harmful pattern of use of cocaine, episodic 6C32.2 Harmful pattern of use of cocaine, continuous 6C32.Z Harmful pattern of use of cocaine, unspecified 6C33 Cocaine dependence 6C34 Cocaine withdrawal 6C35 Cocaine-induced delirium 6C36 Cocaine-induced psychotic disorder 6C36.1 Cocaine-induced psychotic disorder with hallucinations 6C36.2 Cocaine-induced psychotic disorder with delusions 6C36.3 Cocaine-induced psychotic disorder with schizophreniform symptoms 6C36.Z Cocaine-induced psychotic disorder, unspecified 6C37 Cocaine-induced mood disorder 6C37.1 Cocaine-induced mood disorder with depressive symptoms 6C37.2 Cocaine-induced mood disorder with manic symptoms 6C37.3 Cocaine-induced mood disorder with mixed depressive and manic symptoms 6C37.Z Cocaine-induced mood disorder, unspecified 6C38 Cocaine-induced anxiety disorder 6C39 Cocaine-induced obsessive-compulsive or related syndrome 6C3A Cocaine-induced sexual dysfunction 6C3B Cocaine-induced sleep disorder

ICD-11 beta 7. Disorders due to use of stimulants including amphetamines, methamphetamine or methcathinone 6C40 Stimulant intoxication including ~ 6C41 Harmful pattern of use of stimulants including ~ 6C41.1 Harmful pattern of use of stimulants including~, episodic 6C41.2 Harmful pattern of use of stimulants including~, continuous 6C41.Z Harmful pattern of use of stimulants including~, unspecified 6C42 Single episode of harmful use of stimulants including ~ 6C43 Stimulant dependence including ~ 6C43.1 Stimulant dependence including~, current use 6C43.2 Stimulant dependence including~, early full remission 6C43.3 Stimulant dependence including~, sustained partial remission 6C43.4 Stimulant dependence including~, sustained full remission 6C43.Z Stimulant dependence including~, unspecified 6C44 Stimulant withdrawal including ~ 6C45 Stimulant-induced delirium including ~

ICD-11 beta 7. Disorders due to use of stimulants including amphetamines, methamphetamine or methcathinone 6C46 Stimulant-induced psychotic disorder including ~ 6C46.1 Stimulant-induced psychotic disorder including ~ with hallucinations 6C46.2 Stimulant-induced psychotic disorder including ~ with delusions 6C46.3 Stimulant-induced psychotic disorder including amphetamines but excluding caffeine or cocaine with schizophreniform symptoms 6C46.Z Stimulant-induced psychotic disorder including ~, unspecified 6C47 Stimulant-induced mood disorder including ~ 6C47.1 Stimulant-induced mood disorder including ~ with depressive symptoms 6C47.2 Stimulant-induced mood disorder including amphetamines but excluding caffeine or cocaine with manic symptoms 6C47.3 Stimulant-induced mood disorder including ~ with mixed depressive and manic symptoms 6C47.Z Stimulant-induced mood disorder including~, unspecified 6C48 Stimulant-induced anxiety disorder including ~ 6C49 Stimulant-induced obsessive-compulsive or related syndrome including ~ 6C4A Stimulant-induced sexual dysfunction including ~ 6C4B Stimulant-induced sleep disorder including ~

ICD-11 beta 8. Disorders due to use of synthetic cathinones
6C50 Synthetic cathinone intoxication 6C51 Single episode of harmful use of synthetic cathinones 6C52 Harmful pattern of use of synthetic cathinones 6C52.1 Harmful pattern of use of synthetic cathinones, episodic 6C52.2 Harmful use of synthetic cathinones, continuous 6C52.Y Other specified harmful pattern of use of synthetic cathinones 6C52.Z Harmful pattern of use of synthetic cathinones, unspecified 6C53 Synthetic cathinone dependence 6C53.1 Synthetic cathinone dependence, current use 6C53.2 Synthetic cathinone dependence, early full remission 6C53.3 Synthetic cathinone dependence, sustained partial remission 6C53.4 Synthetic cathinone dependence, sustained full remission 6C53.Y Other specified synthetic cathinone dependence 6C53.Z Synthetic cathinone dependence, unspecified 6C54 Synthetic cathinone withdrawal 6C55 Synthetic cathinone-induced delirium

ICD-11 beta 8. Disorders due to use of synthetic cathinones
6C56 Synthetic cathinone-induced psychotic disorder 6C56.1 Synthetic cathinone-induced psychotic disorder with hallucinations 6C56.2 Synthetic cathinone-induced psychotic disorder with delusions 6C56.3 Synthetic cathinone-induced psychotic disorder with schizophreniform symptoms 6C56.Y Other specified synthetic cathinone-induced psychotic disorder 6C56.Z Synthetic cathinone-induced psychotic disorder, unspecified 6C57 Synthetic cathinone-induced mood disorder 6C57.1 Synthetic cathinone-induced mood disorder with depressive symptoms 6C57.2 Synthetic cathinone-induced mood disorder with manic symptoms 6C57.3 Synthetic cathinone-induced mood disorder with mixed depressive or manic symptoms 6C57.Y Other specified synthetic cathinone-induced mood disorder 6C57.Z Synthetic cathinone-induced mood disorder, unspecified 6C58 Synthetic cathinone-induced anxiety disorder 6C59 Synthetic cathinone-induced obsessive-compulsive or related syndrome 6C5A Synthetic cathinone-induced sexual dysfunction 6C5B Synthetic cathinone-induced sleep disorder

Examples of designer drugs
Images reproduced with permission from the Drug Enforcement Agency, US Department of Justice

Prevalence of illicit drug use among high school students
(aged 17–18 years) in the USA Luciano, R. L. & Perazella, M. A. (2014) Nephrotoxic effects of designer drugs, Nat. Rev. Nephrol. doi: /nrneph

ICD-11 beta 9. Disorders due to use of caffeine
6C60 Caffeine intoxication 6C61 Single episode of harmful use of caffeine 6C62 Harmful pattern of use of caffeine 6C62.1 Harmful pattern of use of caffeine, episodic 6C62.2 Harmful pattern of use of caffeine, continuous 6C62.Z Harmful pattern of use of caffeine, unspecified 6C63 Caffeine dependence 6C64 Caffeine withdrawal 6C65 Caffeine-induced anxiety disorder 6C66 Caffeine-induced sleep disorder 6C6Y Other specified disorders due to use of caffeine 6C6Z Disorders due to use of caffeine, unspecified

ICD-11 beta 10. Disorders due to use of hallucinogens
6C70 Hallucinogen intoxication 6C71 Single episode of harmful use of hallucinogens 6C72 Harmful pattern of use of hallucinogens 6C72.1 Harmful pattern of use of hallucinogens, episodic 6C72.2 Harmful pattern of use of hallucinogens, continous 6C72.Z Harmful pattern of use of hallucinogens, unspecified 6C73 Hallucinogen dependence 6C73.1 Hallucinogen dependence, current use 6C73.2 Hallucinogen dependence, early full remission 6C73.3 Hallucinogen dependence, sustained partial remission 6C73.4 Hallucinogen dependence, sustained full remission 6C73.Z Hallucinogen dependence, unspecified 6C74 Hallucinogen-induced delirium 6C75 Hallucinogen-induced psychotic disorder 6C75.1 Hallucinogen-induced psychotic disorder with hallucinations 6C75.Z Hallucinogen-induced psychotic disorder, unspecified 6C76 Hallucinogen-induced mood disorder 6C77 Hallucinogen-induced anxiety disorder 6C7Y Other specified disorders due to use of hallucinogens 6C7Z Disorders due to use of hallucinogens, unspecified

ICD-11 beta 11. Disorders due to use of nicotine
6C80 Nicotine intoxication 6C81 Single episode of harmful use of nicotine 6C82 Harmful pattern of use of nicotine 6C82.1 Harmful pattern of use of nicotine, episodic 6C82.2 Harmful pattern of use of nicotine, continuous 6C82.Z Harmful pattern of use of nicotine, unspecified 6C83 Nicotine dependence 6C83.1 Nicotine dependence, current use 6C83.2 Nicotine dependence, early full remission 6C83.3 Nicotine dependence, sustained partial remission 6C83.4 Nicotine dependence, sustained full remission 6C83.Z Nicotine dependence, unspecified 6C84 Nicotine withdrawal 6C85 Nicotine-induced sleep disorder 6C8Y Other specified disorders due to use of nicotine 6C8Z Disorders due to use of nicotine, unspecified

ICD-11 beta 12. Disorders due to use of volatile inhalants
6C90 Volatile inhalant intoxication 6C91 Single episode of harmful use of volatile inhalants 6C92.1 Harmful pattern of use of volatile inhalants, episodic 6C92.2 Harmful pattern of use of volatile inhalants, continuous 6C92.Z Harmful pattern of use of volatile inhalants, unspecified 6C92 Harmful pattern of use of volatile inhalants 6C93 Volatile inhalant dependence 6C93.1 Volatile inhalant dependence, current use 6C93.2 Volatile inhalant dependence, early full remission 6C93.3 Volatile inhalant dependence, sustained partial remission 6C93.4 Volatile inhalant dependence, sustained full remission 6C93.Z Volatile inhalant dependence, unspecified 6C94 Volatile inhalant withdrawal 6C95 Volatile inhalant-induced psychotic disorder 6C96 Volatile inhalant-induced mood disorder 6C97 Volatile inhalant-induced anxiety disorder 6C98 Volatile inhalant-induced delirium 6C9Y Other specified disorders due to use of volatile inhalants 6C9Z Disorders due to use of volatile inhalants, unspecified

ICD-11 beta 13. Disorders due to use of MDMA or related drugs, including MDA 6D00 MDMA or related drug intoxication, including MDA 6D01 Single episode of harmful use of MDMA or related drugs, including MDA 6D02 Harmful pattern of use of MDMA or related drugs, including MDA 6D02.1 Harmful use of MDMA or related drugs, including MDA, episodic 6D02.2 Harmful use of MDMA or related drugs, including MDA, continuous 6D02.Z Harmful pattern of use of MDMA or related drugs, including MDA, unspecified 6D03 MDMA or related drug dependence, including MDA 6D03.1 MDMA or related drug dependence, including MDA, current use 6D03.2 MDMA or related drug dependence, including MDA, early full remission 6D03.3 MDMA or related drug dependence, including MDA, sustained partial remission 6D03.4 MDMA or related drug dependence, including MDA, sustained full remission 6D03.Z MDMA or related drug dependence, including MDA, unspecified 6D04 MDMA or related drug-induced delirium, including MDA 6D05 MDMA or related drug-induced psychotic disorder, including MDA 6D06 MDMA or related drug-induced mood disorder, including MDA 6D07 MDMA or related drug-induced anxiety disorder 6D08 MDMA or related drug-induced sexual dysfunction

ICD-11 beta 14. Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP] 6D10 Dissociative drug intoxication including Ketamine or PCP 6D11 Single episode of harmful use of dissociative drugs including ketamine or PCP 6D12 Harmful pattern of use of dissociative drugs, including ketamine or PCP 6D12.1 Harmful pattern of use of dissociative drugs including ketamine or PCP, episodic 6D12.2 Harmful pattern of use of dissociative drugs including ketamine or PCP, continuous 6D12.Z Harmful pattern of use of dissociative drugs, including ketamine or PCP, unspecified 6D13 Dissociative drug dependence including ketamine or PCP 6D13.1 Dissociative drug dependence including Ketamine or PCP, current use 6D13.2 Dissociative drug dependence including Ketamine or PCP, early full remission 6D13.3 Dissociative drug dependence including Ketamine or PCP, sustained partial remission 6D13.4 Dissociative drug dependence including Ketamine or PCP, sustained full remission 6D13.Z Dissociative drug dependence including ketamine or PCP, unspecified 6D14 Dissociative drug-induced delirium including ketamine or PCP 6D15 Dissociative drug-induced psychotic disorder including Ketamine or PCP 6D16 Dissociative drug-induced mood disorder including Ketamine or PCP 6D17 Dissociative drug-induced anxiety disorder including Ketamine or PCP

ICD-11 beta 15. Disorders due to use of other specified psychoactive substances 6D20 Other specified psychoactive substance intoxication 6D21 Harmful pattern of use of other specified psychoactive substance 6D21.1 Harmful pattern of use of other specified psychoactive substance, episodic 6D21.2 Harmful pattern of use of other specified psychoactive substance, continuous 6D21.Z Harmful pattern of use of other specified psychoactive substance, unspecified 6D22 Other specified psychoactive substance dependence 6D22.1 Other specified psychoactive substance dependence, current use 6D22.2 Other specified psychoactive substance dependence, early full remission 6D22.3 Other specified psychoactive substance dependence, sustained partial remission 6D22.4 Other specified psychoactive substance dependence, sustained full remission 6D22.Z Other specified psychoactive substance dependence, unspecified 6D23 Other specified psychoactive substance withdrawal 6D23.1 Other specified psychoactive substance withdrawal, uncomplicated 6D23.2 Other specified psychoactive substance withdrawal, with perceptual disturbances 6D23.3 Other specified psychoactive substance withdrawal, with seizures 6D23.4 Other specified psychoactive substance withdrawal, with perceptual disturbances and seizures 6D23.Y Other specified other specified psychoactive substance withdrawal 6D23.Z Other specified psychoactive substance withdrawal, unspecified 6D24 Delirium induced by other specified psychoactive substance 6D25 Psychotic disorder induced by other specified psychoactive substance 6D26 Mood disorder induced by other specified psychoactive substance 6D27 Anxiety disorder induced by other specified psychoactive substance 6D28 Obsessive-compulsive or related syndrome induced by other specified psychoactive substance 6D29 Sexual dysfunction induced by other specified psychoactive substance 6D2A Sleep disorder induced by other specified psychoactive substance

ICD-11 beta 16. Disorders due to unknown or unspecified psychoactive substances 6D30 Intoxication due to unknown or unspecified psychoactive substance 6D31 Single episode of harmful use of unknown or unspecified psychoactive substances 6D32 Harmful pattern of use of unknown or unspecified psychoactive substance 6D32.1 Harmful pattern of use of unknown or unspecified psychoactive substance, episodic 6D32.2 Harmful pattern of use of unknown or unspecified psychoactive substance, continuous 6D32.Z Harmful pattern of use of unknown or unspecified psychoactive substance, unspecified 6D33 Unknown or unspecified psychoactive substance dependence 6D33.1 Unknown or unspecified psychoactive substance dependence, current use 6D33.2 Unknown or unspecified psychoactive substance dependence, early full remission 6D33.3 Unknown or unspecified psychoactive substance dependence, sustained partial remission 6D33.4 Unknown or unspecified psychoactive substance dependence, sustained full remission 6D33.Z Unknown or unspecified psychoactive substance dependence, unspecified 6D34 Withdrawal syndrome due to unknown or unspecified psychoactive substance 6D34.1 Withdrawal syndrome due to unknown or unspecified psychoactive substance, uncomplicated 6D34.2 Withdrawal syndrome due to unknown or unspecified psychoactive substance, with perceptual disturbances 6D34.3 Withdrawal syndrome due to unknown or unspecified psychoactive substance, with seizures 6D34.4 Withdrawal syndrome due to unknown or unspecified psychoactive, with perceptual disturbances and seizures 6D34.Z Withdrawal syndrome due to unknown or unspecified psychoactive substance, unspecified 6D35 Delirium induced by unknown or unspecified psychoactive substance 6D36 Psychotic disorder induced by unknown or unspecified psychoactive substance 6D37 Mood disorder induced by unknown or unspecified psychoactive substance 6D38 Anxiety disorder induced by unknown or unspecified psychoactive substance 6D39 Obsessive-compulsive or related syndrome induced by unknown or unspecified psychoactive substance 6D3A Sexual dysfunction induced by unknown or unspecified psychoactive substance 6D3B Sleep disorder induced by unknown or unspecified psychoactive substance

ICD-11 beta 17. Disorders due to use of non-psychoactive substances
6D40 Single episode of harmful use of non-psychoactive substances 6D41 Harmful pattern of use of non-psychoactive substances 6D41.1 Harmful pattern of use of non-psychoactive substances, episodic 6D41.2 Harmful pattern of use of non-psychoactive substances, continuous 6D41.Z Harmful pattern of use of non-psychoactive substances, unspecified 6D4Y Other specified disorders due to use of non-psychoactive substances 6D4Z Disorders due to use of non-psychoactive substances, unspecified Inclusions Not produce dependence psychotropic drugs abuse of antacids abuse of herbal or folk remedies abuse of hormones abuse of vitamins laxative habit

Summary -Changes from ICD-10 to ICD-11 beta-
Included Addictive behaviors (gambling, gaming) 10 Classes  17 Classes of substances Described each class of substances clinical conditions Acute intoxication specified severity Dependence  Simplified diagnostic guidance ( 3 major features, 2/3) Harmful use  Harmful pattern of use (episodic / continuous), added features: significant harm to the health of other people, Added single episode harmful use Withdrawal  Added perceptual disturbances Psychotic disorder  psychotic, mood, Anxiety, sexual, sleep disorder, obsessive-compulsive disorder seperately Moved out Amnestic disorder (to Amnestic disorder due to substances), dementia (to dementia due to toxins), Residual disorders, late-onset psychotic disorder Moved in Abuse of non psychoactive substances

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Addictive disorders in ICD-11 beta - Substance Use -

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Addictive disorders in ICD-11 beta - Substance Use -

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