Management of substance abuse

Harmful use

Definition

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (e.g. hepatitis following injection of drugs) or mental (e.g. depressive episodes secondary to heavy alcohol intake). Harmful use commonly, but not invariably, has adverse social consequences; social consequences in themselves, however, are not sufficient to justify a diagnosis of harmful use.

The term was introduced in ICD-10 and supplanted “non-dependent use” as a diagnostic term. The closest equivalent in other diagnostic systems (e.g. DSM-IV) is substance abuse, which usually includes social consequences.

ICD-10 Clinical description

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).

ICD-10 Diagnostic guidelines

The diagnosis requires that actual damage should have been caused to the mental or physical health of the user.

Harmful patterns of use are often criticized by others and frequently associated with adverse social consequences of various kinds. The fact that a pattern of use or a particular substance is disapproved of by another person or by the culture, or may have led to socially negative consequences such as arrest or marital arguments is not in itself evidence of harmful use.

Acute intoxication, or “hangover” is not in itself sufficient evidence of the damage to health required for coding harmful use.

Harmful use should not be diagnosed if dependence syndrome, a psychotic disorder, or another specific form of drug- or alcohol-related disorder is present.

ICD-10 Diagnostic criteria for research

  • There must be clear evidence that the substance use was responsible for (or substantially contributed to) physical or psychological harm, including impaired judgement or dysfunctional behaviour, which may lead to disability or have adverse consequences for interpersonal relationships.
  • The nature of the harm should be clearly identifiable (and specified).
  • The pattern of use has persisted for at least 1 month or has occurred repeatedly within a 12-month period.
  • The disorder does not meet the criteria for any other mental or behavioural disorder related to the same drug in the same timed period (except for acute intoxication).
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