The clinician should use the code that applies to the class of substances but record the name of the specific substance. For example, the clinician should record 304.10 (F1320) moderate alprazolam use disorder (rather than moderate sedative, hypnotic, or anxiolytic use disorder) or 305.70 (F1510) mild methamphetamine use disorder (rather than mild stimulant use disorder). For substances that do not fit into any of the classes (e.g., anabolic steroids), the appropriate code for ”other substance use disorder” should be used and the specific substance indicated (e.g., 305.90 [F19.10] mild anabolic steroid use disorder). If the substance taken by the individual is unknown, the code for the class ”other (or unknown)” should be used (e.g., 304.90 [F19.20] severe unknown substance use disorder). If criteria are met for more than one substance use disorder, all should be diagnosed (e.g., 304.00 [F1120] severe heroin use disorder; 304.20 [F1420] moderate cocaine use disorder).
The appropriate ICD-lO-CM code for a substance use disorder depends on whether there is a comorbid substance-induced disorder (including intoxication and withdrawal). In the above example, the diagnostic code for moderate alprazolam use disorder, F13.20, re- ﬂects the absence of a comorbid alprazolam-induced mental disorder. Because ICD-lO—CM codes for substance-induced disorders indicate both the presence (or absence) and severity of the substance use disorder, ICD-lO—CM codes for substance use disorders can be used only in the absence of a substance-induced disorder. See the individual substance-specific sections for additional coding information.
Note that the word addiction is not applied as a diagnostic term in this classification, although it is in common usage in many countries to describe severe problems related to compulsive and habitual use of substances. The more neutral term substance use disorder is used to describe the wide range of the disorder, from a mild form to a severe state of chron- ically relapsing, compulsive drug taking. Some clinicians will choose to use the word ud- diction to describe more extreme presentations, but the word is omitted from the official
DSM-S substance use disorder diagnostic terminology because of its uncertain definition and its potentially negative connotation.
The overall category of substance-induced disorders includes intoxication, withdrawal, and other substance/medication-induced mental disorders (e.g., substance-induced psy- chotic disorder, substance-induced depressive disorder).
Criteria for substance intoxication are included within the substance—specific sections of this chapter. The essential feature is the development of a reversible substance-specific syndrome due to the recent ingestion of a substance (Criterion A). The clinically significant problematic behavioral or psychological changes associated with intoxication (e.g., bellig- erence, mood lability, impaired judgment) are attributable to the physiological effects of the substance on the central nervous system and develop during or shortly after use of the substance (Criterion B). The symptoms are not attributable to another medical condition and are not better explained by another mental disorder (Criterion D). Substance intoxi- cation is common among those with a substance use disorder but also occurs frequently in individuals without a substance use disorder. This category does not apply to tobacco.
The most common changes in intoxication involve disturbances of perception, wake- fulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behav- ior. Short-term, or "acute,” intoxications may have different signs and symptoms than sustained, or "chronic,” intoxications. For example, moderate cocaine doses may initially produce gregariousness, but social withdrawal may develop if such doses are frequently repeated over days or weeks.