Specify the specific substance that causes the withdrawal syndrome (i.e., amphet- amine-type substance, cocaine, or other stimulant).
Coding note: The |CD-9-CM code is 292.0. The |CD-10-CM code depends on whether the stimulant is an amphetamine, cocaine, or other stimulant. The |CD-10-CM code for amphetamine or an other stimulant withdrawal is F15.23, and the |CD-10-CM for cocaine withdrawal is F14.23. Note that the |CD-10-CM code indicates the comorbid presence of a moderate or severe amphetamine, cocaine, or other stimulant use disorder, reflecting the fact that amphetamine, cocaine, or other stimulant withdrawal can only occur in the presence of a moderate or severe amphetamine, cocaine, or other stimulant use disorder.
It is not permissible to code a comorbid mild amphetamine, cocaine, or other stimulant use disorder with amphetamine, cocaine, or other stimulant withdrawal.
The essential feature of stimulant withdrawal is the presence of a characteristic With- drawal syndrome that develops within a few hours to several days after the cessation of terion A). The withdrawal syndrome is characterized by the development of dysphoric mood accompanied by two or more of the following physiological changes: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation (Criterion B). Bradycardia is often present and is a reliable mea- sure of stimulant withdrawal.
Anhedonia and drug craving can often be present but are not part of the diagnostic cri- teria. These symptoms cause clinically significant distress or impairment in social, occu- pational, or other important areas of functioning (Criterion C). The symptoms must not be attributable to another medical condition and are not better explained by another mental disorder (Criterion D).
Acute withdrawal symptoms (”a crash”) are often seen after periods of repetitive high-dose use (”runs” or ”binges”). These periods are characterized by intense and unpleasant feelings of lassitude and depression and increased appetite, generally requiring several days of rest and recuperation. Depressive symptoms with suicidal ideation or behavior can occur and are gen- erally the most serious problems seen during ”crashing” or other forms of stimulant with- drawal. The majority of individuals with stimulant use disorder experience a withdrawal syndrome at some point, and virtually all individuals with the disorder report tolerance.
Stimulant use disorder and other stimulant-induced disorders. Stimulant withdrawal is distinguished from stimulant use disorder and from the other stimulant-induced disor- ders (e.g., stimulant-induced intoxication delirium, depressive disorder, bipolar disorder, psychotic disorder, anxiety disorder, sexual dysfunction, sleep disorder) because the symptoms of withdrawal predominate the clinical presentation and are severe enough to warrant independent clinical attention.
The following stimulant-induced disorders (which include amphetamine-, cocaine-, and other stimulant—induced disorders) are described in other chapters of the manual with dis— orders with which they share phenomenology (see the substance/medication-induced mental disorders in these chapters): stimulant—induced psychotic disorder (”Schizophrenia ual Dysfunctions”). For stimulant intoxication delirium, see the criteria and discussion of delirium in the chapter "Neurocognitive Disorders.” These stimulant-induced disorders are diagnosed instead of stimulant intoxication or stimulant withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.