Coding note: The ICD-9-CM code is 292.0. The |CD-10-CM code for other (or unknown) sub- stance withdrawal is F19.239. Note that the |CD-10-CM code indicates the comorbid presence of a moderate or severe other (or unknown) substance use disorder. It is not permissible to code a comorbid mild other (or unknown) substance use disorder with other (or unknown) sub- stance withdrawal.
Note: For information on Risk and Prognostic Factors and Diagnostic Markers, see the cor- responding sections in other (or unknown) substance use disorder.
Other (or unknown) substance withdrawal is a clinically significant mental disorder that develops during, or within a few hours to days after, reducing or terminating dosing with a substance (Criteria A and B). Although recent dose reduction or termination usually is clear in the history, other diagnostic procedures are very challenging if the drug is un- known. Criterion B requires development of a "substance-specific syndrome” (i.e., the in- dividual’s signs and symptoms must correspond with the known withdrawal syndrome for the recently stopped drug)—a requirement that rarely can be met with an unknown substance. Consequently, clinical judgment must guide such decisions when information is this limited. Criterion D requires ruling out other medical conditions, mental disorders, or withdrawals from familiar substances. When the substance is known, it should be re- ﬂected in the name of the disorder upon coding (e.g., betel nut withdrawal).
The prevalence of other (or unknown) substance withdrawal is unknown.
Withdrawal signs commonly appear some hours after use of the substance is terminated, but the onset and course vary greatly, depending on the dose typically used by the person and the rate of elimination of the specific substance from the body. At peak severity, with- drawal symptoms from some substances involve only moderate levels of discomfort, whereas withdrawal from other substances may be fatal. Withdrawal-associated dyspho- ria often motivates relapse to substance use. Withdrawal symptoms slowly abate over days, weeks, or months, depending on the particular drug and doses to which the indi- vidual became tolerant.
Culture-related issues in diagnosis will vary with the particular substance.
Withdrawal from any substance may have serious consequences, including physical signs and symptoms (e.g., malaise, vital sign changes, abdominal distress, headache), intense drug craving, anxiety, depression, agitation, psychotic symptoms, or cognitive impairments.
These consequences may lead to problems such as dysfunction at work, problems in in- terpersonal relationships, failure to fulfill role obligations, traffic accidents, fighting, high- risk behavior (e.g., having unprotected sex), suicide attempts, and substance or medica- tion overdose. The pattern of consequences will vary with the particular substance.
Dose reduction after extended dosing, but not meeting the criteria for other (or un- known) substance withdrawal. The individual used other (or unknown) substances, but the dose that was used was insufficient to produce symptoms that meet the criteria re- quired for the diagnosis.
Substance withdrawal or other substance/medication-induced disorders. Familiar substances may be sold in the black market as novel products, and individuals may expe- rience withdrawal when discontinuing those substances. History, toxicology screens, or chemical testing of the substance itself may help to identify it.
Different types of other (or unknown) substance—related disorders. Episodes of other (or unknown) substance withdrawal may occur during, but are distinct from, other (or un- known) substance use disorder, unspecified other (or unknown) substance—related disor- der, and unspecified other (or unknown) substance—induced disorders.
Other toxic, metabolic, traumatic, neoplastic, vascular, or infectious disorders that im- pair brain function and cognition. Numerous neurological and other medical condi- tions may produce rapid onset of signs and symptoms mimicking those of withdrawals.