Intoxications usually appear and then peak minutes to hours after use of the substance, but the onset and course vary with the substance and the route of administration. Generally, substances used by pulmonary inhalation and intravenous injection have the most rapid onset of action, while those ingested by mouth and requiring metabolism to an active product are much slower. (For example, after ingestion of certain mushrooms, the first signs of an eventually fatal intoxication may not appear for a few days.) Intoxication ef- fects usually resolve within hours to a very few days. However, the body may completely eliminate an anesthetic gas such as nitrous oxide just minutes after use ends. At the other extreme, some ”hit-and-run" intoxicating substances poison systems, leaving permanent impairments. For example, MPTP (1-methy1—4-phenyl-1,2,3,6-tetrahydropyridine), a con- taminating by-product in the synthesis of a certain opioid, kills dopaminergic cells and in- duces permanent parkinsonism in users who sought opioid intoxication.
Impairment from intoxication with any substance may have serious consequences, includ- ing dysfunction at work, social indiscretions, problems in interpersonal relationships, fail- ure to fulfill role obligations, traffic accidents, fighting, high-risk behaviors (i.e., having unprotected sex), and substance or medication overdose. The pattern of consequences will vary with the particular substance.
Use of other or unknown substance, without meeting criteria for other (or unknown) substance intoxication. The individual used an other or unknown substance(s), but the dose was insufficient to produce symptoms that meet the diagnostic criteria required for the diagnosis.
Substance intoxication or other substance/medication-induced disorders. Familiar sub- stances may be sold in the black market as novel products, and individuals may experience intoxication from 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 intoxication may occur during, but are distinct from, other (or un- known) substance use disorder, unspecified other (or unknown) substance—related disor- der, and other (or unknown) substance—induced disorders.
Other toxic, metabolic, traumatic, neoplastic, vascular, or infectious disorders that impair brain function and cognition. Numerous neurological and other medical conditions may produce rapid onset of signs and symptoms mimicking those of intoxications, including the examples in Criterion B. Paradoxically, drug withdrawals also must be ruled out, because, for example, lethargy may indicate withdrawal from one drug or intoxication with another drug.
As with all substance-related disorders, adolescent conduct disorder, adult antisocial per- sonality disorder, and other substance use disorders tend to co-occur with other (or un- known) substance intoxication.
Diagnostic Criteria 292.0 (F19.239)
A. Cessation of (or reduction in) use of a substance that has been heavy and prolonged.
B. The development of a substance-specific syndrome shortly after the cessation of (or reduction in) substance use.
C. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not attributable to another medical condition and are not better ex- plained by another mental disorder, including withdrawal from another substance.
E. The substance involved cannot be classified under any of the other substance catego- ries (alcohol; caffeine; cannabis; opioids; sedatives, hypnotics, or anxiolytics; stimu- lants; or tobacco) or is unknown.