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. 2023 May 9;22(2):203–229. doi: 10.1002/wps.21073

Table 1.

ICD‐11 diagnostic requirements for disorders due to psychoactive substance use 16

Episode of Harmful Psychoactive Substance Use

  1. An episode of use of a psychoactive substance that has caused clinically significant damage to a person's physical health or mental health, or has resulted in behaviour leading to harm to the health of others.

  2. Harm to health of the individual occurs due to one or more of the following: a) behaviour related to intoxication; b) direct or secondary toxic effects on body organs and systems; or c) a harmful route of administration.

  3. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to substance intoxication on the part of the person to whom the diagnosis applies.

  4. Harm to health is not better accounted for by another medical condition or another mental disorder, including another Disorder Due to Substance Use.

Harmful Pattern of Psychoactive Substance Use

  1. A pattern of continuous, recurrent, or sporadic use of a psychoactive substance that has caused clinically significant damage to a person's physical health or mental health, or has resulted in behaviour leading to harm to the health of others.

  2. Harm to health of the individual occurs due to one or more of the following: a) behaviour related to intoxication; b) direct or secondary toxic effects on body organs and systems; or c) a harmful route of administration.

  3. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to substance intoxication on the part of the person to whom the diagnosis applies.

  4. The pattern of use of the relevant substance is evident over a period of at least 12 months if substance use is episodic or at least 1 month if use is continuous.

  5. Harm to health is not better accounted for by another medical condition or another mental disorder, including another Disorder Due to Substance Use.

Substance Dependence

  1. A pattern of recurrent episodic or continuous use of a psychoactive substance with evidence of impaired regulation of use of that substance that is manifested by two or more of the following:

    1. Impaired control over substance use (i.e., onset, frequency, intensity, duration, termination, context);

    2. Increasing precedence of substance use over other aspects of life, including maintenance of health, and daily activities and responsibilities, such that substance use continues or escalates despite the occurrence of harm or negative consequences (e.g., repeated relationship disruption, occupational or scholastic consequences, negative impact on health);

    3. Physiological features indicative of neuroadaptation to the substance, including: a) tolerance to the effects of the substance or a need to use increasing amounts of the substance to achieve the same effect; b) withdrawal symptoms following cessation or reduction in use of that substance, or c) repeated use of the substance or pharmacologically similar substances to prevent or alleviate withdrawal symptoms. Physiological features are only applicable for certain substances.

  2. The features of dependence are usually evident for a period of at least 12 months but the diagnosis may be made if use is continuous (daily or almost daily) for at least 3 months.