Disorders due to use of non-psychoactive substances

Description

Disorders due to use of non-psychoactive substances are characterised by the pattern and consequences of non-medical use of non-psychoactive substances. Non-psychoactive substances include laxatives, anabolic steroids, growth hormone, erythropoietin, and non-steroidal anti-inflammatory drugs. They may also include proprietary or over-the-counter medicines and folk remedies. Non-medical use of these substances may be associated with harm to the individual due to the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration (e.g., infections due to intravenous self-administration). They are not associated with intoxication or with a dependence or withdrawal syndrome and are not recognized causes of substance-induced mental disorders. [1]

Diagnostic requirements

WHO clinical descriptions and diagnostic requirements [1,2].

Subcategories

• 6C4H.0 Episode of harmful use of non-psychoactive substances

  An episode of use of a non-psychoactive substance that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to direct or secondary toxic effects on body organs and systems or a harmful route of administration. This diagnosis should not be made if the harm is attributed to a known pattern of non-psychoactive substance use. [1]

  Essential (Required) Features:

  • An episode of use of a non-psychoactive substance that has caused clinically significant damage to a person’s physical health or mental health.
  • Harm to health of the individual occurs due to the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration.
  • Harm to health is not better accounted for by a medical condition not caused by the substance or by another mental disorder.

  Note: Harm to physical health includes acute health problems resulting from non-psychoactive substance use such as dehydration, dyslipidemia, and exacerbation or decompensation of pre-existing chronic health problems such as hypertension, liver disease, or peptic ulceration. Harm may also result from a harmful route of administration (e.g., non-sterile intravenous self-administration causing infections). Harm to mental health refers to psychological and behavioural symptoms following non-psychoactive substance use (e.g., severe depressive symptoms following dehydration and mineral loss from inappropriate use of laxatives).

  Additional Clinical Features:

  • There must be explicit evidence of harm to the individual’s physical or mental health. There must also be a clear causal relationship between the harm to health and the episode of non-psychoactive substance use in question.
  • Non-psychoactive substance use may occur in the context of other mental disorders (e.g., use of laxatives in Anorexia Nervosa to reduce body weight, use of anabolic steroids in Body Dysmorphic Disorder to increase muscle mass). An additional diagnosis of Episode of Harmful Psychoactive Substance Use can be made if the specific episode of non-psychoactive substance use in question has resulted in clinically significant harm to the individual’s physical or mental health.
  • A diagnosis of Episode of Harmful Use of Non-Psychoactive Substances often signals an opportunity for intervention, including lower-intensity interventions that can be implemented in a wide range of settings aimed at reducing the likelihood of additional harmful episodes or of progression to Harmful Pattern of Non-Psychoactive Substance Use.
  • As more information becomes available indicating that an episode is part of a continuous or recurrent pattern of harmful non-psychoactive substance use, a diagnosis of Episode of Harmful Psychoactive Substance Use should be changed to Harmful Pattern of Non-Psychoactive Substance Use.

  Boundary with Normality (Threshold):

  • The diagnosis of Episode of Harmful Use of Non-Psychoactive Substances requires clinically significant harm to the individual’s physical or mental health. Examples of impact on physical or mental health that would not be considered clinically significant include mild hangover, brief episodes of vomiting, or transient depressed mood.
  • An episode of non-psychoactive substance use may also cause social problems that do not constitute clinically significant harm to physical or mental health (e.g., arguments with loved ones). A diagnosis of Episode of Harmful Use of Non-Psychoactive Substances should not be assigned in these circumstances.

  Boundaries with Other Disorders and Conditions (Differential Diagnosis):

  • Boundary with Other Specified Hazardous Drug Use: The category Other Specified Hazardous Drug Use from the chapter on ‘Factors Influencing Health Status or Contact with Health Services’ may be assigned if the episode of non-psychoactive substance use in question appreciably increases the risk of harmful physical or mental health consequences to an extent that warrants attention and advice from health professionals, but has not resulted in specific identifiable harm to the individual’s physical or mental health.
  • Boundary with Harmful Pattern of Non-Psychoactive Substance Use: If the harm to health is a result of a known episodic or continuous pattern of non-psychoactive substance use, Harmful Pattern of Non-Psychoactive Substance Use is the appropriate diagnosis rather than Episode of Harmful Use of Non-Psychoactive Substances. Substance use is generally considered to be following a pattern if there has been at least episodic or intermittent use over a period of at least 12 months, or continuous use over at least 1 month. If harm is caused by use of a non-psychoactive substance but no information is available about the pattern or history of substance use, a diagnosis of Episode of Harmful Use of Non-Psychoactive Substances may be assigned until such time as evidence for a pattern of use is ascertained.
  • Boundary with Injury, Poisoning, or Certain Other Consequences of External Causes: When use of a non-psychoactive substance results in injury or life-threatening symptoms (e.g., coma, severe cardiac or respiratory symptoms), a diagnosis from the grouping of Harmful Effects of Substances in the chapter on Injury, Poisoning or Certain Other Consequences of External Causes should also be assigned.
• 6C4H.1 Harmful pattern of use of non-psychoactive substances

  A pattern of use of non-psychoactive substances that has caused clinically significant harm to a person’s physical or mental health. The pattern of use is evident over a period of at least 12 months if use is episodic and at least one month if use is continuous (i.e., daily or almost daily). Harm may be caused by the direct or secondary toxic effects of the substance on body organs and systems, or a harmful route of administration. [1]

  Essential (Required) Features:

  • A pattern of repeated or continuous use of a non-psychoactive substance that has caused clinically significant damage to a person’s physical health or mental health.
  • Harm to health of the individual occurs due to the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration.
  • 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.
  • Harm to health is not better accounted for by a medical condition not caused by the substance or by another mental disorder.

  Note: Harm to physical health includes acute or chronic health problems resulting from a pattern of non-psychoactive substance use such as testicular atrophy, cardiomegaly, and exacerbation or decompensation of pre-existing chronic health problems such as hypertension, liver disease, or peptic ulceration. Harm may also result from a harmful route of administration (e.g., non-sterile intravenous self-administration causing infections). Harm to mental health refers to psychological and behavioural symptoms following non-psychoactive substance use (e.g., severe depressive symptoms due to dehydration and mineral loss from inappropriate use of laxatives).

  Course Specifiers:

  6C4H.10 Harmful Pattern of Use of Non-Psychoactive Substances, episodic

  This category is assigned when all the diagnostic requirements for Harmful Pattern of Use of Non-Psychoactive Substances are met and there is evidence of a pattern of recurrent episodic or intermittent use of the relevant non-psychoactive substance over a period of at least 12 months that has caused clinically significant harm to a person’s physical or mental health.

  6C4H.11 Harmful Pattern of Use of Non-Psychoactive Substances, continuous

  This category is assigned when all the diagnostic requirements for Harmful Pattern of Use of Non-Psychoactive Substances are met and there is evidence of a pattern of continuous substance use (daily or almost daily) of the relevant non-psychoactive substance over a period of at least 1 month that has caused clinically significant harm to a person’s physical or mental health.

  6C4H.1Z Harmful Pattern of Use of Non-Psychoactive Substances, unspecified

  Additional Clinical Features:

  • There must be explicit evidence of harm to the individual’s physical or mental health. There must also be a clear causal relationship between the harm to health and the episode of non-psychoactive substance use in question.
  • Non-psychoactive substance use may occur in the context of other mental disorders (e.g., use of laxatives in Anorexia Nervosa to reduce body weight, use of anabolic steroids in Body Dysmorphic Disorder to increase muscle mass). An additional diagnosis of Harmful Pattern of Non-Psychoactive Substance Use can be made if the pattern of non-psychoactive substance use has resulted in clinically significant harm to the individual’s physical or mental health.

  Boundary with Normality (Threshold):

  • The diagnosis of Harmful Pattern of Use of Non-Psychoactive Substances requires clinically significant harm to the individual’s physical or mental health. Examples of impact on physical or mental health that would not be considered clinically significant include mild hangover, brief episodes of vomiting, or transient depressed mood.
  • A pattern of non-psychoactive substance use may also cause social problems that do not constitute clinically significant harm to physical or mental health (e.g., arguments with loved ones). A diagnosis of Harmful Pattern of Use of Non-Psychoactive Substances should not be assigned in these circumstances.

  Boundaries with Other Disorders and Conditions (Differential Diagnosis):

  • Boundary with Episode of Harmful Non-Psychoactive Substance Use: If the harm to health is a result of a single episode of non-psychoactive substance use rather than an episodic or continuous pattern of substance use, Episode of Harmful Use of Non-Psychoactive Substances is the appropriate diagnosis rather than Harmful Pattern of Non-Psychoactive Substance Use. Substance use is generally considered to be following a pattern if there has been at least episodic or intermittent use over a period of at least 12 months, or continuous use over at least 1 month. If harm is caused by use of a non-psychoactive substance but no information is available about the pattern or history of substance use, a diagnosis of Episode of Harmful Use of Non-Psychoactive Substances may be assigned until such time as evidence for a pattern of use is ascertained.
  • Boundary with Injury, Poisoning, or Certain Other Consequences of External Causes: When use of a non-psychoactive substance results in injury or life-threatening symptoms (e.g., coma, severe cardiac or respiratory symptoms), a diagnosis from the grouping of Harmful Effects of Substances in the chapter on Injury, Poisoning or Certain Other Consequences of External Causes should also be assigned.

References

1. World Health Organization. International Classification of Diseases, 11th Revision, for Mortality and Morbidity Statistics (ICD-11 MMS), 2026-01 release. World Health Organization; 2026.
2. World Health Organization. Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders (CDDR). World Health Organization; 2024.

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