Inhalant Abuse and Dependence (305.9)

DSM-IV-TR criteria

INHALANT DEPENDENCE. The DSM-IV-TR specifies that three or more of the following symptoms must occur at any time during a 12-month period (and cause significant impairment or distress) in order to meet diagnostic criteria for inhalant dependence:

• Tolerance. The individual either has to use increasingly higher amounts of the drug over time in order to achieve the same effect, or finds that the same amount of the drug has much less of an effect over time than before. After using inhalants regularly for a while, people may find that they need to use at least 50% more than the amount they started with in order to get the same effect.
• Loss of control. The person either repeatedly uses a larger quantity of inhalant than planned, or uses the inhalant over a longer period of time than planned. For instance, someone may begin using inhalants on school days, after initially limiting their use to weekends.
• Inability to stop using. The person has either unsuccessfully attempted to cut down or stop using the inhalants, or has a persistent desire to stop using. Users may find that despite efforts to stop using inhalants on school days, they cannot stop.
• Time. The affected person spends large amounts of time obtaining inhalants, using them, being under the influence of inhalants, and recovering from their effects. Obtaining the inhalants might not take up much time because they are readily available for little money, but the person may use them repeatedly for hours each day.
• Interference with activities. The affected person either gives up or reduces the amount of time involved in recreational activities, social activities, and/or occupational activities because of the use of inhalants. The person may use inhalants instead of playing sports, spending time with friends, or going to work.
• Harm to self. The person continues to use inhalants in spite of developing either a physical (liver damage or heart problems, for example) or psychological problem (such as depression or memory problems) that is caused by or made worse by the use of inhalants

INHALANT ABUSE. The DSM-IV-TR specifies that one or more of the following symptoms must occur at any time during a 12-month period (and cause significant impairment or distress) in order to meet diagnostic criteria for inhalant abuse:

1. Interference with role fulfillment. The person’s use of inhalants frequently interferes with his or her ability to fulfill obligations at work, home, or school. People may find they are unable to do chores or pay attention in school because they are under the influence of inhalants.
2. Danger to self. The person repeatedly uses inhalants in situations in which their influence may be physically hazardous (while driving a car, for example).
3. Legal problems. The person has recurrent legal problems related to using inhalants (such as arrests for assaults while under the influence of inhalants).
4. Social problems. The person continues to use inhalants despite repeated interpersonal or relationship problems caused by or made worse by the use of inhalants. For example, the affected person may get into arguments related to inhalant use

DSM-V Proposed Changes: adding “Inhalant-Use Disorder”

DSM-V Inhalant-Use Disorder Criteria:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:

1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

3. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

4. tolerance, as defined by either of the following:

• a need for markedly increased amounts of the substance to achieve intoxication or desired effect
• markedly diminished effect with continued use of the same amount of the substance

(Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.)

5. withdrawal, as manifested by either of the following:

• the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

• the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.)

6. the substance is often taken in larger amounts or over a longer period than was intended

7. there is a persistent desire or unsuccessful efforts to cut down or control substance use

8. a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

9. important social, occupational, or recreational activities are given up or reduced because of substance use

10. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

11. Craving or a strong desire or urge to use a specific substance.

Severity specifiers:

• Moderate: 2-3 criteria positive
• Severe: 4 or more criteria positive

Specify if:

• With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 4 or 5 is present)
• Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 4 nor 5 is present)

Course specifiers (see text for definitions):

• Early Full Remission
• Early Partial Remission
• Sustained Full Remission
• Sustained Partial Remission
• On Agonist Therapy
• In a Controlled Environment