DSM-IV

In DSM-IV, this is a category called Inhalant Use Disorders

Disorders

  1. Inhalant Dependence
  2. Inhalant Abuse

 DSM-5

Diagnostic Criteria

A. A problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. The inhalant substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control use of the inhalant substance.
  3. A great deal of time is spent in activities necessary to obtain the inhalant substance, use it, or recover from its effects.
  4. Craving, or a strong desire or urge to use the inhalant substance.
  5. Recurrent use of the inhalant substance resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued use of the inhalant substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  7. Important social, occupational, or recreational activities are given up or reduced because of use of the inhalant substance.
  8. Recurrent use of the inhalant substance in situations in which it is physically hazardous.
  9. Use of the inhalant substance 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.
  10. Tolerance, as defined by either of the following:
    • a. A need for markedly increased amounts of the inhalant substance to achieve intoxication or desired effect.
    • b. A markedly diminished effect with continued use of the same amount of the inhalant substance

Specify the particular inhalant: When possible, the particular substance involved should be names (e.g., "solvent use disorder").

Specify if:

  • In early remission: After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the inhalant substance," may be met).
  • In sustained remission: After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the inhalant substance," may be met).

Specify if:

  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to inhalant substances is restricted.

Note: If an inhalant intoxication or another inhalant-induced mental disorder is also present, the comorbid inhalant use disorder is indicated in the inhalant-induced disorder. For example, if there is comorbid inhalant-induced depressive disorder and inhalant use disorder, only the inhalant-induced depressive disorder diagnosis is given, with the recording indicating whether the comorbid inhalant use disorder is mild, moderate, or severe (e.g., mild inhalant use disorder with inhalant-induced depressive disorder; moderate or severe inhalant use disorder with inhalant-induced depressive disorder).

Specify current severity:

  • Mild: Presence of 2-3 symptoms.
  • Moderate: Presence of 4-5 symptoms.
  • Severe: Presence of 6 or more symptoms.

Specifiers

This manual recognizes volatile hydrocarbon use meeting the above diagnostic criteria as inhalant use disorder. Volatile hydrocarbons are toxic gases from glues, fuels, paints, and other volatile compounds. When possible, the particular substance involved should be names (e.g., "toluene use disorder"). However, most compounds that are inhaled are a mixture of several substances that can produce psychoactive effects, and it is often difficult to ascertain the exact substance responsible for the disorder. Unless there is clear evidence that a single, unmixed substance has been used, the general term inhalant should be used in recording the diagnosis. Disorders arising from inhalation of nitrous oxide or of amyl-, butyl-, or isobutylnitrite are considered as other (or unknown) substance use disorder.

"In a controlled environment" applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment). Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units.

The severity of the individuals' inhalant use disorder is assessed by the number of diagnostic criteria endorsed. Changing severity of individuals' inhalant use disorder across time is reflected by reductions in the frequency (e.g., days used per month) and/or dose (e.g., tubes of glue per day) used, as assessed by the individual's self-report, report of others, clinician's observations, and biological testing (when practical).

Differential Diagnosis

Inhalant exposure (unintentional) from industrial or other accidents

This designation is used when findings suggest repeated or continuous inhalant exposure but the involved individual and other informants deny any history of purposeful inhalant use.

Inhalant use (intentional), without meeting criteria for inhalant use disorder

Inhalant use is common among adolescents, but for most of those individuals, the inhalant use does not meet the diagnostic standard of two or more Criterion A items for inhalant use disorder in the past year.

Inhalant intoxication, without meeting criteria for inhalant use disorder

Inhalant intoxication occurs frequently during inhalant use disorder but also may occur among individuals whose use does not meet criteria for inhalant use disorder, which requires at least two of the 10 diagnostic criteria in the past year.

Inhalant-induced disorders (i.e., inhalant-induced psychotic disorder, depressive disorder, anxiety disorder, neurocognitive disorder, other inhalant-induced disorders) without meeting criteria for inhalant use disorder

Criteria are met for a psychotic, depressive, anxiety, or major neurocognitve disorder, and there is evidence from history, physical examination, or laboratory findings that the deficits are etiologically related to the effects of inhalant substances. Yet, criteria for inhalant use disorder may not be met (i.e., fewer than 2 of the 10 criteria were present).

Other substance use disorders, especially those involving sedating substances (e.g., alcohol, benzodiazepines, barbiturates)

Inhalant use disorder commonly co-occurs with other substance use disorders, and the symptoms of the disorders may be similar and overlapping. To disentangle symptom patterns, it is helpful to inquire about which symptoms persisted during periods when some of the substances were not being used.

Other toxic, metabolic, traumatic, neoplastic, or infectious disorders impairing central or peripheral nervous system function

Individuals with inhalant use disorder may present with symptoms of pernicious anemia, subacute combined degeneration of the spinal cord, psychosis, major or minor cognitive disorder, brain atrophy, leukoencephalopathy, and many other nervous system disorders. Of course, these disorders also may occur in the absence of inhalant use disorder. A history of little or no inhalant use helps to exclude inhalant use disorder as the source of these problems.

Disorders of other organ systems

Individuals with inhalant use disorder may present with symptoms of hepatic or renal damage, rhabdomyelysis, methemoglobinemia, or symptoms of other gastrointestinal, cardiovascular, or pulmonary diseases. A history of little or no inhalant use helps to exclude inhalant use disorder as the source of such medical problems.

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