DSM-IV

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

Disorders

  1. Hallucinogen Dependence
  2. Hallucinogen Abuse

 DSM-5

Diagnostic Criteria

A. A problematic pattern of hallucinogen (other than phencyclidine) use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. The hallucinogen 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 hallucinogen use.
  3. A great deal of time is spent in activities necessary to obtain the hallucinogen, use the hallucinogen, or recover from its effects.
  4. Craving, or a strong desire or urge to use the hallucinogen.
  5. Recurrent hallucinogen use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor performance related to hallucinogen use; hallucinogen-related absences, suspensions, or expulsions from school; neglect of children or household).
  6. Continued hallucinogen use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the hallucinogen (e.g., arguments with a spouse about consequences of intoxication; physical fights).
  7. Important social, occupational, or recreational activities are given up or reduced because of hallucinogen use.
  8. Recurrent hallucinogen use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by the hallucinogen).
  9. Hallucinogen 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 hallucinogen.
  10. Tolerance, as defined by either of the following:
    • a. A need for markedly increased amounts of the hallucinogen to achieve intoxication or desired effect.
    • b. A markedly diminished effect with continued use of the same amount of the hallucinogen.

Note: Withdrawal symptoms and signs are not established for hallucinogens, and so this criterion does not apply.

Specify the particular hallucinogen.

Specify if:

  • In early remission: After full criteria for other hallucinogen use disorder were previously met, none of the criteria for other hallucinogen 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 hallucinogen," may be met).
  • In sustained remission: After full criteria for other hallucinogen use disorder were previously met, none of the criteria for other hallucinogen 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 hallucinogen," may be met).

Specify if:

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

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

Specify current severity:

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

Specifiers

"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.

Differential Diagnosis

Other substance use disorders

The effects of hallucinogens must be distinguished from those of other substances (e.g., amphetamines), especially because contamination of the hallucinogens with other drugs is relatively common.

Schizophrenia

Schizophrenia also must be ruled out, as some affected individuals (e.g., individuals with schizophrenia who exhibit paranoia) may falsely attribute their symptoms to use of hallucinogens.

Other mental disorders or medical conditions

Other potential disorders or conditions to consider include panic disorder, depressive and bipolar disorders, alcohol or sedative withdrawal, hypoglycemia and other metabolic conditions, seizure disorder, stroke, ophthalmological disorder, and central nervous system tumors. Careful history of drug taking, collateral reports from family and friends (if possible), age, clinical history, physical examination, and toxicology reports should be useful in arriving at the final diagnostic decision.

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