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INTRODUCTION

According to the biobehavioral developmental perspective and trajectories of adolescent substance use and substance use disorders (SUD), adolescents have not yet reached adulthood and therefore cannot be considered as simply "miniature adults." In addition, during adolescence and young adulthood, between the ages of 12 and 25 years, the nucleus accumbens, which drives reward-seeking behaviors, develops earlier than the prefrontal cortex, which is responsible for inhibitory and executive functioning. This leads adolescents to normatively seek out pleasurable activities, including high-risk sexual, driving, and substance-use experiences.

ESSENTIALS OF DIAGNOSIS ICD-10 Diagnostic Criteria

Mental and Behavioral Disorders due to Psychoactive Substance Use (F10-F19)

This characterization of disorders includes a greater spectrum of, and greater detail pertaining to, SUDs than the previous iteration of ICD coding. Substance Use Disorders are coded using the format F1x.xxx, where the third character of the code indicates substance used (i.e. alcohol), and the fourth plus characters indicate clinical state, including amount, extent of harm, or other related disorder (i.e. intoxication, dependence, medical comorbidity, psychosis). F10-F19 represents use of the following psychoactive substances, in numerical order: alcohol, opioids, cannabis, sedatives/hypnotics/anxiolytics, cocaine, stimulants, hallucinogens, nicotine and other psychoactive substances or polysubstance use.

The fourth plus characters of the ICD-10 code represents the following designations:

.0 Acute Intoxication

A condition that follows the administration of a psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behavior, or other psycho-physiological functions and responses. The disturbances are directly related to the acute pharmacological effects of the substance and resolve with time, with complete recovery, except where tissue damage or other complications have arisen. Complications may include trauma, inhalation of vomitus, delirium, coma, convulsions, and other medical complications. The nature of these complications depends on the pharmacological class of substance and mode of administration.

.1 Harmful Use

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).

Psychoactive substance abuse.

.2 Dependence

A cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

.3 Withdrawal State

A group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance. The onset and course of the withdrawal state are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. The withdrawal state may be complicated by convulsions.

.4 Withdrawal State with Delirium

A condition where the withdrawal state as defined in the common fourth character .3 is complicated ...

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