Prof Colin Blakemore: Beckley Foundation/Strategy Unit, Alcohol & other recreational drugs [2003]

A Scientifically Based Scale of Harm for all Social Drugs [pdf, 128Kb] , by Colin Blakemore, Chief Executive Medical Research Council:


[Illegal drugs] are classified by the Misuse of Drugs Act as Class A/B/C, an inflexible system of classification that is based on a mixture of scientific evidence, familiarity with the particular drug, and the needs of the legal system.

The acceptability of social drugs varies from culture to culture around the world, so there is no sharp global distinction between legal and illegal drugs. Alcohol is legal in the UK but not in some Muslim countries.


Alcohol and tobacco are likely to be at or near the top of the comparative scale of harm for every criterion listed. This must be kept in mind when framing attitudes to other drugs, which are currently illegal and consequently viewed as unacceptable by society. ….
The present classification of drugs makes little sense. It is antiquated and reflects the prejudices and misconceptions of an era in which drugs were placed in arbitrary categories with notable, often illogical, consequences. The continuous review of evidence, and the inclusion of legal drugs in the same review, will allow more sensible and rational classification, putting illegal drugs in context with those already accepted.


Prof Blakemore & Nutt: ACMD evidence to Parliamentary Science & Technology Committee


Appendix 14, A rational scale for assessing the risks of drugs of potential misuse, submitted by the ACMD:

- The current classification system has evolved in an unsystematic way from somewhat arbitrary foundations with seemingly little scientific basis.

- The correlation between MDAct classification and harm rating was not statistically significant.

- Alcohol [and] tobacco … were ranked as more harmful than LSD.

- Our findings raise questions about the validity of the current MDAct classification, despite the fact that this is nominally based on an assessment of risk to users and society. This is especially true in relation to psychedelic type drugs. They also emphasise that the exclusion of alcohol and tobacco from the MDAct is, from a scientific perspective, arbitrary.

- Our findings reveal no clear distinction between socially accepted and illicit substances.


Prof Michael Rawlins, ACMD Chairman:


Oral evidence to Science & Technology Committee, 15 February 2006, HC 900-i:

Q127 Chairman: Bearing in mind that alcohol probably kills directly or indirectly about 32,000 people a year, tobacco 130,000 people a year, and those deaths are far in excess of all the deaths caused by the use of all illicit drugs, why is your committee not enabled to look at tobacco and alcohol as well as all the other substances?

Professor Sir Michael Rawlins: I think the idea that we would control tobacco and alcohol in the form of the Misuse of Drugs Act (which would thereby render them illegal in terms of possession or supply) - the Americans tried this in Prohibition days in the 1930s, and it was a disaster and just encouraged crime, and quite clearly it is not a practicable proposition.

Q128 Chairman: But, Professor Rawlins, that is exactly what has happened in terms of the drugs classification system. It is exactly what happened with the prohibition of alcohol in the States.

Professor Sir Michael Rawlins: I would not disagree with that.


Oral evidence to Science & Technology Committee, 22 November 2006, HC 65

Q68 Professor Sir Michael Rawlins: It seems to be a principle of British justice that the penalty fits the crime. The more severe the crime and the more nasty stuff you are purveying then you go to prison for longer periods of time. That seems to be a perfectly reasonable approach to justice and I had always believed it to be the approach underpinning the classification system; the nastier the drug the longer you go to jail if you start trading in it.

Q69 Chairman: Nastier means the degree of harm to the individual and to society?

Professor Sir Michael Rawlins: Exactly.

Q70 Chairman: Which is why we sell alcohol in every supermarket!

Professor Sir Michael Rawlins: It would be a very brave Home Secretary who declared alcohol a controlled substance.

Q81 Dr Turner: I think the point is that you cannot necessarily put them into totally distinct categories because if you talk to anyone who drinks a bit and certainly anyone that smokes, nine times out of ten they will say, "I do not do drugs", but of course they do.
Professor Sir Michael Rawlins: Coffee, tea, the whole lot; we all do drugs.


Dr Russell Newcombe, researcher at Lifeline:


A Drug Users Charter - May, 2007

Why drug users need a charter:
Drug users have a position in society that potentially compromises their rights in similar ways to other minority groups. They are also regularly the subject of comprehensive medical, criminal and social records. These interventions, combined with legal and public perceptions of drug use mean drug users would benefit from structural protection. 


Second Class Citizens: Discrimination against drug users

Russell Newcombe, Lifeline, Manchester , England

Paper to be presented at the 7 th International Conference on Diversity in Communities, Organisations and Nations; Amsterdam , Netherlands ; July 2007.

Billions of pounds are spent each year enforcing drug laws and providing services to help people with drug problems, most of whom are marginalized and socially excluded. Yet, when drug users become officially identified – particularly as offenders or as treatment clients – they suffer even more discrimination in every area of life, and from most sections of society. Some forms of discrimination are against all known drug users, while other forms are used against particular sub-groups. Some kinds of discrimination are absolutely unjustified, because they violate basic human rights, while others are unjustified by the relative extremeness of the response. This paper describes research into discrimination against known drug users in the UK , which identified 10 main types, involving: education, work, housing, finances, driving, travel, children, leisure, health and criminal justice. It is concluded that since there is growing evidence that drug dependence and misuse are rooted in both genes and social background, then drug users should be regarded as a minority group comparable to gays or ethnic groups, i.e. part of the natural diversity of modern societies. It is thus recommended that (1) governments need to introduce legislation to support drug users' rights, and protect them from discrimination and social exclusion; and that (2) public education campaigns are needed to change negative attitudes toward drug users, and to counter-balance the stereotypes propagated by the mass media.


His presentation of above describes discrimination in greater detail [ppt, 222Kb]:

[p.3:] Definition of discrimination: The process by which a member of a socially defined group is treated differently because of their membership of that group.

Minority group: relatively small and/or powerless group within the general population.

[p.5:] Why drug users are a minority group whose rights need protecting:

(1) In a democracy, drug use in private is a victimless crime and therefore should be permitted behaviour, not amenable to legal control by the state/government  similar to gay sex

(2) Drug-taking/addiction is partly genetic/inherited, and partly learned/environmental, i.e. not a moral choice - similar to the gender behaviour of women, and sexual orientation of gays  

(3) Some official services classify and/or treat problem drug users as sub-groups of the disabled (eg. Dept. Work) or mentally ill (eg. NHS)

(4) Problem drug users have high rates of socio-economic exclusion - unemployment, poverty, homelessness, etc. - similar to blacks and other ethnic groups

(5) Drug users are marginalised by mainstream society because their behaviour is criminalised and so seen as immoral – like sex workers

[p.9:] Sources of discrimination:

- National laws and social policies

- Organisational policies and regulations

- Professional practices and procedures

- Mass media representation (myths, stereotypes)

- Individual attitudes and behaviour (prejudice)


Robin Room, sociologist:

2006- Works primarily in Melbourne, Australia. Guest professor in Stockholm.


UK’s Foresight Project: Social Policy and Psychoactive substances 2004 [pdf, 136Kb]


[p.2:] A ranking based on present levels of health harm puts tobacco and alcohol in the top two positions, but policy should take into account both present patterns of use and also the potential for harm under changed regimes. Alcohol and tobacco are undercontrolled and cannabis is overcontrolled in terms of what the relative ratings for heavy use patterns would support.

[p.8:] Rationales for controls on psychoactive substances

Governments have had many motives for controlling the supply and consumption of psychoactive substances. They have included:
      - as sumptuary or other symbolically discriminatory legislation. In many societies, access to psychoactive substances has been limited to categories defined by age, gender or social status. Often, use has been a prerogative of the powerful. In many village and tribal societies, the use of alcoholic beverages is forbidden for women.
       - to favour or disfavour specific economic interests. Probably the most common motivation for this sort of regulation has been to favour domestic over foreign producers.
       - to enforce a religious principle or cultural value. Abstention from alcohol is a marker of an observant Moslem. Many Islamic countries that follow the sharia prohibit alcohol sales. In a European or North American context, it can be argued that regulations on psychoactive substances, particularly those seen as intoxicating, reflect a cultural bias against intoxication as a pleasure or recreation.
       - to protect public order. Alcohol and other psychoactive drugs have often been associated with political subversion (Rorabaugh 1981: 35), resulting in such measures as the repression of taverns in 1870s France (Barrows 1991). The fact that coffee-houses and tobacco shops have also been seen as threats suggests that the perceived problem has been as much from congregating and sociability as from drug use.

[p.11:] Some psychoactive substances are covered by international conventions controlling their production, distribution and use, while others are not. Alcohol is prominent among the substances not controlled internationally, and the controls on tobacco ... are emergent and will initially be weak. At the other extreme, the regime with the tightest market controls (the Single Convention of 1961) is applied to substances derived from three plants the opium poppy, the coca bush and the cannabis plant....
The official Commentary on the 1971 Convention (United Nations 1976) notes that 'alcohol appears to be covered by' its wording but adds that the 'public health and social problem' that alcohol presents is not of such a nature as to warrant it being placed under 'international control'. Alcohol does not 'warrant' that type of control because it is not 'suitable' for the régime of the 1971 Convention. The Commentary then goes on to provide similar reasoning for why tobacco 'is not covered' by the paragraph.

[p.20:] Political systems have responded slowly to the over-regulation of cannabis and the under-regulation of alcohol and tobacco. For alcohol and tobacco, there are large economic interests at stake, which have fought against any increase in control, in the case of alcohol, quite successfully. For cannabis, as a drug included in the international drug-control system, any substantial change in status is politically very difficult, at least until there is a change of position by the US, as the prime mover of the international control system (Bullington 2004, Bewley-Taylor 1997). And for both alcohol and cannabis, a shift in control status requires pushing against the general weight of public opinion.


Dangerousness of Drugs 2003 [pdf, 56Kb]


In terms of relative rankings alcohol and tobacco are undercontrolled, and by most rankings cannabis is overcontrolled. …Why tobacco and alcohol do not qualify for coverage in the international control system has long been an obvious question. …The official Commentary on the 1971 Convention offers justifications for the exclusion of tobacco and alcohol (UN 1976, pp. 47–49), but these read even more lamely now than they did then. Occasionally, officials of the international drug control system have acknowledged, with specific reference to tobacco and alcohol, that it is ‘increasingly difficult to justify the continuing distinction among substances solely according to their legal status and social acceptability’ (Giacomelli 1994). More often, one encounters unease about making comparisons of controlled drugs with tobacco and alcohol at all; to defenders of the system this ‘seems to set the scene . . .for liberalizing’ controls (Ghodse 1996).....
the sources of resistance to a rethinking of dangerousness and its implications for drug control systems: On one hand, alcohol is so deeply enculturated in western societies that even considering it in the same frame as derogated drugs is unacceptable to many. On the other hand, there is an enormous commitment by many involved in the international control system and equivalent national systems to keeping the status quo, with the outer defensive line often set around cannabis.


Addiction concepts and international control 2006 [pdf, 33Kb]


...the official Commentary on the 1971 Convention acknowledges that “alcohol appears to be covered” by the criterion that it has the “capacity to produce a state of dependence”, but argues that “the ‘public health and social problem’ which alcohol presents is not of such a nature as to warrant its being placed under ‘international control’” (Commentary 1976:48).  Besides, the Commentary adds, “the 1971 Conference … did not intend to apply the Vienna Convention to alcohol”.


"Justly anxious respecting the moral and material consequences": The proliferation of international control regimes for psychoactive substances [2007] [pdf, 106Kb]


Societies in the modern world thus face a dilemma concerning psychoactive substances: their sale and consumption is an engine of the economy, but on the other hand heavy use of some, like tobacco or alcohol, produces severe health consequences….Another escape from the dilemma is to decide there are good and bad forms of a particular substance, and that the problems are due to the bad forms. The form of use – in particular the mode of administration – can make a huge difference in the risk from use of a particular substance. But on the other hand, there is a tendency to deflect attention from a deeply culturally entrenched substance as a cause of problems by ascribing them to some marginalized and derogated form. … Banning a derogated form of a substance will undoubtedly affect some commercial interests, but often this is seen as a small price to pay to maintain unfettered markets for other forms.



Thinking about how social inequalities relate to alcohol and drug use and problems:


An individual’s patterns of psychoactive substance use, in a great many societies, are thus not only a matter of public health interest, but are also a subject of social evaluation in terms of approval or disapproval, of honour or stigma, in everyday life. The evaluations attached to a particular pattern of substance use vary over time and between cultures, and often vary also within a culture according to circumstances and who is using. As in the case of drug use which is defined as illegal, disapproval may be expressed in the form of state sanctions, up to and including being deprived of life, liberty or property.


Symbolism and rationality in the politics of psychoactive substances:


[Conclusion:] To understand the politics of psychoactive substances, it is certainly relevant to consider the empirical research and to study its role in the arguments for and against particular policies.  But my main conclusion is that this is not enough.  To restrict our field of attention to rational action and argument is to miss crucial parts of the reality of the politics of psychoactive substances.  In a heavily symbolic arena, where deep personal and societal values are at stake, we must develop paradigms of research which bring the taken-for-granted assumptions and the values into the object-field of the research.


Prof Eiser


J. Richard Eiser, Centre for Research in Social Attitudes, Department of Psychology

University of Sheffield, Sheffield S10 2TP, UK

Email:; Tel. 0114-222-6622; Fax. 0114-276-6515.


Public perception of risk 2004 [pdf, 296 Kb]


This review considers public perception of risk from a perspective based primarily on psychological theories of attitudes, decision-making, learning and social influence.

Part I presents the theoretical framework. Part II applies this to three specific contexts, or ‘case studies’, relevant to particular Foresight projects: the Flood and Coastal Defence Project, the Cyber Trust and Crime Prevention project and the Brain Science, Addiction and Drugs project.


[p.53:] Drug use and decision-making

One of the most misleading assumptions about drugs and drug use is that drug users are fundamentally different in the way they think and make choices about their lives from ‘the rest of us’. Drug users are ordinary people, and there is no evidence that they are less intelligent or capable of rational thought than anyone else.

[p.56:] Drug use causes, and is perceived to cause, a variety of societal problems that affect people other than the users. There is a danger of hypocrisy in demonising drug-users as evil or sick people set apart from the rest of society. In fact, legal drugs cause major costs to society. Millions of ‘ordinary’ citizens enjoy tobacco, but it is one of the major causes of death and disease in the western (and increasingly the developing) world. The main victims are smokers themselves, but risks are also displaced onto others through passive smoking, smoking by pregnant women, and fires (to say nothing of the burden on health services). Alcohol is not far behind, with its major contributions to road traffic accidents, injuries and death. It plays a part in statistics on sexually transmitted diseases and unwanted pregnancy and is strongly implicated in domestic violence.

[He ends on p.57 saying:] Another difficulty concerns the selectivity of attention by more or less everyone involved, including the media, politicians and medical researchers (at any point in time) to certain kinds of ‘drug problems’ rather than others.



Giancarlo Arnao: The Semantics of Prohibition 1990


The basic premise of the drug control system is the proscription of a number of substances, whose supposed effects on humans are either intrinsically bad, or intrinsically different from the effects of other substances. The difference between legal and illegal substances is couched in a terminology which is seemingly objective, scientific and descriptive, but whose actual meaning is subjective and ideological. ...
From a strictly logical point of view, the term 'abuse' has a relative meaning, insofar as it is related to the concept of 'use', i.e. 'abuse' is defined as a type of 'use' that has negative effects. In its XVI Report, The Expert Committee on Drug Dependence of the WHO adopted a definition of 'drug abuse' as "persistent or sporadic excessive drug use, inconsistent with or unrelated to acceptable medical practice" (1969). This definition therefore considers 'drug abuse' to be any kind of non-medical use. The same concept was expressed by the American Psychiatric Association in 1972: " as a general rule, we reserve the term drug abuse to apply to the illegal, non-medical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norm and defined by statute to be inappropriate, undesirable, harmful, threatening or, at minimum, culturealien" (Glasscote et al). This definition is more overtly bound to evaluations that are not scientific, such as legality and conformity to the mainstream culture....
Furthermore, an extensive reading of the UN and WHO literature clearly indicates that, whenever illegal substances are concerned, they are always referred to in terms of 'abuse' instead of 'use'. This semantic attitude seems to postulate the equivalence between 'abuse' and 'use of illegal substances' and, therefore, the idea that the consequences of the use of illegal substances are necessarily pathologic an idea which suits the philosophy of other UN agencies: 'The UN discourages the use of all the following terms and concepts: 'recreational use' of drugs, 'responsible use' of drugs ..." (UN 1987).
According to the US National Commission, "the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong" (op.cit., p.l3).
Addiction and dependence
...the WHO classified ... drug dependence ... in 1965 by a new general definition worded as follows: "Drug dependence is a state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterised by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present" (WHO. 19fiS) This generic definition was supplied with separate definitions of 'specific dependencies', related to nine different types of substances: alcohol; amphetamines; barbiturates; cannabis; cocaine; hallucinogens; khat; opiates; and solvents....
On the other hand, the WHO classification doesn't explain why, or according to which criteria, the concept of "specific dependence" was attributed to some substances and not to others. For example, it is not clear why the label of dependence was attached to hallucinogens (which are almost universally used occasionally) and not t tobacco. In fact, it seems that the WHO classification of 'drug dependence' is void of any scientific meaning.
Non-medical use
...the expression 'other than medically indicated' is clearly related to any kind of recreational use. But, as we know, the international control system has never included some recreational drugs, like alcohol and tobacco, in spite of their dependence-producing properties. The arbitrary code of 'non medical use' is, therefore, the semantic key to the discrimination between the so called 'drugs' and the traditional social intoxicants of western countries.
The semantic system of the UN authorities, when examined critically, evinces a tautology that can be worded as follows: some substances are illegal because they are 'abused'; 'abuse' equals 'non-medical use'; 'non-medical use' is any use of illegal substances.


Prof Bollinger, German law professor: see German equality case 1994


The 2nd Senat of the BVerfG also dismisses the argument of a violation of Art. 3 Par. 1 GG because of unequal treatment by law of cannabis and alcohol users.

But the [court’s] reasoning is deficient: Unequal treatment of alcohol and cannabis users is justified by a totally unqualified differentiation of those drugs. Cannabis is, in a very superficial way, only defined as a narcotic which subsequently can only have intoxicating and narcoticizing effects. Alcohol on the other side is defined as a substance for casual and recreational use ("Genußmittel"), a consumer good basically intended for nourishment, enjoyment and other socially accepted functions. …

The logical mistake of the BVerfG is to take illicitness as a natural feature of cannabis [note: i.e. discrimination on the ground of legal status]. If cannabis were not illegal there would be multifold social uses of the substance while if alcohol were totally prohibited only social use of it as an intoxicant would exist.
The BVerfG also returns to the further and very worn-out argument of "cultural alienity" of cannabis in contrast to alcohol [note: i.e. discrimination on the ground of familiarity/public acceptability/cultural and historical precedent]. This can also be easily discounted as cannabis has been present even in the German culture for centuries, probably as long as in the mediterranean culture where it dates back thousands of years. But even the fact that now contendedly 800.000 to 4 million citizens are consuming it on a more or less regular basis implies that it is now culturally integrated. This holds true all the more as the official self-conception of the German society is one of pluralism and a multi-cultural society where mass consumption and the "pursuit of happiness" are dominant values.



World Health Organisation: Management of substance abuse

WHO is the only agency dealing with all psychoactive substances, regardless of their legal status. 

International Classification of Diseases (ICD-10):

Chapter V
Mental and behavioural disorders (F00-F99)
Mental and behavioural disorders due to psychoactive substance use (F10-F19)

This block contains a wide variety of disorders that differ in severity and clinical form but that are all attributable to the use of one or more psychoactive substances, which may or may not have been medically prescribed. The third character of the code identifies the substance involved, and the fourth character specifies the clinical state. The codes should be used, as required, for each substance specified, but it should be noted that not all fourth character codes are applicable to all substances.

Identification of the psychoactive substance should be based on as many sources of information as possible. These include self-report data, analysis of blood and other body fluids, characteristic physical and psychological symptoms, clinical signs and behaviour, and other evidence such as a drug being in the patient's possession or reports from informed third parties. Many drug users take more than one type of psychoactive substance. The main diagnosis should be classified, whenever possible, according to the substance or class of substances that has caused or contributed most to the presenting clinical syndrome. Other diagnoses should be coded when other psychoactive substances have been taken in intoxicating amounts (common fourth character .0) or to the extent of causing harm (common fourth character .1), dependence (common fourth character .2) or other disorders (common fourth character .3-.9).

Only in cases in which patterns of psychoactive substance-taking are chaotic and indiscriminate, or in which the contributions of different psychoactive substances are inextricably mixed, should the diagnosis of disorders resulting from multiple drug use (F19.-) be used.

Excludes: abuse of non-dependence-producing substances ( F55 ) [Note: see bottom of this page]
The following fourth-character subdivisions are for use with categories F10-F19:
.0 Acute intoxication
  A condition that follows the administration of a psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, 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.
  Acute drunkenness in alcoholism
"Bad trips" (drugs)
Drunkenness NOS
Pathological intoxication
Trance and possession disorders in psychoactive substance intoxication
.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 syndrome
  A cluster of behavioural, 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.

The dependence syndrome may be present for a specific psychoactive substance (e.g. tobacco, alcohol, or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of pharmacologically different psychoactive substances.

  Chronic alcoholism
Drug addiction
.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 by delirium as defined in F05.-. Convulsions may also occur. When organic factors are also considered to play a role in the etiology, the condition should be classified to F05.8.
  Delirium tremens (alcohol-induced)
.5 Psychotic disorder
  A cluster of psychotic phenomena that occur during or following psychoactive substance use but that are not explained on the basis of acute intoxication alone and do not form part of a withdrawal state. The disorder is characterized by hallucinations (typically auditory, but often in more than one sensory modality), perceptual distortions, delusions (often of a paranoid or persecutory nature), psychomotor disturbances (excitement or stupor), and an abnormal affect, which may range from intense fear to ecstasy. The sensorium is usually clear but some degree of clouding of consciousness, though not severe confusion, may be present.
ˇ hallucinosis
ˇ jealousy
ˇ paranoia
ˇ psychosis NOS
.6 Amnesic syndrome
  A syndrome associated with chronic prominent impairment of recent and remote memory. Immediate recall is usually preserved and recent memory is characteristically more disturbed than remote memory. Disturbances of time sense and ordering of events are usually evident, as are difficulties in learning new material. Confabulation may be marked but is not invariably present. Other cognitive functions are usually relatively well preserved and amnesic defects are out of proportion to other disturbances.
  Amnestic disorder, alcohol- or drug-induced
Korsakov's psychosis or syndrome, alcohol- or other psychoactive substance-induced or unspecified
.7 Residual and late-onset psychotic disorder
  A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect, personality, or behaviour persist beyond the period during which a direct psychoactive substance-related effect might reasonably be assumed to be operating. Onset of the disorder should be directly related to the use of the psychoactive substance. Cases in which initial onset of the state occurs later than episode(s) of such substance use should be coded here only where clear and strong evidence is available to attribute the state to the residual effect of the psychoactive substance. Flashbacks may be distinguished from psychotic state partly by their episodic nature, frequently of very short duration, and by their duplication of previous alcohol- or other psychoactive substance-related experiences.
  Alcoholic dementia NOS
Chronic alcoholic brain syndrome
Dementia and other milder forms of persisting impairment of cognitive functions
Late-onset psychoactive substance-induced psychotic disorder
Posthallucinogen perception disorder
ˇ affective disorder
ˇ disorder of personality and behaviour
.8 Other mental and behavioural disorders
.9 Unspecified mental and behavioural disorder
F10   Mental and behavioural disorders due to use of alcohol
F11   Mental and behavioural disorders due to use of opioids
F12   Mental and behavioural disorders due to use of cannabinoids
F13   Mental and behavioural disorders due to use of sedatives or hypnotics
F14   Mental and behavioural disorders due to use of cocaine
F15   Mental and behavioural disorders due to use of other stimulants, including caffeine
F16   Mental and behavioural disorders due to use of hallucinogens
F17   Mental and behavioural disorders due to use of tobacco
F18   Mental and behavioural disorders due to use of volatile solvents
F19   Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances
    This category should be used when two or more psychoactive substances are known to be involved, but it is impossible to assess which substance is contributing most to the disorders. It should also be used when the exact identity of some or even all the psychoactive substances being used is uncertain or unknown, since many multiple drug users themselves often do not know the details of what they are taking.
    Includes: misuse of drugs NOS
F55   Abuse of non-dependence-producing substances
    A wide variety of medicaments and folk remedies may be involved, but the particularly important groups are: (a) psychotropic drugs that do not produce dependence, such as antidepressants, (b) laxatives, and (c) analgesics that may be purchased without medical prescription, such as aspirin and paracetamol.

Persistent use of these substances often involves unnecessary contacts with medical professionals or supporting staff, and is sometimes accompanied by harmful physical effects of the substances. Attempts to dissuade or forbid the use of the substance are often met with resistance; for laxatives and analgesics this may be in spite of warnings about (or even the development of) physical harm such as renal dysfunction or electrolyte disturbances. Although it is usually clear that the patient has a strong motivation to take the substance, dependence or withdrawal symptoms do not develop as in the case of the psychoactive substances specified in F10-F19.

    Abuse of:
ˇ antacids
ˇ herbal or folk remedies
ˇ steroids or hormones
ˇ vitamins
Laxative habit