Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

• Tolerance, as defined by either of the following:

  • A need for markedly increased amounts of the substance to achieve desired effect.

  • Diminished effect with continued use of the same amount of the substance.

• Withdrawal, as manifested by either of the following:

  • The characteristic withdrawal syndrome for the substance.

  • The same substance is taken to relieve or avoid withdrawal symptoms.

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

• There is a persistent desire or unsuccessful efforts to cut down or control substance use.

• A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects.

• Important social, occupational, or recreational activities are given up or reduced because of substance use.

• 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 (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal.

Without Physiological Dependence: no evidence of tolerance or withdrawal.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.