Table 1.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnostic criteria for substance abuse and substance dependence

Substance abuse

The DSM-IV defines the diagnostic criteria for substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

1.Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home (e.g. repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household).

2.Recurrent substance use in situations in which it is physically hazardous (e.g. driving an automobile or operating a machine when impaired by substance use).

3.Recurrent substance-related legal problems (e.g. arrests for substance-related disorderly conduct).

4.Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g. arguments with spouse about consequences of intoxication, physical fights).

Substance dependence

The DSM-IV defines the diagnostic criteria for substance dependence as a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

1.Tolerance, as defined by either of the following:

The need for markedly increased amounts of the substance to achieve intoxication or desired effect.

Markedly diminished effect with continued use of the same amount of the substance.

2.Withdrawal, as manifested by either of the following:

The characteristic withdrawal syndrome for the substance.

The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

3.Taking the substance often in larger amounts or over a longer period than was intended.

4.A persistent desire or unsuccessful efforts to cut down or control substance use.

5.Spending a great deal of time in activities necessary to obtain or use the substance (e.g. driving long distances) or to recover from its effects.

6.Giving up social, occupational or recreational activities because of substance use.

7.Continuing the substance use with the knowledge that it is causing or exacerbating a persistent or recurrent physical or psychological problem (e.g. continuing to drink despite an ulcer made worse by alcohol use).