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. Author manuscript; available in PMC: 2010 Jul 1.
Published in final edited form as: Clin J Pain. 2009 Jul–Aug;25(6):477–484. doi: 10.1097/AJP.0b013e31819c2c2f

Table 1.

DSM-IV Definition of Substance Abuse and Dependence

Criteria for Substance Abuse
A. 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 fulfill major role obligations at work, school, or home

  2. recurrent substance use in situations in which it is physically hazardous

  3. recurrent substance-related legal problems

  4. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

B. The symptoms have never met criteria for Substance Dependence for this class of substance.
Criteria for 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:
  1. tolerance, as defined by either of the following:
    1. a need for markedly increased amounts of the substance to achieve intoxication or desired effect
    2. markedly diminished effect with continued use of the same amount of the substance
  2. withdrawal, as manifested by either of the following:
    1. the characteristic withdrawal syndrome for the substance
    2. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

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

  4. there is a persistent desire or unsuccessful efforts to cut down or control substance use

  5. 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

  6. important social, occupational, or recreational activities are given up or reduced because of substance use

  7. 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)

Note. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.