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Tolerance, including need for more of a substance to achieve the same effect or a diminished effect when using the same amount of the substance over time.
Example: Alcohol dependent individual does not feel intoxicated after consuming entire 6-pack in an evening.
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Withdrawal, including characteristic syndrome of withdrawal symptoms for specific substance or use of the substance or a similar one to relieve or prevent those symptoms.
Example: Heroin dependent individual experiences dysphoria, nausea, sweating, and insomnia when she can’t obtain heroin, takes oxycontin to compensate.
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Individual frequently takes more of a substance than intended or takes it over a longer period of time than planned.
Example: Alcoholic plans to stop at the local bar for one beer, ends up staying until closing and having several drinks.
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Repeated unsuccessful efforts to reduce substance use or persistent desire to do so.
Example: Cocaine dependent individual repeatedly vows to stop using at the start of the day, but ends up using by the end of the day.
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Substantial amount of time spent obtaining, using, or recovering from use of substance.
Example: Cannabis dependent individual spends hours calling his various contacts to locate available marijuana, travels 2 hours to get it, then smokes for most of the weekend.
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Individual abandons or cut back on social activities, work or family responsibilities, and recreational interests in order to use substances.
Example: Drug user stops associating with non-drug using friends.
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Substance use continues in spite of associated physical and psychological problems.
Example: Alcohol dependent individual continues to drink after being diagnosed with hypertension and gastric ulcers.
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Physiological tolerance unlikely, but some individuals feel need for increased quantities of food in order to feel satisfied.
Example: Overweight or obese individual feels hungry after a large meal.
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Comparable withdrawal syndrome not yet identified, but dieters and other individuals deprived of food report psychological preoccupation with food, and some individuals use substances such as nicotine or stimulants to suppress appetite.
Example: Dieter feels lethargic and depressed, smokes or drinks caffeinated beverages to compensate.
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Food is often consumed in larger amounts or over a longer time than was intended.
Example: Dieter plans to have one small serving of ice cream, but ends up having eating an entire pint.
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Obese individuals who overeat often have a persistent wish to reduce or control how much they eat or try repeatedly to eat less.
Example: Repeated, unsuccessful diets or regaining weight after successful diet are the norm for most obese individuals.
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Overeaters can spend substantial time shopping for food, eating and snacking, and recovering from physical and psychological effects of overeating (e.g., nausea, guilt about eating too much)
Example: Obese individual snacks throughout the day in addition to or instead of eating regular meals.
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A range of activities may be abandoned or reduced because of consequences of overeating (i.e., obesity) and accompanying decreased mobility, increased social anxiety, etc.
Example: Obese individual stops participating in sports or going to the beach because of embarrassment about weight.
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Overeating continues in spite of associated physical and psychological problems.
Example: Obese individual continues to eat candy after being diagnosed with type II diabetes mellitus.
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