Substance abuse is defined 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:
Note: The symptoms for abuse have never met the criteria for
dependence for this class of substance. According to the DSM-IV,
a person can be abusing a substance or dependent on a
substance but not both at the same time.
- Recurrent substance use resulting in a failure to fulfill major
role obligations at work, school, or home (such as repeated absences
or poor work performance related to substance use; substance-related
absences, suspensions, or expulsions from school; or neglect of
children or household).
- Recurrent substance use in situations in which it is physically
hazardous (such as driving an automobile or operating a machine when
impaired by substance use)
- Recurrent substance-related legal problems (such as arrests for
substance related disorderly conduct)
- Continued substance use despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the effects
of the substance (for example, arguments with spouse about
consequences of intoxication and physical fights).
DSM-IV Substance Dependence Criteria
Substance dependence is defined as a maladaptive pattern of substance
use leading to clinically significant impairment or distress, as
manifested by three (or more) of the following, occurring any time in
the same 12-month period:
American Psychiatric Association. 1994. Diagnostic and Statistical
Manual of Mental Disorders: DSM-IV. Washington D.C.: American
Psychiatric Association. (pp. 181-183)
- Tolerance, as defined by either of the following: (a) A need for
markedly increased amounts of the substance to achieve intoxication or
the desired effect or (b) Markedly diminished effect with continued
use of the same amount of the substance.
- Withdrawal, as manifested by either of the following: (a) The
characteristic withdrawal syndrome for the substance or (b) The same
(or closely related) substance is taken to relieve or avoid withdrawal
- The substance is often taken in larger amounts or over a longer
period than 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, use the substance, 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 physical or psychological problem that is likely to have
been caused or exacerbated by the substance (for example, current
cocaine use despite recognition of cocaine-induced depression or
continued drinking despite recognition that an ulcer was made worse by