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Diagnostic Criteria for Substance Dependence

When we last visited the topic of Substance Abuse we looked at the diagnostic criteria for substance abuse. Today we look at substance dependence, which differs from abuse in that the component of addiction and addictive behavior is also present. So how do we know if a person has moved from substance abuse to substance dependence?

The DSM-IV-TR lists the following guidelines for a diagnosis of substance dependence:

A maladaptive pattern of substance abuse leading to significant impairment or distress as manifested by at least three of the following within a 12-month period:

  1. Tolerance to the substance as defined by:
    (a) A need for marked increased amounts of the substance to achieve intoxication or the desired emotional and physical effect.
    (b) Markedly lowered effect with continued use of the same amount of the substance.
  2. Withdrawal, as manifested by either of the following:
    (a) the characteristic withdrawal symptoms for the substance concerned
    (b) the same (or chemically similar) substance is taken to relieve or avoid withdrawal symptoms.
  3. The substance is often taken in larger amounts or over a longer period of time.
  4. There is a persistent desire or unsuccessful attempt to reduce or control substance abuse.
  5. Large mounts of time and effort are expended in activities designed to obtain the substance (e.g. visiting multiple doctors, or traveling long distances), use the substance, or recover from its effects.
  6. Important social, occupational or recreational activities are avoided because of substance abuse.
  7. The substance abuse is continued despite knowledge of having a persistent physical or psychological problem that is caused or exacerbated by the substance.

According to statistics, the most highly addictive substance and the most difficult to cease use of is nicotine. This is followed by ice, crack, and crystal meth which form the next highest group, followed by valium and other prescription tranquillizers. Alcohol and heroin rank lower, as do cocaine, caffeine, PCP and marijuana.

In coming blogs, we will continue to look at other aspects of drug usage and abusage.


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