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Symptoms - Alcohol or Substance Dependence


The Diagnostic and Statistical Manual of Mental Disorders (currently the fourth edition, text-revision) is the standard reference against which all mental disorders (substance use disorders included) are made. The criteria involved for making a formal Substance Dependence diagnosis is as follows:

  • The patient shows . . . 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:
    • Tolerance, as defined by either of the following:
      • a 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

    • Withdrawal, as manifested by either of the following:
      • The characteristic withdrawal syndrome for the substance
      • The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

    • The substance is often taken in larger amounts or over a longer period than was 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 (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), 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 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)

When a diagnosis of Substance Dependence is made, the diagnosing doctor must also specifiy whether or not the patient is Physiologically Dependent.  Physiological dependence, in this case means that there is evidence of tolerance or withdrawal (as defined in the first two criteria).  Note that it is possible to be diagnosed with Substance Dependence without displaying either tolerance or withdrawal. 

Note that only a doctor can make a formal diagnosis of substance abuse or substance dependance.

Criteria sumarized from:
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition. text revision Washington, DC: American Psychiatric Association.


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