DSM-IV Substance Dependence Criteria

Addiction (termed substance dependence by the American Psychiatric Association) 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:
1. 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
(b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance
(b) The same (or 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 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, use the substance, or recover
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 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 alcohol consumption).
DSM-IV criteria for substance dependence include several specifiers, one of which outlines whether substance
dependence is with physiologic dependence (evidence of tolerance or withdrawal) or without physiologic
dependence (no evidence of tolerance or withdrawal). In addition, remission categories are classified into four
subtypes: (1) full, (2) early partial, (3) sustained, and (4) sustained partial; on the basis of whether any of the
criteria for abuse or dependence have been met and over what time frame. The remission category can also be
used for patients receiving agonist therapy (such as methadone maintenance) or for those living in a controlled,