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DSM-IV-TR Diagnostic Criteria

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Substance Abuse

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  1. 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:

    1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

    1. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

    1. recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

    1. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights)

  2. The symptoms have never met the criteria for Substance Dependence for this class of substance.

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(Reprinted, with permission, from Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Text Revision. Copyright 2000 American Psychiatric Association.)

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DSM-IV-TR diagnostic criteria for substance abuse and dependence are the same for adolescents and adults. Empirical data generally support the validity of the DSM-IV-TR diagnosis for substance abuse and dependence in adolescents. However, compared with adults adolescents are polysubstance users, context of use in social setting is more common than using alone, have a more rapid transition from use to dependence, are less likely to experience blackouts and have alcohol withdrawal less often. It is important to differentiate between substance abuse and dependence and not assume a natural continuity between the two. Abuse is not always a prodrome for dependence and in most instances abuse does not progress into dependence which may also develop without having gone through an abuse phase. Abuse which includes all criteria possible of abuse plus two of the dependence criteria might present a clinical situation that is more severe of dependence that is composed of merely the minimum required (i.e., 3 criteria).

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Some symptoms of the dependence category may often be developmentally limited (e.g., impaired control and tolerance which is associated with the changing body mass of the individual adolescent). Another important nosological entity in youth is entitled orphan diagnoses, including subthreshold alcohol or other substance dependence (i.e., one or two symptoms only). A 3-year follow-up study demonstrated that this entity has a trajectory dissimilar to those of abuse and dependence. Nevertheless, adolescents who fall into this category may manifest impairment that deserves an intervention. It is expected that the development of DSM-V will take these findings into consideration and that symptom count will generate a better developmentally sound diagnostic profile for youth.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.
Angold A,Costello EJ,Farmer EMZ, et al.: Impaired but undiagnosed. JAACAP 1999;38:129–137.  ...

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