Chapter 15. Substance-Related Disorders

DSM-IV Diagnostic Criteria

Substance Dependence

1. 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:

   1. tolerance

   2. withdrawal

   3. the substance is often taken in larger amounts or over a longer period than was 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 from its effects

   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 or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

Substance Abuse

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 failure to fulfill major role obligations at work, school, or home

   2. recurrent substance use in situations in which it is physically hazardous

   3. recurrent substance-related legal problems

   4. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

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

Substance Intoxication

1. The development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance.

2. Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system.

3. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Substance Withdrawal

1. The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged.

2. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

3. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

(Adapted, with permission, from Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Copyright 1994 American Psychiatric Association.)

This work was supported in part by the National Institute on Alcohol Abuse and Alcoholism (RO1 AA014969) and the National Institute on Drug Abuse (RO1 DA015713 and T32 DA021123).

The substance-related disorders are classified into two categories: (1) substance-use disorders and (2) substance-induced disorders (Table 15–1). The substance-use disorders are (somewhat arbitrarily) dichotomized into substance abuse and substance dependence based on the number of relevant symptoms that the patient exhibits. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) specifies substance-use disorders that result from the self-administration of several ...