A. The diagnosis of substance dependence requires substance use, accompanied by impairment, and the presence of 3 of the following in a 12-month period:
1. Tolerance: An increased amount of substance is required to achieve the same effect, or a decreased effect results when the same amount is used.
2. Withdrawal: A characteristic withdrawal syndrome occurs, or the substance is used in an effort to avoid withdrawal symptoms.
3. The substance is used in increasingly larger amounts or over a longer period of time than desired.
4. The patient attempts or desires to decrease use.
5. A significant amount of time is spent obtaining, using, or recovering from the substance.
6. Substance use results in a decreased amount of time spent in social, occupational, or recreational activities.
7. The patient has knowledge that the substance use is detrimental to his health, but that knowledge does not deter continued use.
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