Substance Dependence

Maladaptive pattern of substance use, leading to clinically significant impairment or distress

Manifested by three or more of the following, occurring at any time in the same twelve-month period

Tolerance, as defined by either:

• need for markedly increased amounts of substance to achieve intoxication or desired effect

• markedly diminished effect with continued use of same amount of substance

Withdrawal, as manifested by either:

• characteristic withdrawal syndrome for substance

• same (or closely related) substance taken to relieve or avoid withdrawal symptoms

Substance often taken in larger amounts or over longer period than intended

Persistent desire or unsuccessful efforts to cut down or control substance use

Great deal of time spent in activities necessary to obtain substance, use substance, or recover from its effects

Important social, occupational, or recreational activities given up or reduced because of substance use

Substance use continues despite knowledge of persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by substance

Specify if with Physiological Dependence (evidence of tolerance or withdrawal) or Without Physiological Dependence (no evidence of tolerance or withdrawal)

Course specifiers: Early Full Remission; Early Partial Remission; Sustained Full Remission; Sustained Partial Remission; on Agonist Therapy; in a Controlled Environment

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