[1]

The DSM-IVR defines substance dependence as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 3 or more of the following during a 12 month period:

1. tolerance (see below)
2. withdrawal (see below)
3. the substance is taken in larger amounts or over a longer period of time than intended
4. the persons experiences 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 it, 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 physical or psychological problem that is likely to have been caused or exacerbated by the substance

[2]

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by a need for increasing amounts of the substance to achieve intoxication, markedly diminished effect of the substance with continued use, the need to continue to take the substance in order to avoid withdrawal symptoms, and other serious behavioral effects, occurring at any time in the same 12-month period.

Substance dependence is more serious than abuse. This maladaptive pattern of substance use includes such features as increased tolerance for the substance, resulting in the need for ever-greater amounts of the substance to achieve the intended effect; an obsession with securing the substance and with its use; or persistence in using the substance in the face of serious physical or mental health problems. See the text box on page 23 for more information.