DSM-IV-TR, APA, 2000 Criteria for Substance Dependence: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 or more of the following, occurring at any time in the same 12 month period:

Criteria for Substance Dependence cont’d Tolerance, as defined by either of the following: A need for markedly increased amounts of the substance to achieve intoxication or desired effect Markedly diminished effect with continued use of the same amount of the substance.

Criteria for Substance Dependence cont’d Withdrawal, as manifested by either of the following: The characteristic withdrawal syndrome for the substance. The same or a closely related substance is taken to relieve or avoid withdrawal symptoms.

Criteria for Substance Dependence cont’d The substance is often taken in larger amounts or over a longer period than was intended. There is a persistent desire for or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities necessary to obtain the substance( visiting multiple doctors or driving long distances), or recover from its effects (e.g., chain-smoking). Important social, occupational, or recreational activities are given up or reduced because of substance use. 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.

Criteria for Substance Dependence cont’d Specify if: With Physiological Dependence Without Physiological Dependence Course Specifiers: Early Full Remission Early Partial Remission Sustained Full Remission Sustained Partial Remission On Agonist Therapy In a Controlled Environment

Criteria for Substance Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 1 or more of the following, occurring within a 12 month period: Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household).

Substance Abuse cont’d Recurrent substance use in situations in which it is physically hazardous. Recurrent substance-related legal problems. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.

Criteria for Substance Intoxication The development of a reversible substance-specific syndrome due to recent ingestion of or exposure to a substance. NOTE: Different substances may produce similar or identical syndromes. Clinically significant maladaptive behavior or psychological changes that are due to the effect of the substance on the central nervous system and develop during or shortly after use of the substance. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Criteria for Substance Withdrawal Development of a substance-specific syndrome due to the cessation of , or reduction in, substance use that has been heavy and prolonged. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Criteria Available for the following Substance-Related Disorders: Alcohol Amphetamine Cannabis Cocaine Hallucinogen Nicotine Sedative, Hypnotic or Anxiolytic Polysubstance - Repeatedly using during the same 12-month period, at least 3 groups of substance (not including caffeine and nicotine), but no single substance predominated.