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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

BOX 1.3

Criteria for substance dependence in DSM-IV
According to the DSM-IV, substance dependence is:
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, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve
intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the
substance
2. withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance
(b) the same (or a closely related) substance is taken to relieve or avoid
withdrawal symptoms
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
(e.g. visiting multiple doctors or driving long distances), use the substance
(e.g. chain-smoking), 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 (e.g. current cocaine use despite recognition
of cocaine-induced depression, or continued drinking despite recognition that
an ulcer was made worse by alcohol consumption)
Source: American Psychiatric Association, 1994.

American Psychiatric Association (1994) are similar to those of ICD-10 (Box 1.3),
as well as those in many research studies. Other terms used in relation to the
use of psychoactive substances are presented in Box 1.4.
A further difficulty is that the diagnostic definition of dependence, as noted
above, requires that the case is positive on any three of the six criteria. This
means that a case can qualify for dependence without being positive on either
of the two biologically-measurable criteria; and it means that any case

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