TABLE 9–2Criteria for Substance Dependence from DSM IV

DSM-IVIDC-10
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifest by three (or more) of the following, occurring at any time in the same 12-month period
Tolerance—need increased amounts of substance to achieve desired effect, or diminished effect with continued use of same amountIncreased tolerance
WithdrawalSometimes, physical withdrawal
Substance often taken in larger amounts or over a longer period than intendedA strong desire to take the drug
Persistent or unsuccessful efforts to cut down or control substance useDifficulty controlling use
Great deal of time spent in activities necessary to obtain the substance or recover from its effects
Important social, occupational, or recreational activities given up or reduced because of substance useHigher priority given to drug use than to other activities and obligations
Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by the substancePersisting use despite harmful consequences

SOURCE: Adapted from RCP, 2000.

From: 9, Nicotine Pharmacology

Cover of Clearing the Smoke
Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction.
Institute of Medicine (US) Committee to Assess the Science Base for Tobacco Harm Reduction; Stratton K, Shetty P, Wallace R, et al., editors.
Washington (DC): National Academies Press (US); 2001.
Copyright 2001 by the National Academy of Sciences. All rights reserved.

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