DSM-IV-TR Criteria for Substance Abuse and Substance Dependence

1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
2. recurrent substance use in situations in which it is physically hazardous
3. recurrent substance-related legal problems
4. continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance

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 (refer to Criteria A and B of the criteria set for opioid withdrawal)
   • 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, use the substance, 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.

With Physiological Dependence: evidence of tolerance or withdrawal

Without Physiological Dependence: no evidence of tolerance or withdrawal