The DSM-IV defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one or more of the following:
- Failure to fulfill major role obligations at home, school, or work;
- Recurrent substance use in situations in which it is physically hazardous;
- Recurrent substance-related legal problems;
- Recurrent substance use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
Substance dependence is defined as 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 a 12-month period:
- Repeated, unintended, excessive use;
- Persistent failed efforts to cut down;
- Excessive time spent trying to obtain the substance;
- Reduction in important social, occupational, or recreational activities;
- Continued use despite awareness that substance is the cause of psychological or physical difficulties.
Although each substance dependence disorder has unique features, these are considered the common features that define substance dependence. Each substance use disorder is discussed, with particular attention to their unique features.
Revision date: June 21, 2011
Last revised: by Andrew G. Epstein, M.D.