According to the Diagnostic and Statistical Manual of Mental Disorders, substance use is considered abusive or addictive if the person has experienced three or more of the following signs during a 12-month period:
- Tolerance is evident when (1) a need exists for increased amounts of a substance to achieve intoxication or desired effects or (2) the effect of a substance is diminished with continued use of the same amount of the substance.
- Withdrawal is evident when (1) characteristic, uncomfortable symptoms occur with abstinence from the particular substance or (2) taking the same (or closely related) substance relieves or avoids the withdrawal symptoms.
- The substance is used in greater quantities or for longer periods than intended.
- The person has a persistent desire to cut down on use of the substance, or the person's efforts to cut down on use of the substance have failed.
- Considerable time and effort are spent obtaining or using the substance or recovering from its effects.
- Important social, employment, and recreational activities are given up or reduced because of an intense preoccupation with substance use.
- Substance use is continued even though some other persistent physical or psychological problem is likely to have been caused or worsened by the substance (for example, an ulcer made worse by alcohol consumption or emphysema caused by smoking).
Drug abuse can occur with or without tolerance or withdrawal. Tolerance and withdrawal indicate physical dependence. A key issue in evaluating addiction is if a person is unable to stop using the harmful substance (loss of control). Often people who are addicted to a drug do not have insight into their inability to stop drug use and falsely believe they could stop if they "wanted to." This is called denial.
No single event or criterion is indicative of an addictive disorder; drug use becomes addiction (drug abuse) only after a pattern of behavior that takes place over time. In many ways, current definitions of addiction are limited and mostly incorporate behavioral symptoms in the definition.
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