PRIMARY CARE
ADdiction TOOLKIT
Fundamentals of addiction
What are the DSM-IV criteria for addiction?
© 2010 CAMH and St. Joseph’s Health Centre, Toronto
Many clinicians and researchers prefer to use the term “dependence” as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as it is more precise than “addiction.” Drug dependence, in the DSM’s terms, indicates the existence of a brain disease and is distinct from drug abuse, which may only indicate bad judgment (Erickson, 2007).
The use of the term “dependence” can be a source of confusion, as health care providers often assume that addiction is synonymous with physical dependence. In fact, addiction implies both physical dependence and some form of loss of control.
Substance dependence, or addiction, as defined by the DSM-IV, is indicated by the presence of three or more of the criteria listed below in the last 12 months. Note that all but the first two criteria reflect some form of loss of control over the use of or effects of the drug.
- Tolerance: Does the patient tend to need more of the drug over time to get the same effect?
- Withdrawal symptoms: Does the patient experience withdrawal symptoms when he or she does not use the drug?
- Continued use of drug despite harm: Is the patient experiencing physical or psychological harm from the drug?
- Loss of control: Does the patient take the drug in larger amounts, or for longer than planned?
- Attempts to cut down: Has the patient made a conscious, but unsuccessful, effort to reduce his or her drug use?
- Salience: Does the patient spend significant time obtaining or thinking about the drug, or recovering from its effects?
- Reduced involvement: Has the patient given up or reduced his or her involvement in social, occupational or recreational activities due to the drug?
Substance abuse, as defined by the DSM-IV, involves a maladaptive pattern of substance use resulting in significant negative physical, social, interpersonal or legal consequences. Unlike substance dependence, the criteria for abuse do not include tolerance, withdrawal or a pattern of compulsive or uncontrolled use.
Definitions of substance dependence and substance abuse adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition (Copyright 2000, American Psychiatric Association).
Contents of Fundamentals of Addiction
Introduction
FAQ: What is addiction?
FAQ: Mental health and addiction
FAQ: Asking about substance use
FAQ: Reporting to the Ontario Ministry of Transportation
FAQ: Methods of managing addiction
Tools and resources
Patient handouts
References