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DSM IV (TR)
THE CRITERIA
PHYSIOLOGY

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CRITERIA FOR SUBSTANCE DEPENDENCE

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 THE SAME 12-MONTH PERIOD:

  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
    (B)  THE SAME OR 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 PERSISTENT DESIRE OR UNSUCCESSFUL EFFORTS TO CUT DOWN OR CONTROL THE 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 THE SUBSTANCE USE

  7. THE SUBSTANCE USE IS CONTINUED DESPITE KNOWLEDGE OF HAVING A PERSISTENT PHYSICAL OR PSYCHOLOGICAL PROBLEM THAT IS LIKELY TO HAVE BEEN CAUSED OR EXACERBATED BY THE SUBSTANCE

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WITH PHYSIOLOGIC DEPENDENCE- EVIDENCE OF TOLERANCE(1) OR WITHDRAWAL(2)

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WITHOUT PHYSIOLOGIC DEPENDENCE-NO EVIDENCE OF TOLERANCE(1) OR WITHDRAWAL(2)

     THERE ARE IMPORTANT REASONS FOR THE RED AND BLUE TEXT ABOVE. THE FIRST TWO CRITERIA WHICH ARE WITHDRAWAL AND TOLERANCE ARE THE TWO CRITERIA FOR PHYSICAL OR PHYSIOLOGIC DEPENDENCE. IT IS VERY IMPORTANT TO REALIZE THIS DIFFERENCE BETWEEN PHYSIOLOGIC DEPENDENCE AND ADDICTION.   
    
MOST OF THE PORTRAYALS OF ADDICTS IN THE MEDIA INCLUDING TV, MOVIES, AND NEWS SHOW ADDICTS EITHER IN WITHDRAWAL OR TRYING TO GET "A FIX". PHYSICAL DEPENDENCE IS NOT ADDICTION BY ITSELF.  ANY PERSON CAN DEVELOP PHYSICAL DEPENDENCY.  MANY PATIENTS WHO ARE ADMITTED TO THE ACUTE CARE HOSPITALS FOR MAJOR ILLNESSES AND MAJOR ACCIDENTS WHO REQUIRE MULTIPLE SURGERIES AND NARCOTICS FOR AN EXTENDED PERIOD OF TIME CERTAINLY DEVELOP TOLERANCE OVER TIME AND IF THEIR NARCOTICS WERE STOPPED ABRUPTLY AS OPPOSED TO BEING TAPERED WOULD DEVELOP SEVERE WITHDRAWAL SYMPTOMS. WHAT WE AS PHYSICIANS DO IS TO GO FROM HIGH POTENCY INTRAVENOUS NARCOTICS TO LESS POTENT INTRAMUSCULAR OR INTRAVENOUS NARCOTICS AND THEN LESSER POTENCY ORAL PAIN MEDICATIONS OVER TIME TO PREVENT WITHDRAWAL SYMPTOMS.
      ANY ONE OF YOU READING THIS PAGE CAN BECOM PHYSIOLOGICALLY DEPENDENT ON ANY OF A NUMBER OF SUBSTANCES IF TAKEN FOR PURELY MEDICAL REASONS FOR A PERIOD OF TIME AND AT A CERTAIN AMOUNT THAT IS INDIVIDUAL TO EACH PERSON. THIS DOES NOT MAKE YOU AN ADDICT OR DEPENDENT.  THIS IS THE REASON THE TWO SPECIFIERS ARE LISTED ABOVE I.E. WITH PHYSIOLOGIC DEPENDENCE AND WITHOUT PHYSIOLOGIC DEPENDENCE.  IF YOU HAVE THESE TWO CRITERIA YOU MUST HAVE A LEAST ONE OF THE OTHER FIVE CRITERIA.  CONVERSELY YOU CAN HAVE THREE OF THE CRITERIA LISTED IN BLUE (OUT OF 3-7) AND HAVE NO PHYSIOLOGIC DEPENDENCE AND BE ADDICTED OR DEPENDENT.