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June 7, 1995

Addiction Medicine

Author Affiliations

Northwestern University Medical School, Chicago, III

JAMA. 1995;273(21):1656-1657. doi:10.1001/jama.1995.03520450026012

Diagnoses for substance dependence and abuse have been modified in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)1 published by the American Psychiatric Association. Substance dependence is defined as a maladaptive pattern of use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following symptoms occurring at any time in the same 12-month period: (1) tolerance; (2) withdrawal; (3) substance taken for longer periods or in larger amounts than intended; (4) persistent or unsuccessful efforts to cut down on use; (5) a great deal of time spent in activities necessary to obtain the substance or recover from its effects; (6) important social, occupational, or recreational activities given up or reduced because of use; and/or (7) continued use despite knowledge of having a persistent or recurrent physical or psychological problem likely to be caused or exacerbated by the substance.

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