TABLE 9–2 Criteria for Substance Dependence from DSM IV



A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifest by three (or more) of the following, occurring at any time in the same 12-month period


Tolerance—need increased amounts of substance to achieve desired effect, or diminished effect with continued use of same amount

Increased tolerance


Sometimes, physical withdrawal

Substance often taken in larger amounts or over a longer period than intended

A strong desire to take the drug

Persistent or unsuccessful efforts to cut down or control substance use

Difficulty controlling use

Great deal of time spent in activities necessary to obtain the substance or recover from its effects


Important social, occupational, or recreational activities given up or reduced because of substance use

Higher priority given to drug use than to other activities and obligations

Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by the substance

Persisting use despite harmful consequences


SOURCE: Adapted from RCP, 2000.

were also included. The number or type of symptoms experienced varies across different drugs of abuse. The major difference between nicotine and some other drugs of abuse is the lack of intoxication in regular tobacco users that results in behavioral and cognitive disruption (U.S. DHHS, 1988). However, this makes nicotine no less an agent of addiction or dependence than other drugs (Stolerman and Jarvis, 1995). In fact, many cigarette smokers exhibit at least as many indicators of dependence as other drug users and abusers (CDC, 1995b; U.S. DHHS, 1988). Assessment of nicotine dependence using these criteria can be made by a number of diagnostic structured instruments including the Composite International Diagnostic Interview-Substance Abuse Module, the National Institute of

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