cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of harm.

Narrowing of the personal repertoire of patterns of psychoactive substance use has also been described as a characteristic feature (e.g. a tendency to drink alcoholic drinks in the same way on weekdays and weekends, regardless of social constraints that determine appropriate drinking behavior).

It is an essential characteristic of the dependence syndrome that either psychoactive substance taking or a desire to take a particular substance should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use. This diagnostic requirement would exclude, for instance, surgical patients given opioid drugs for the relief of pain, who may show signs of an opiate withdrawal state when drugs are not given, but who have no desire to continue taking drugs.

The dependence syndrome may be present for a specific substance (e.g., tobacco or diazepam), for a class of substances (e.g., opioid drugs); or for a wider range of different substances (as for those individuals who feel a sense of compulsion regularly to use whatever drugs are available and who show distress, agitation, and/ or physical signs of a withdrawal state upon abstinence).

The diagnosis of the dependence syndrome may be further specified by the following:

• Currently abstinent

• Currently abstinent, but in a protected environment (e.g., in hospital, in a therapeutic community, in prison, etc.)

• Currently on a clinically supervised maintenance or replacement regime (e.g., with methadone; nicotine-gum or patch)

• Currently abstinent, but receiving treatment with aversive or blocking drugs (e.g. naltrexone or disulfiram)

• Currently using the substance (active dependence)

• Continuous use

• Episodic use (dipsomania)

 

SOURCE: WHO (World Health Organization). 1992. International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Geneva: WHO. WHO. 1990. Draft of chapter V: mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. International Classification of Diseases. 10th Revision. Geneva: WHO. As cited in: O'Brien CP, Jaffe JH, eds. Addictive States. New York: Raven Press.



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