Alcohol (or other drug) dependence is defined as a syndrome characterized by 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:
- Tolerance, as defined by either of the following:
- a need for markedly increased amounts of the substance to achieve intoxication or desired effect, or
- markedly diminished effect with continued use of the same amount of the substance
- Withdrawal, as manifested by either of the following:
- the characteristic withdrawal for the substance
- the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful attempts to cut down or control the substance use.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Important social, occupational, or recreational activities are given up or reduced because of substance use.
- The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance use.
Ray Baker, MD