The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the current revision is called the DSM-IV. This is the document that Psychiatrists, Psychologists, and the rest of the mental health field uses to define and diagnose mental disorders.

The DSM uses the same criteria for both alcohol and substance abuse or dependency, so I publish the two here together. Significantly, the DSM does not define either malady as a “disease,” but as a “disorder.” As you can see below, there are two “degrees” of disorder, Abuse and Dependence. The criteria differ, and, as pointed out, an effected person must be diagnosed as one-or-the-other. Most substance dependent individuals meet the requirement for Abuse, but they are diagnosed solely as dependent, not both. Also, the DSM views abuse and dependency as a continuum, meaning addiction is not, in their eyes, an on-or-off proposition, but a disorder with degrees of affliction. The distinction is important when compared to 12-step programs, which preach that one is either addicted or not, and if you are, you are powerless over such addiction.

The DSM-IV abuse and dependency criteria differ significantly, in some respects from what AA considers “Alcoholism,” and we will be discussing some of those differences as we move along in the book, so I though it would be useful to have the actual, medical definitions readily available.

The following was taken from the latest edition of the DSM-IV, published in 1994 by the American Psychiatric Association in Washington D.C., pages 181-183:

DSM-IV Substance Abuse Criteria:

Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:

1.    Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).

2.    Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use).

3.    Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct).

4.    Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Note: The symptoms for abuse have never met the criteria for dependence for this class of substance. According to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time.

DSM-IV Substance Dependence Criteria:

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

1.    Tolerance, as defined by eith of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of substance.

2.    Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (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 then intended.

4.    There is a persistent desire or unsuccessful efforts to cut down or control 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 substance use.

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 (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

From: Powerless no longer