Table 1

Definition of Substance Dependence and Substance Abuse

Substance dependence is manifested by three or more of the following:


(i) tolerance, as marked by the need for larger doses to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance;

(ii) development of withdrawal symptoms or use of substance to relieve or avoid withdrawal symptoms;

(iii) taking larger amounts or over longer periods than intended;

(iv) persistent desire or unsuccessful efforts to cut down or control substance use;

(v) spending time obtaining the substance, using the substance or recovering from its effects;

(vi) performing important social, occupational or recreational activities less frequently because of the substance;

(vii) continuing use of the substance despite knowledge of adverse physical or psychological problems.


Substance abuse is manifested by at least one of the following:


(i) recurrent use resulting in failure to fulfill major obligations at work, home or school;

(ii) recurrent use in situations in which it is physically hazardous;

(iii) recurrent substance-related legal problems;

(iv) continued use despite having persistent or recurrent social or interpersonal problems.


de Wit et al. BMC Anesthesiology 2007 7:3   doi:10.1186/1471-2253-7-3

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