Once a thorough patient assessment has been performed, a formal diagnosis of either opioid dependence or abuse can be made. A substance dependence or abuse diagnosis, according to current DSM-IV diagnostic schema, is based on clusters of behaviors and physiological effects occurring within a specific time frame. A diagnosis of dependence always takes precedence over that of abuse, i.e., a diagnosis of abuse is made only if DSM-IV criteria for dependence have never been meet.
3 or more in a 12-month period
1 or more in a 12-month period
(symptoms must never have met criteria for dependence)
- Tolerance (marked increase in amount; marked decrease in effect)
- Characteristic withdrawal symptoms ; substance taken to relieve withdrawal
- Substance taken in larger amount and for longer period than intended
- Persistent desire or repeated unsuccessful attempt to quit
- Much time/activity to obtain , use , recover
- Important social, occupational ,or recreational activities given up or reduced
- Use continues despite knowledge of adverse consequences(e.g., failure to fulfill role obligation, use when physically hazardous)
- Recurrent use resulting in failure to fulfill major role obligation at work, home, or school
- Recurrent use in physically hazardous situations
- Recurrent substance related legal problems
- Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance
In using the DSM-IV criteria, one should specify whether substance dependence is with physiologic dependence (i.e., there is evidence of tolerance or withdrawal) or without physiologic dependence (i.e., no evidence of tolerance or withdrawal). In addition, patients may be variously classified as currently manifesting a pattern of abuse or dependence or as in remission. Those in remission can be divided into four subtyped-full, early partial, sustained, and sustained partial-on the basis of whether any of the criteria for abuse have been met and over what time frame. The remission category can also be used for patients receiving agonist therapy (e.g., methadone maintenance) or for those living in a controlled drug-free environment.
*criteria from American Psychiatric Association (2000).Diagnostic and Statistical Manual of Mental
Disorders, fourth Edition, text Revision. Washington, DC, American Psychiatric Association page 197.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorder, Text Revision,
Fourth Edition, (copyright 2000). American Psychiatric Association