Substance Use and Abuse 207Box 26.2A summary of ICD-10 criteria for Dependence syndrome∗
Three or more of the following have occurred together repeatedly for over a
month, or occurred repeatedly within a 12-month period:
1 A strong desire or sense of compulsion to take the substance.
2 Impaired control over substance taking, for example, using larger quantities
of the substance or over a longer period than intended, a persistent desire to
reduce or control substance use, or unsuccessful efforts to do so.
3 Withdrawal symptoms when cutting down or stopping. This is shown either by
the emergence of the characteristic withdrawal syndrome for that substance,
or by needing to using the substance (or a closely related substance) with the
intention of relieving or avoiding withdrawal symptoms.
4 Evidence of tolerance: either needing much more of the substance to achieve
the desired effect, or obtaining a much diminished effect from taking the same
amount.
5 Preoccupation with substance use, for example, much time is spent obtaining
and using the substance, much less time is devoted to alternative pleasures
and interests.
6 Substance use persists despite clear evidence of harmful consequences.
Note:∗DSM-IV criteria for Substance Dependence are similar.TheICD-10Clas-
sification of Mental and Behavioural Disorders: Diagnostic Criteria for Research
(World Health Organization, 1993).about by impaired judgement and dysfunctional behaviour secondary
to substance use, for example, causing an accident when driving while
drunk. Other common adverse consequences include school drop-out,
repeated criminal convictions and disrupted relationships with partners
or family members.
3 Acute intoxication: The ICD-10 term ‘acute intoxication’ is equivalent to
‘intoxication’ in DSM-IV. This syndrome refers to a reversible syndrome
of maladaptive behavioural or psychological changes that is charac-
teristic of the relevant substance, and that occurs during or shortly
after substance use. Different substances sometimes result in similar
intoxication syndromes.
4 Withdrawal: This syndrome is triggered by the cessation or reduction of
what had previously been heavy and prolonged use. The relevant with-
drawal features typically vary according to which substance is involved.
For example, the withdrawal syndrome can include: tremor, seizures
and hallucinations for alcohol withdrawal; and lethargy, increased ap-
petite and vivid unpleasant dreams for amphetamine withdrawal.
Applying this template to all forms of substance use and abuse is a clever
way of bringing out shared features and differences, while also keeping the
system simple and memorable enough to be useful. However, it does not
solve all problems and may generate some difficulties of its own:
1 The distinction between the dependence syndrome and the harmful
use syndrome may be misleading, at least for children and adolescents.