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Page 1 of 1 Introduction to Addictions and Addictive Behavior

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Diagnosis Template

Place a check in front of each symptom present.

Substance Abuse

Recurrent substance use resulting in failure to fulfill major role obligations at home, work, or school

Recurrent use of substances in situations in which it is physically hazardous

Recurrent substance-related legal problems

Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

One or more checks in this section = substance abuse

Substance Dependence

Tolerance as defined by

A need for markedly increased amounts of the substance to achieve intoxication or desired effect

Markedly diminished effect with continued use of the same amount of the substance

Withdrawal as manifested by

The characteristic withdrawal syndrome for the substance

The same (or a 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 efforts to cut down or control 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

Three or more checks in this section = substance dependence

Reference:

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. (4th ed. text revision). Washington, DC: American Psychiatric Association.