BUPRENORPHINEMAINTENANCETREATMENT

PHYSICIAN/OFFICEINFORMATION
DSMIVcriteriaforsubstancedependenceandsubstanceabuse
Onceathoroughpatientassessmenthasbeenperformed,aformaldiagnosisofeitheropioid
dependenceorabuseshouldbemade.Asubstancedependenceorabusediagnosis,accordingto
currentDSMIVdiagnosticschema,isbasedonclustersofbehaviorsandphysiologicaleffects
occurringwithinaspecifictimeframe.Thediagnosisofdependencealwaystakesprecedence
overthatofabuse,e.g.,adiagnosisofabuseismadeonlyifDSMIVcriteriafordependence
haveneverbeenmet.
ThefollowingpageprovidestheDSMIVcriteriafordiagnosingsubstancedependenceand
abuse.
DSMIVCriteriaforSubstanceDependenceandSubstanceAbuse

Dependence

Abuse

(3ormoreina12monthperiod)

(1ormoreina12monthperiod)
Symptomsmustneverhavemetcriteriafor
substancedependenceforthisclassof
substance.

Tolerance(markedincreaseinamount;marked
decreaseineffect)
Characteristicwithdrawalsymptoms;
substancetakentorelievewithdrawal
Substancetakeninlargeramountandfor
longerperiodthanintended
Persistentdesireorrepeatedunsuccessful
attempttoquit

Recurrentuseresultinginfailuretofulfill
majorroleobligationatwork,homeorschool

Recurrentuseinphysicallyhazardous
situations
Recurrentsubstancerelatedlegalproblems
Continuedusedespitepersistentorrecurrent
socialoarinterpersonalproblemscausedor
exacerbatedbysubstance

Muchtime/activitytoobtain,use,recover
Importantsocial,occupational,orrecreational
activitiesgivenuporreduced
Usecontinuesdespiteknowledgeofadverse
consequences(e.g.,failuretofulfillrole
obligation,usewhenphysicallyhazardous)

InusingtheDSMIVcriteria,oneshouldspecifywhethersubstancedependenceiswith
physiologicdependence(i.e.,thereisevidenceoftoleranceorwithdrawal)orwithout
physiologicdependence(i.e.,noevidenceoftoleranceorwithdrawal).Inaddition,patientsmay
bevariouslyclassifiedascurrentlymanifestingapatternofabuseordependenceorasin
remission.Thoseinremissioncanbedividedintofoursubtypesfull,earlypartial,sustained,
andsustainedpartialonthebasisofwhetheranyofthecriteriaforabuseordependencehave
beenmetandoverwhattimeframe.Theremissioncategorycanalsobeusedforpatients
receivingagonisttherapy(e.g.,methadonemaintenance)orforthoselivinginacontrolleddrug
freeenvironment.

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