A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

• tolerance, as defined by either of the following:

  • 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 either of the following:

  • the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

  • 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 (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), 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 (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)