Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Substance-Related Disorders > Introduction > Substance Use Disorders > Substance Abuse Topics Discussed: substance abuse. Excerpt: "The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. In order for an Abuse criterion to be met, the substance-related problem must have occurred repeatedly during the same 12-month period or been persistent. There may be repeated failure to fulfill major role obligations, repeated use in situations in which it is physically hazardous, multiple legal problems, and recurrent social and interpersonal problems (Criterion A). Unlike the criteria for Substance Dependence, the criteria for Substance Abuse do not include tolerance, withdrawal, or a pattern of compulsive use and instead include only the harmful consequences of repeated use. A diagnosis of Substance Abuse is preempted by the diagnosis of Substance Dependence if the individual's pattern of substance use has ever met the criteria for Dependence for that class of substances (Criterion B). Although a diagnosis of Substance Abuse is more likely in individuals who have only recently started taking the substance, some individuals continue to have substance-related adverse social consequences over a long period of time without developing evidence of Substance Dependence. The category of Substance Abuse does not apply to caffeine and nicotine. The term abuse should be applied only to a pattern of substance use that meets the criteria for this disorder; the term should not be used as a synonym for "use,""misuse," or "hazardous use."The individual may repeatedly demonstrate intoxication or other substance-related symptoms when expected to fulfill major role obligations at work, school, or home (Criterion A1). There may be repeated absences or poor work performance related to recurrent hangovers. A student might have substance-related absences, suspensions, or expulsions from school. While intoxicated, the individual may neglect children or household duties. The person may repeatedly be intoxicated in situations that are physically hazardous (e.g., while driving a car, operating machinery, or engaging in risky recreational behavior such as swimming or rock climbing) (Criterion A2). There may be recurrent substance-related legal problems (e.g., arrests for disorderly conduct, assault and battery, driving under the influence) (Criterion A3). The person may continue to use the substance despite a history of undesirable persistent or recurrent social or interpersonal consequences (e.g., marital difficulties or divorce, verbal or physical fights) (Criterion A4)...." DOI: 10.1176/appi.books.9780890423349.818 The content above is only an excerpt. For full access subscribe now or log into your account below. You can also purchase 24- or 48-hour access; learn more Username: Password:   FORGOT your subscriber username and/or password? Get a reminder via email: The email I registered with is:  Not a subscriber? Subscribe Today PsychiatryOnline is a powerful website that features DSM-IV-TR® and The American Journal of Psychiatry as the cornerstones of an unsurpassed collection of psychiatric references, including books, journals, and self-assessment tools. PsychiatryOnline’s innovative platform makes these resources easy and convenient to use, offering Precise and powerful searching across books and journals. Quick pathways to related material. Mobile access from any computer with a Web connection. Ability to download any book section to PDA. Links from bibliographic references to the full text of journal articles. References to material not located in the PsychiatryOnline collection lead you to PubMed. Learn more about PsychiatryOnline Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).