Box 3.2 DSM-IV Criteria for Substance Dependence      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: (1) Tolerance, as defined by either of the following: (a) A need for markedly increased amount of the substance to achieve intoxication or desired effect. (b) Markedly diminished effect with continued use of the same amount of the substance. (2) Withdrawal, as defined by either of the following: (a) The characteristic withdrawal syndrome for the substance. (b) The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms. (3) The substance is often taken in larger amounts or over a longer period than was intended. (4) There is a persistent desire or unsuccessful efforts to cut down or control substance use. (5) A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), to use the substance (e.g., chain-smoking), or to recover from its effects. (6) Important social, occupational, or recreational activities are given up or reduced because of substance use. (7) 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). Substance abuse with physiological dependence is diagnosed if there is evidence of tolerance or withdrawal. Substance abuse without physiological dependence is diagnosed if there is no evidence of tolerance or withdrawal.