The DSM-IV criteria for substance abuse and dependence are shown in Figure 1. Dependence was diagnosed when three or more dependence criteria were met. Among those with no dependence diagnosis, abuse was diagnosed when at least one abuse criterion was met. The division into two disorders was guided by the concept that the “dependence syndrome” formed one dimension of substance problems, while social and interpersonal consequences of heavy use formed another (3, 4). Although the dimensions were assumed to be related (3, 4), DSM-IV placed dependence above abuse in a hierarchy by stipulating that abuse should not be diagnosed when dependence was present. The dependence diagnosis represented a strength of the DSM-IV approach to substance use disorders: it was consistently shown to be highly reliable (5) and was validated with antecedent and concurrent indicators such as treatment utilization, impaired functioning, consumption, and comorbidity (6–9).
