The work group noted that many clinical studies define remission and relapse in terms of substance use per se, not in terms of DSM criteria. The work group did not do this in order to remain consistent with DSM-IV criteria, and because the criteria focus on substance-related difficulties, not the extent of use, for the reasons discussed in the section on adding criteria. In addition, a lack of consensus on the level of use associated with a good outcome (111, 112) complicates substance use as a course specifier for the disorder.
