NOT a diagnostic criterion for Substance Abuse Disorder within a 12-month period?

NOT a diagnostic criterion for Substance Abuse Disorder within a 12-month period?

• A. Increase in tolerance
• B. Recurrent use resulting in a failure to fulfill major obligations at work, school, or home
• C. Recurrent use in situations which are physically hazardous
• D. Legal problems resulting from recurrent use

Answer: (A)

The idea being tested is which features belong to Substance Abuse Disorder versus Dependence in the older DSM framework. For Substance Abuse, the diagnosis is based on behavioral harms and risky use within a year, not on physiological adaptation. Increase in tolerance signals physiological adaptation to the drug and is a hallmark of Dependence, not Abuse, in the DSM-IV-TR criteria. That’s why it’s not used to diagnose Substance Abuse Disorder within a 12-month period. The other options describe problems that Substance Abuse criteria explicitly include: repeatedly failing to meet major role obligations, using in physically hazardous situations, and having legal problems due to use. Each of these fits the abuse pattern of problematic use within a year. Note that in DSM-5, the terms shift to Substance Use Disorder, where tolerance and withdrawal are among the criteria, but the question reflects the older Abuse framework where tolerance isn’t part of the Abuse diagnosis.

The idea being tested is which features belong to Substance Abuse Disorder versus Dependence in the older DSM framework. For Substance Abuse, the diagnosis is based on behavioral harms and risky use within a year, not on physiological adaptation.

Increase in tolerance signals physiological adaptation to the drug and is a hallmark of Dependence, not Abuse, in the DSM-IV-TR criteria. That’s why it’s not used to diagnose Substance Abuse Disorder within a 12-month period.

The other options describe problems that Substance Abuse criteria explicitly include: repeatedly failing to meet major role obligations, using in physically hazardous situations, and having legal problems due to use. Each of these fits the abuse pattern of problematic use within a year.

Note that in DSM-5, the terms shift to Substance Use Disorder, where tolerance and withdrawal are among the criteria, but the question reflects the older Abuse framework where tolerance isn’t part of the Abuse diagnosis.