The use of the term ‘dependence’ indicates the presence of a dependency syndrome as defined by the World Health Organisation (1981). This modern concept of dependence encompasses both the psycho-social and physical characteristics of addiction and includes a number of ‘symptoms’:
- A stereotyped pattern of substance use
- Prioritisation of drug-seeking and using behaviour over other daily activity
- Tolerance to the effects of substances
- Withdrawal symptoms on cessation or reduction of substance use
- Use of substances to prevent the occurrence of withdrawal symptoms
- Persistence of substance misuse despite awareness of harm
- Loss of control over the onset, termination and amount of substance use
- Rapid reinstatement of the syndrome after a period of abstinence.
Not all of these symptoms need to be present to indicate the presence of a dependency syndrome, and it is often the case that an individual is dependent on a substance in the absence of a withdrawal syndrome. Equally, harm and dependency are not necessarily correlated, and some non-dependent substance users may suffer physical, psychological and social consequences of the misuse.
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