The American Psychiatric Association uses the term “substance dependence” in place of “addiction” however the two terms are synonymous, or more precisely “substance dependence” = “substance addiction” (since gambling addiction is not substance dependence) and is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress.
To meet the criteria of Substance Dependence (addiction) as defined in the DSM-IV, a patient must meet 3 or more of the following occurring any time in the same 12-month period:
1, Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
(b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance
(b) The same (or 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 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, use the substance, or 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 physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer
was made worse by alcohol consumption).
Due to the resulting confusion between the terms "physical dependence" and "substance dependence" there is some talk within the industry of reintroducing the term "addiction" because it is better understood and may pose less chance of confusion.