This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Anesthesia  • Substance Abuse/ Alcoholism  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: Dr Contreras raises an important point concerning the concept and term of "dependence," as it applies to patients with chronic pain who are treated with opioid analgesics. The DSM-IV diagnosis of substance dependence is based on "a maladaptive pattern of substance use," as manifested by the presence of 3 (or more) of 7 criteria.¹ One criterion is "dependence," as evidenced by the occurrence of a withdrawal syndrome when a substance is withdrawn. Another is "tolerance," the need for increased amounts of a substance to achieve a desired effect, or diminished effect with continued use of the same amount. The other 5 DSM-IV criteria include taking larger amounts of a substance than intended, unsuccessful efforts to control use, a great deal of time spent in activities to obtain a substance, the reduction of important activities, and persistent use despite known substance-related physical or psychological problems.

The DSM-IV criteria do . . . [Full Text of this Article]

Patrick G. O’Connor, MD, MPH
patrick.oconnor@yale.edu
Section of General Internal Medicine
Department of Internal Medicine
Yale University School of Medicine
New Haven, Conn

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?