Substance-use disorders: key distinctions

Related terms describe different phenomena

Intoxication concerns the acute effects of a substance; withdrawal concerns symptoms associated with reduction or cessation after exposure. Tolerance concerns a change in response with repeated exposure. These concepts do not, individually, describe the whole longer-term pattern of use.

A dependence assessment examines impaired regulation and the priority given to use alongside consequences and, where applicable, physiological features. Avoid making a diagnosis solely from the presence of tolerance or a single quantity reported.

Use a substance-specific timeline

Document each substance, route and pattern separately, including the timing of psychiatric and physical symptoms. Periods of sustained non-use, recurrence of use and previous treatment can clarify the longitudinal picture. Record uncertainty about amount and preparation.

Co-occurring mental disorders are not automatically explained by substance use. Examine whether symptoms preceded exposure, changed with it or remained present outside its acute effects. A temporal relationship needs careful interpretation.

Explain the framework being used

The ICD-11 source and the older ICD-10-oriented handout organize dependence differently. Do not mix their criteria into one checklist. Describe the observed features, identify the classification reference and let the clinician evaluate the complete requirements.

A learning discussion should include functioning, consequences, supports and the person’s goals. This website does not provide withdrawal treatment, detoxification instructions or automated labels for individual patients.

For your next supervision discussion

Compare evidence of tolerance with evidence of impaired regulation of use. Which facts concern physiological adaptation, which concern the pattern of behaviour, and which important parts of the history are absent?