Psychological Disorders: Amphetamine Dependence

American Description
A. Amphetamine (or similar stimulant) abuse: A destructive pattern of amphetamine (or similar stimulant) use, leading to significant social, occupational, or medical impairment.

B. Must have three (or more) of the following, occurring when the amphetamine (or similar stimulant) use was at its worst:

1. Amphetamine (or similar stimulant) tolerance:
Either need for markedly increased amounts of amphetamine (or similar stimulant) to achieve intoxication, or markedly diminished effect with continued use of the same amount of amphetamine (or similar stimulant).

2. Amphetamine (or similar stimulant) withdrawal symptoms:
Either (a) or (b).
(a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged amphetamine (or similar stimulant) use:
sweating or rapid pulse
increased hand tremor
insomnia
nausea or vomiting
physical agitation
anxiety
transient visual, tactile, or auditory hallucinations or illusions
grand mal seizures
(b) Amphetamine (or similar stimulant) is taken to relieve or avoid withdrawal symptoms.

3. Greater use of amphetamine (or similar stimulant) than intended:
Amphetamine (or similar stimulant) was often taken in larger amounts or over a longer period than was intended

4. Unsuccessful efforts to cut down or control amphetamine (or similar stimulant) use:
Persistent desire or unsuccessful efforts to cut down or control amphetamine (or similar stimulant) use

5. Great deal of time spent in using amphetamine (or similar stimulant), or recovering from hangovers

6. Amphetamine (or similar stimulant) caused reduction in social, occupational or recreational activities:
Important social, occupational, or recreational activities given up or reduced because of amphetamine (or similar stimulant) use.

7. Continued using amphetamine (or similar stimulant) despite knowing it caused significant problems:
Amphetamine (or similar stimulant) use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by amphetamine (or similar stimulant)

European Description
A cluster of physiological, behavioural, and cognitive phenomena in which the use of other stimulants including caffeine takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take stimulants (which may or may not have been medically prescribed). There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.

Diagnostic Guidelines
A definite diagnosis of dependence should usually be made only if three or more of the following have been experienced or exhibited at some time during the previous year:

(a) a strong desire or sense of compulsion to take stimulants;

(b) difficulties in controlling stimulant-taking behaviour in terms of its onset, termination, or levels of use;

(c) a physiological withdrawal state when stimulant use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for stimulants; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;

(d) evidence of tolerance, such that increased doses of stimulants are required in order to achieve effects originally produced by lower doses;

(e) progressive neglect of alternative pleasures or interests because of stimulant use, increased amount of time necessary to obtain or take the substance or to recover from its effects;

(f) persisting with stimulant use despite clear evidence of overtly harmful consequences, such as depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

Narrowing of the personal repertoire of patterns of stimulant use has also been described as a characteristic feature.

It is an essential characteristic of the dependence syndrome that either stimulant taking or a desire to take stimulants should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use.