Chemical Dependence, as defined in the DSM, considers a number of factors, including the presence of abuse over time, as well as physiologic factors

Although dependence is often associated with addiction, it can be the body’s normal response to a substance. Previously, drug or alcohol dependence was a separate diagnosis, which caused a lot of confusion for both patients and doctors.

Today, the diagnosis of substance abuse disorder categorizes substance abuse and substance dependence into a single disorder, which has a rating from mild to severe. Mild substance use disorder in DSM-5 requires two to three symptoms out of 11 listed. So it’s harder to be diagnosed with this disorder than previously.

Change From DSM-IV

Previously, the distinction between abuse and dependence was based on the concept of abuse as a
mild or early phase and dependence as the more severe manifestation. In practice, the abuse criteria
were sometimes quite severe. The revised substance use disorder, a single diagnosis, will better match
the symptoms that patients experience.

DSM-IV criteria for substance dependence included whether substance dependence coincided with or without physiologic dependence (tolerance or withdrawal).


In addition, remission categories are classified into four subtypes:

  1. full
  2. early partial
  3. sustained
  4. sustained partial

Remission is based on the designation for abuse or dependence, and may also be used if a patient is receiving agonist therapy, like methadone maintenance to help with withdrawal. It may also be used for people who have just completed a drug rehab program and are now living in a drug-free environment, such as a sober living home, or aftercare facility.


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Association, 2015. Substance related and addictive disorders

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.