Home › DSM-IV Diagnostic Criteria of Mental Disorders › Substance Use Disorders ›

Opioid Dependence

Opioid Dependence Diagnostic Criteria

  1. Opioid abuse: A destructive pattern of opioid use, leading to significant social, occupational, or medical impairment.
  2. Must have three (or more) of the following, occurring when the opioid use was at its worst:
    1. Opioid tolerance: Either need for markedly increased amounts of opioid to achieve intoxication, or markedly diminished effect with continued use of the same amount of opioid.
    2. Opioid 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 opioid 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
      Opioid is taken to relieve or avoid withdrawal symptoms
    3. Greater use of opioid than intended: opioid was often taken in larger amounts or over a longer period than was intended
    4. Unsuccessful efforts to cut down or control opioid use:
      Persistent desire or unsuccessful efforts to cut down or control opioid use
    5. Great deal of time spent in using opioid, or recovering from hangovers
    6. Opioid caused reduction in social, occupational or recreational activities: Important social, occupational, or recreational activities given up or reduced because of opioid use.
    7. Continued using opioid despite knowing it caused significant problems: Continued opioid use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by nicotine

Associated Feature

  • Learning Problem
  • Dysarthria or Involuntary Movement
  • Hypoactivity
  • Euphoric Mood
  • Depressed Mood
  • Somatic or Sexual Dysfunction
  • Addiction
  • Sexually Deviant Behavior
  • Dramatic or Erratic or Antisocial Personality

Differential Diagnosis

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which he/she needs to rule out to establish a precise diagnosis.

  • Nonpathologic opioid use for recreational or medical purposes;
  • Repeated episodes of Opioid Intoxication.