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Definitions, Clinical Description, and Diagnosis

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There is a range of use behaviors and patterns of use. At one end of the use spectrum lies abstinence. Substance use (often without significant consequences or impairment) comprises the largest group of adolescents. DSM-IV (American Psychiatric Association 1994), and its text revision, DSM-IV-TR (American Psychiatric Association 2000), contain two substance-related diagnoses, abuse and dependence. Substance use per se is not sufficient for a diagnosis of abuse or dependence, even in adolescents. There are three distinct concepts to consider: abuse and dependence, misuse (which includes use), and diversion. Although not an official term, misuse can be defined as use for a purpose not consistent with medical guidelines (e.g., modifying dose, using to achieve euphoria, and/or using with other nonprescribed psychoactive substances [World Health Organization 2007]). The term diversion is the transfer of medication from the individual for whom it was prescribed to one for whom it was not prescribed. While abuse and dependence are terms that connote psychopathology related to substance use, diversion and misuse are not.

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