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Alcohol & Substance Dependence Symptoms

Also Known as Alcoholism or Addiction

Dependence upon alcohol or a specific substance (such as cocaine, nicotine, marijuana, etc.) is characterized by a maladaptive pattern of alcohol or substance use, leading to clinically significant impairment or distress, as manifested by 3 or more of the following, occurring at any time in the same 12-month period:

  1. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of the alcohol or substance to achieve intoxication or desired effect
    • Markedly diminished effect with continued use of the same amount of the alcohol or substance
  2. Withdrawal, as manifested by either of the following:
    • 2 or more of the following, developing within several hours to a few days of reduction in heavy or prolonged alcohol or substance 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
    • The same substance (or another substance) or alcohol is taken to relieve or avoid withdrawal symptoms
  3. The substance or alcohol is often taken in larger amounts or over a longer period than was intended
  4. There is a persistent desire or unsuccessful efforts to cut down or control use of alcohol or the substance
  5. A great deal of time is spent in activities necessary to obtain alcohol or the substance (e.g., visiting multiple doctors or driving long distances), using alcohol or a substance (e.g., chain-smoking), or recovering from its effects
  6. Important social, occupational, or recreational activities are given up or reduced because of the continued alcohol or substance use
  7. The substance or alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)


***NOTE: This condition is not a disorder recognized within the DSM-5, the 2013 update of the diagnostic manual. This page is here on PsychCentral for historical purposes only.  See revised symptoms of substance use disorders.

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John M. Grohol, Psy.D.

Dr. John Grohol is the founder and Editor-in-Chief of Psych Central. He is an author, researcher, and expert in mental health online, and has been writing about online behavior, mental health and psychology issues since 1995. Dr. Grohol has a Master's degree and doctorate in clinical psychology from Nova Southeastern University. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member of the Society for Participatory Medicine. You can learn more about Dr. John Grohol here.

APA Reference
Grohol, J. (2020). Alcohol & Substance Dependence Symptoms. Psych Central. Retrieved on November 26, 2020, from
Scientifically Reviewed
Last updated: 8 Jul 2020 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2020
Published on Psych All rights reserved.