Table 1

Criteria for the dependence syndrome according to the Tenth Revision of the International Classification of Diseases and Health Problems (ICD-10)16

ICD-10 criteria for dependence syndromeWTS publications addressing each criterion
1. A strong desire or sense of compulsion to take the substance32 66 97 98 100 101
2. Impaired capacity to control substance-taking behaviour in terms of its onset, termination or levels of use, as evidenced by the substance being often taken in larger amounts or over a longer period than intended, or by a persistent desire or unsuccessful efforts to reduce or control substance use32 98 101 102
3. A physiological withdrawal state when substance use is reduced or ceased, as evidenced by the characteristic withdrawal syndrome for the substance, or by use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms66 104
4. Evidence of tolerance to the effects of the substance, such that there is a need for significantly increased amounts of the substance to achieve intoxication or the desired effect, or a markedly diminished effect with continued use of the same amount of the substance63 74 80 100 106
5. Preoccupation with substance use, as manifested by important alternative pleasures or interests being given up or reduced because of substance use; or a great deal of time being spent in activities necessary to obtain, take or recover from the effects of the substance29 80 100
6. Persistent substance use despite clear evidence of harmful consequences as evidenced by continued use when the individual is actually aware, or may be expected to be aware, of the nature and extent of harm 
  • WTS, Waterpipe tobacco smoking.