The DSM-IV Substance Use Disorders Workgroup carried out extensive analysis in an effort to define abuse more precisely. Accordingly, in DSM-IV, four separate items, not included in dependence, are listed for the diagnosis of abuse, focusing on social, physical, legal, and interpersonal problems associated with alcohol use. These problems must have occurred repeatedly over a 12-month period, and caused 'clinically significant impairment or distress' ( Tabie.5).

Table 5 Criteria for abuse or harmful use of substances

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