Clinicians treating patients with HIV/AIDS must have a good working knowledge of SUDs, since most of their patients will have a current or lifetime history of at least one such disorder. Using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV; American Psychiatric Association, 1994) terminology, SUDs can be divided into three basic categories: substance abuse, substance dependence, and substance-induced disorders. The criteria for abuse and dependence are listed in Table 8.1. Tolerance refers to an acquired decrease in the effect of a substance usually manifested by a need for increased amounts of the substance to achieve the desired effect. Withdrawal is a substance-specific group of signs and symptoms that follows the abrupt discontinuation, reduction, or antagonistic blockage of a substance. It should be noted that tolerance and physical dependence evidenced by withdrawal symptoms are not sufficient in and of themselves to warrant a diagnosis of substance dependence. Rather, substance dependence should be recognized as a cluster of cognitive, behavioral, and physiological symptoms indicating that a person is continuing to use a substance despite having clinically significant substance-related problems (Cami and Farre, 2003). The substance-induced disorders are listed in Table 8.2.
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