How do physicians diagnose opioid dependence?
Physicians use the DSM-IV-TR criteria for substance dependence and substance abuse to diagnose opioid dependence. Physicians evaluate a cluster of behaviors and physiologic effects that occurs in an opioid-dependent person within a specific time frame. Prior to making a diagnosis, the physician interviews the patient to obtain a history and conducts a physical examination. Physicians new to the field of opioid dependence can learn more about opioid-dependent patients when a collaborative system is in place; ie, one that includes counseling professionals.
A diagnosis of opioid dependence is based on the DSM-IV Criteria for Substance-Related Disorders.7 According to these criteria, a person is considered opioid-dependent when he or she manifests 3 or more of the following within a 12-month period7: • Tolerance (defined as a need for substantially greater amounts of an opioid to achieve the desired effect or a substantially reduced effect with continued use of the same amount of the opioid) • Withdrawal (which, for opioid dependence, is characterized by certain symptoms that appear when heavy or prolonged use of the opioid ceases or when an opioid antagonist is taken after a period of opioid use) • Frequent use of larger amounts of the opioid than planned or use of it over a longer period of time than planned • Persistent desire to cut down or control use of the opioid or trying unsuccessfully to do so • Devotion of a great deal of time toward obtaining the opioid, using it, or recovering from its effects • Surrendering of or reduction of
