substance dependence
Enable an agent to recognise and represent substance dependence under an explicit clinical or research framework, assess the evidence and course, and identify appropriate assessment or support actions without inferring a diagnosis from substance use alone.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an agent to recognise and represent substance dependence under an explicit clinical or research framework, assess the evidence and course, and identify appropriate assessment or support actions without inferring a diagnosis from substance use alone.
Substance dependence is a clinical syndrome involving impaired control over repeated psychoactive substance use, increasing priority given to use, and persistence despite harm, sometimes accompanied by tolerance or withdrawal, and is distinct from physiological adaptation alone.
It can be Clarify which meaning of dependence a statement uses and identify incompatible interpretations.; Organise substance-specific evidence for qualified assessment while preserving uncertainty and conflicting accounts.; Compare longitudinal changes using a consistent framework and explicit observation periods.; Distinguish exposure, physiological adaptation, acute harm, and dependence-related behaviour.; Identify when reported acute symptoms or contemplated changes in use require clinical assessment.; Record the person's goals, consent, and available supports to inform appropriate next steps..
Distinguishing features
An instance requires an explicit meaning of dependence and evidence relevant to that meaning; frequency of consumption alone does not establish it.
Physiological dependence concerns adaptation to exposure and must be distinguishable from a syndrome involving impaired regulation of use.
Tolerance or withdrawal during prescribed treatment must not automatically be interpreted as addiction or a substance use disorder.
An isolated episode of intoxication or substance-related harm does not by itself establish a continuing dependence pattern.
Evidence is attributed to an identified substance or justified substance grouping and a defined period, rather than to an undifferentiated label applied to a person.
Scope
+ Definitions of dependence, their authorities, and their relationship to addiction and substance use disorder
+ Substance-specific patterns of impaired control, increasing priority of use, and persistence despite adverse consequences
+ Tolerance, withdrawal, and physiological adaptation interpreted in their exposure and prescribing context
+ Evidence, uncertainty, functional effects, and changes over time
+ Assessment, support, and referral decisions constrained by consent and clinical competence
- Chemical composition, manufacture, and general pharmacology of substances
- Intoxication, poisoning, overdose, and withdrawal syndromes as standalone acute conditions
- Behavioural addictions without substance exposure
- Detailed treatment protocols, medication selection, and dosing
- Drug markets, criminal offences, and population drug policy
- Co-occurring conditions except where they affect interpretation of dependence
Characteristics
- Interpretive framework
- Named clinical classification and version; research definition; physiological dependence; colloquial usage; unresolved The same term can denote different conditions and support different conclusions.
- Substance and exposure context
- Person linked to substance or substance class, route, exposure period, and prescribed or non-prescribed context Dependence evidence and withdrawal implications depend on the exposure being described.
- Use pattern
- Substance-appropriate quantity and unit, frequency, duration, and variability; unknown where unavailable Exposure history supports interpretation but is not a standalone diagnostic threshold.
- Regulation of use
- Reported or observed difficulty controlling initiation, amount, circumstances, or termination; absent; uncertain; not assessed Loss of regulation distinguishes some dependence concepts from repeated but controlled consumption.
- Priority and persistence
- Evidence of displacement of activities or continuation despite recognised adverse consequences, with context and timeframe These patterns help characterise a dependence syndrome while requiring contextual interpretation.
- Physiological adaptation
- Tolerance and withdrawal recorded separately as supported, absent, uncertain, or not assessed Adaptation affects interpretation and safety without independently resolving the meaning of dependence.
- Functional effects
- Links to health, daily activities, relationships, and responsibilities, with attribution confidence Consequences need to be distinguished from coincident difficulties and effects of stigma or exclusion.
- Course and assessment status
- Time-indexed suspected or assessed condition; framework-specific course status; unknown Historical evidence and current state should not be conflated.
- Evidence basis
- Self-report, clinical assessment, collateral account, observation, or test; source, date, consent basis, and limitations Different evidence types support different inferences and may conflict.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 19 findings · 32 questions.
Definitions and instance boundaries Establishes what substance dependence means in this model instance and what evidence can support that interpretation.
The registry supplies no definition, and dependence cannot safely be treated as an unambiguous synonym for addiction.
Framework and authority
Records the source, version, and intended use of the operative definition.
Meaning of dependence
A structural requirement to distinguish a clinical syndrome, physiological adaptation, and informal usage.
- Does dependence here mean a clinical syndrome, physiological adaptation, or another explicitly defined construct? definition
- Which authority, classification version, or research source supplies that meaning? provenance
Operationalisation and neighbours
Makes instance criteria and relationships to neighbouring concepts explicit.
Criteria and concept mapping
Separates the chosen definition's requirements from potentially overlapping labels.
- What evidence, observation period, exclusions, and decision rules does the selected framework require? measurement
- How does this framework relate dependence to addiction, harmful use, and substance use disorder without assuming equivalence? boundary
Substance exposure and adaptation Locates dependence evidence in an identifiable substance exposure and distinguishes adaptation from behavioural regulation.
An agent needs enough exposure context to interpret tolerance and withdrawal without mistaking consumption or prescribed treatment for a dependence syndrome.
Exposure pattern
Records the substance, route, timing, and context of use.
Attributable substance history
Connects each assessment to a specific exposure history and records uncertainty about mixed or unidentified substances.
- Which substance or substance class, route, quantity, frequency, and duration are supported by the available history? measurement
- Can the reported pattern be attributed to one substance, or do co-use and uncertain composition prevent that attribution? boundary
Tolerance and withdrawal
Assesses physiological adaptation in relation to exposure changes and alternative explanations.
Adaptation in context
Keeps tolerance and withdrawal separate from conclusions about impaired control or addiction.
- What evidence supports tolerance or withdrawal, and how does it relate in time to continued, reduced, or interrupted exposure? measurement
- Could prescribed treatment, recurrence of the treated condition, or another process explain the reported changes? boundary
- Does a proposed reduction or interruption require substance-specific clinical assessment before action? action
Regulation, priority, and consequences Examines the behavioural and experiential patterns relevant to syndrome-based meanings of dependence.
Exposure measures alone cannot show how substance use is regulated or how it competes with other activities.
Control and desire
Separates intended use, actual use, craving, and circumstances affecting choice.
Difficulty regulating use
Organises concrete examples of difficulty controlling use without treating desire or external restriction as sufficient evidence.
- When has actual use departed from the person's intentions about starting, amount, setting, or stopping? measurement
- How are craving, pain management, withdrawal avoidance, and environmental constraints distinguished in the person's account? boundary
Priority and adverse effects
Examines displacement of activities and continuation in the presence of recognised consequences.
Use relative to other commitments
Records concrete changes in activities and consequences while preserving uncertainty about causation.
- Which valued activities or responsibilities have been displaced, and over what period? measurement
- What adverse consequences were recognised before use continued, and whose account establishes that sequence? provenance
- Which difficulties arise from substance effects or use patterns, and which may arise from stigma, deprivation, or other conditions? boundary
Evidence and longitudinal state Preserves the basis of an assessment and tracks changes without turning a past label into a permanent identity.
Dependence assessments require interpretation across time, and evidence may be incomplete, inconsistent, or gathered under constrained conditions.
Assessment evidence
Separates reports, observations, instruments, tests, and qualified judgments.
Evidence strength and limits
Records what each source supports and what remains unassessed.
- Who supplied each observation, when was it obtained, and what limitations or disagreements affect it? provenance
- Does an instrument or test support screening, exposure detection, or diagnosis under the chosen framework? boundary
Course and context
Represents transitions in use, symptoms, functioning, and assessment status.
Time-indexed dependence state
Distinguishes current evidence from historical assessment and interprets reduced use in context.
- How have use, control, adaptation, and functioning changed across clearly dated periods? measurement
- How do treatment, restricted access, or environmental changes affect interpretation of reduced use or apparent remission? boundary
- Which framework-specific rules justify a course label, and what evidence is still missing? definition
Support and action boundaries Connects the represented condition to proportionate, person-directed support and appropriate clinical escalation.
Recognising a possible dependence pattern should enable useful action without authorising diagnosis, coercion, or an improvised treatment plan.
Acute needs and referral
Routes immediate concerns to assessment of the relevant acute condition.
Clinical assessment triggers
Keeps acute safety decisions distinct from whether a dependence diagnosis has been established.
- Are there current reports suggesting overdose, severe intoxication, withdrawal, or another acute condition requiring assessment? action
- Which verified clinical guidance and local service pathway govern the response to this substance-specific concern? provenance
Goals, consent, and support
Records the person's priorities and practical conditions for agreed next steps.
Person-directed next step
Links support options to expressed goals, access, and permission to use or share sensitive information.
- What change or support does the person want, and what barriers or existing supports affect that choice? action
- What next step is within the agent's role, and what consent is needed for referral or information sharing? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- The unqualified registry label is interpreted as the clinical dependence syndrome, not physical dependence alone; its placement under ACT.ACT does not settle that ambiguity.
- Diagnostic criteria, duration requirements, and exact codes should be checked against the intended classification edition and national modification.
- This is recalled knowledge, not source-verified research; the DSM criterion count measures substance use disorder severity rather than a universal dependence scale.
- Which of these check these first hold for the sense of substance dependence this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Alcohol dependence
- Opioid dependence
- Nicotine dependence
- Sedative, hypnotic or anxiolytic dependence
- Stimulant dependence
- Cannabis dependence
- Which of these kinds and varieties hold for the sense of substance dependence this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 - F10-F19 with fourth character .2 - WHO dependence-syndrome codes are differentiated by substance class; national modifications may use additional characters.
- ICD-11 - Substance-specific dependence categories within disorders due to substance use - The identifier depends on the substance and clinical category; no single code is asserted here.
- Which of these identifiers and schemes hold for the sense of substance dependence this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- World Health Organization ICD-10: substance-specific dependence syndrome categories.
- World Health Organization ICD-11: substance-specific dependence categories and diagnostic requirements.
- American Psychiatric Association DSM-5-TR: substance use disorders integrate the former abuse and dependence diagnoses into substance-specific disorders graded by severity.
- Which of these standards and regulation hold for the sense of substance dependence this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical assessment and diagnostic coding.
- Planning substance-specific treatment and continuing care.
- Assessing withdrawal risk and the need for medically supervised withdrawal.
- Population surveillance and evaluation of treatment outcomes.
- Determining eligibility for services under jurisdiction-specific rules.
- Which of these real-world use hold for the sense of substance dependence this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- DSM-5-TR substance use disorder criterion count - For most substance classes: 2-3 mild, 4-5 moderate, and 6 or more severe within 12 months - criteria met
- Frequency of substance use - 0-30 in a 30-day assessment window - days of use
- Which of these typical measurements hold for the sense of substance dependence this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Mistaking tolerance or withdrawal during prescribed treatment for a dependence syndrome or substance use disorder.
- Missing potentially life-threatening alcohol or sedative withdrawal.
- Overdose, including after loss of tolerance during abstinence and when combining substances with respiratory-depressant effects.
- Stigma and diagnostic assumptions that obscure co-occurring conditions or discourage care.
- Applying criteria or measurement instruments across substances and populations without checking their suitability.
- Which of these failure modes and hazards hold for the sense of substance dependence this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Health systems differ in their use of ICD versions, national coding modifications, and DSM terminology.
- Access to treatment, harm reduction, and controlled medicines varies by jurisdiction.
- Legal and cultural responses to substance use influence disclosure, diagnosis, and service access.
- Which of these regional variation hold for the sense of substance dependence this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Physical dependence - Physiological adaptation produces withdrawal when exposure stops or falls; it can occur without impaired control, prioritisation of use, or continued use despite harm.
- Substance use disorder - DSM-5-TR uses a graded criterion-based diagnosis that replaced separate abuse and dependence diagnoses; it is not an exact synonym for ICD dependence.
- Addiction - An overlapping term commonly emphasising compulsive use despite adverse consequences, but its diagnostic scope is not uniform across institutions.
- Substance intoxication - An acute substance-related state can occur after an episode of use without an established dependence syndrome.
- Substance withdrawal - A substance-specific syndrome following reduction or cessation of exposure does not by itself establish the broader dependence syndrome.
- Harmful pattern of substance use - Substance use causing clinically significant harm need not meet the additional requirements for dependence.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of substance dependence this model covers, and on what evidence? provenance
What the second pass must settle
- Does the registry intend substance dependence to denote a clinical syndrome, physiological dependence, or an umbrella covering both?
- Which authoritative classification versions and research definitions should anchor this model, and where do their criteria and concept boundaries differ?
- Which substance-specific assessment measures are appropriate across age groups, prescribing contexts, languages, and care settings?
- How should mixed-substance exposure and uncertain composition be represented when dependence-related evidence cannot be attributed reliably?
- Does an existing Vercy world model already own this concept, and how should this registry entry link to models of addiction, substance use disorder, and withdrawal without duplicating them?