substance dependence refers to a diagnosis of an adolescent (or adult) who must show a maladaptive pattern of substance use for at least 12 months, accompanied by three (3) or more significant clinical signs of distress tolerance (the need for increased amounts to achieve intoxication), withdrawal (cognitive and physiological changes upon discontinuation of the drug), and other indices of compulsive use. Substance dependence is also characterized as with or without physiological dependence (i.e., with or without evidence of tolerance or withdrawal).

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