• Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant. • Tolerance, as defined by either of the following: o A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect. o A markedly diminished effect with continued use of the same amount of the stimulant. • Withdrawal, as manifested by either of the following: o The characteristic withdrawal syndrome for the stimulant. o The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. Opioid use disorder A problematic pattern of opioid use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period: • Opioids are often taken in larger amounts or over a longer period than was intended. • There is a persistent desire or unsuccessful efforts to cut down or control opioid use. • A great amount of time is spent in activities necessary to obtain opioids, use opioids, or recover from their effects. • Craving, or a strong desire or urge to use opioids. • Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home. • Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. • Important social, occupational, or recreational activities are given up or reduced because of opioid use. • Recurrent opioid use in situations in which it is physically hazardous. • Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
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