sire to cut down or regulate substance use and may report multiple unsuccessful efforts to
decrease or discontinue use (Cri terion 2). The individual may sp end a great deal of time ob-
taining the substance, using the substance, or recovering from  its effects (Criterion 3). In
some instances of more severe substance use disorders, virtually all of the individual’s daily
activities revolve around  the substance. Craving (Criterion 4) is manifested by an intense de-
sire or urge for the drug that may occur at an y time but is more likely when in an environ-
ment where the drug previous ly was obtained or used. Cr aving has also been shown to
involve classical conditioning and is associated with activation of specific reward structures
in the brain. Craving is queried by asking if there has ever been a time when they had such
strong urges to take the drug th at they could not think of anythi ng else. Current craving is of-
ten used as a treatment outcome measure becaus e it may be a signal of impending relapse.
Social impairment is the second grouping of  criteria (Criteria 5–7) . Recurrent substance
use may result in a failure to fulfill major role obligations at work, sc hool, or home (Crite-
rion 5). The individual may continue substanc e use despite having persistent or recurrent
social or interpersonal problems caused or ex acerbated by the effects of the substance (Cri-
terion 6). Important social, occupational, or re creational activities ma y be given up or re-
duced because of substance us e (Criterion 7). The individual may withdraw from family
activities and hobbies in order to use the substance. 
Risky use of the substance is the third grouping of criteria (Criteria 8–9). This may take