486 Substance-Related and Addictive Disorders
sustained, or “chronic,” intoxications. For example, moderate cocaine doses may initially
produce gregariousness, but social withdrawal  may develop if such doses are frequently
repeated over days or weeks.
When used in the physiological sense, the term intoxication  is broader than substance
intoxication as defined here. Many substances may produce physiological or psychologi-
cal changes that are not necessarily problematic. For example, an individual with tachy-
cardia from substance use has a physiological effe ct, but if this is the only symptom in the
absence of problematic behavior, the diagnosis of intoxication would not apply. Intoxica-
tion may sometimes persist beyond the time when the substance is detectable in the body.
This may be due to enduring central nervous system effects,  the recovery of which takes
longer than the time for elimination of the su bstance. These longer-term effects of intoxi-
cation must be distinguished from withdraw al (i.e., symptoms initiated by a decline in
blood or tissue concentrat ions of a substance).
Criteria for substance withdrawal are included within the su bstance-specific sections of
this chapter. The essential feat ure is the development of a subs tance-specific problematic be-
havioral change, with physiologic al and cognitive concomitants, that is due to the cessation of,
or reduction in, heavy and prolonged substance use (Criterion A). The substance-specific syn-
drome causes clinically significant distress or impairment in social, oc cupational, or other im-
portant areas of functioning (Criterion C). The symptoms are not due to another medical
condition and are not better explained by anot her mental disorder (Criterion D). Withdrawal
is usually, but not always, as sociated with a substance use disorder. Most individuals with