578 Substance-Related and Addictive Disorders
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication
or desired effect.
b. A markedly diminished effect with continued use of the same amount of the sub-
stance.
11. Withdrawal, as manifested by either of the following: 
a. The characteristic withdrawal syndrome fo r other (or unknown) substance (refer to
Criteria A and B of the criteria sets fo r other [or unknown] substance withdrawal,
p. 583).
b. The substance (or a closely related substance) is taken to relieve or avoid with-
drawal symptoms.
Specify if:
In early remission:  After full criteria for other (or unknown) substance use disorder were
previously met, none of the criteria for other (or unknown) substance use disorder have
been met for at least 3 months but for less than 12 months (with the exception that Cri-
terion A4, “Craving, or a strong desire or urge to use the substance,” may be met).
In sustained remission:  After full criteria for other (or unknown) substance use disor-
der were previously met, none of the criteria  for other (or unknown) substance use dis-
order have been met at any time during a period of 12 months or longer (with the
exception that Criterion A4, “Craving, or a strong desire or urge to use the substance,”
may be met).
Specify if:
In a controlled environment:  This additional specifier is used if the individual is in an
environment where access to the substance is restricted.
Coding based on current severity:  Note for ICD-10-CM codes: If an other (or unknown) sub-