specific intoxication or substance-specific wi thdrawal will usually suffice to categorize the
symptom presentation. A diag nosis of substance/medication-induced anxiety disorder
should be made in addition to  substance intoxication or su bstance withdrawal when the
panic or anxiety symptoms are predominant in the clinical picture and are sufficiently se-
vere to warrant independent c linical attention. For example, panic or anxiety symptoms
are characteristic of alcohol withdrawal. 
Anxiety disorder (i.e., not indu ced by a substance/medication). Substance/medication-
induced anxiety disorder is judged to be etio logically related to the substance/medication.
Substance/medication-induced anxiety disord er is distinguished from a primary anxiety
disorder based on the onset, course, and othe r factors with respect to substances/medica-
tions. For drugs of abuse, there must be eviden ce from the history, physical examination, or
laboratory findings for use,  intoxication, or withdrawal . Substance/medication-induced
anxiety disorders arise only in association with  intoxication or with drawal states, whereas
primary anxiety disorders may precede the onse t of substance/medication use. The pres-
ence of features that are atypical of a primary anxiety disorder, such as atypical age at onset
(e.g., onset of panic disorder after age 45 year s) or symptoms (e.g., atypical panic attack
symptoms such as true vertigo, loss of balanc e, loss of consciousness , loss of bladder con-
trol, headaches, slurred speech) may suggest a substance/medication -induced etiology. A
primary anxiety disorder diagnosis is warranted if the panic or anxiety symptoms persist
for a substantial period of time (about 1 mont h or longer) after the end of the substance in-