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Addiction historically has been a difficult concept to define. Because substances differ in their potential addictiveness, as do people in their susceptibility to the effects of such substances, it has been difficult to develop a definition that embraces all the variables. The two main definitions of addiction in the United States come from the World Health Organization’s (WHO) International Classification of Diseases (ICD) and from the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM).

A cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

The dependence syndrome may be present for a specific psychoactive substance (e.g. tobacco, alcohol, or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of pharmacologically different psychoactive substances.

Criteria for substance dependence
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

tolerance, as defined by either of the following:

a need for markedly increased amounts of the substance to achieve intoxication or desired effect
markedly diminished effect with continued use of the same amount of the substance

withdrawal, as manifested by either of the following:

the characteristic withdrawal syndrome for the substance . . .
the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

the substance is 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 substance use
a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
important social, occupational, or recreational activities are given up or reduced because of substance use
the substance 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 substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

The symptoms have never met the criteria for substance dependence for this class of substance.

Problems with these definitions

The first problem is that words like “desire” and “compulsion” are subjective and therefore difficult to meaningfully define for a large population. If I really want a cold beer at the end of a long hike, or a glass of wine after a day in court, that string desire is a legitimate desire, isn’t it? If I’m willing to drive half an hour to find an open tavern, is that a compulsion? If I really need a cup of coffee to stay awake while studying or driving, is that a compulsion? Second, cocaine exhibits few physical withdrawal symptoms. How can non-physical withdrawal be measured to determine addiction? Finally, there are many different forms of tolerance, some physical, some environmental and some psychological. Neither the WHO nor the APA definition specifies which kinds, and what level, of tolerance constitute addiction. Nevertheless there are millions of Americans who are unable to control their use of cocaine and whose lives—and the lives of those around them—are seriously hurt at the price of great pain and extraordinary personal, familial and public cost. Every person reacts differently to drugs: pinpointing the likelihood of addiction for any given person is nearly impossible.