What indicates the presence of tolerance in substance use disorders?

The presence of tolerance in substance use disorders is indicated by the need for larger amounts of a substance to achieve the desired effects. Tolerance occurs when a person’s body becomes accustomed to the substance, leading to diminished effects with the same amount, which prompts the individual to consume greater quantities to reach the same level of intoxication or effect they previously experienced with lesser amounts. This is a key diagnostic criterion in the DSM-5-TR, as it reflects a physiological adaptation to the substance.

In contrast, increased cravings after use, social disengagement, and regular participation in activities without the substance do not specifically signify tolerance. While cravings can indicate a strong desire to use a substance, and disengagement might reflect the negative consequences of substance use, they do not measure the physiological changes associated with needing more of the substance. Regularly participating in activities without the substance can be a sign of recovery or control rather than a sign of tolerance. Thus, the requirement for larger amounts ties directly to the concept of tolerance.