the International Classifcation of Diseases, Version 10 (ICD‑10), a diagnosis of drug dependency should be made if more than three of the following elements are present:7 X a strong desire or sense of compulsion to take the substance; X difculties in controlling substance‑taking behaviour in terms of its onset, termination or levels of use; Xa physiological withdrawal state when substance use has ceased or been reduced, as evidenced by the characteristic withdrawal syndrome for the substance; X evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve efects originally produced by lower doses; X progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its efects; X persisting with substance use despite clear evidence of overtly harmful consequences. The diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM‑IV) are, in essence, the same, apart from the additional item “persistent desire or unsuccessful eforts to cut down or control substance use”.8 Adverse consequences The adverse health consequences of psychoactive drug dependency include the acute and chronic toxic efects of the drug itself, accidental or suicidal overdose, intoxication, trafc accidents and chronic toxicity, mainly by alcohol and tobacco but also chronic neuropsychiatric conditions of other substance groups. Other adverse health sequels relate to poverty and lifestyle, such as malnutrition, sexually transmitted diseases, tuberculosis and dental problems, or to the route of drug application, such as the blood‑borne transmissible infections HIV/hepatitis B and C, bacterial septicaemia, lung abscesses, endo‑ carditis and others in intravenous injectors, or destruction of nasal mucosa in cocaine snifers and others. 7. WHO: ICD‑10 (Geneva 2010). 8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (Washington DC 1994). Psychoactive drugs and the medical management of drug‑addicted prisoners Page 73