Which of the following is NOT a symptom of substance dependence as per DSM IV-TR?

The correct answer identifies complicated relationships as not being a specific symptom of substance dependence according to the DSM IV-TR. Substance dependence primarily includes physiological and behavioral symptoms that directly relate to the individual's relationship with the substance itself.

Tolerance refers to the need to increase the amount of a substance to achieve the same effects, which is a clear physiological symptom. Withdrawal symptoms involve physical and psychological issues that arise when a person reduces or stops using a substance, indicating a physical dependence. Unsuccessful attempts to cut down reflect a behavioral pattern of dependence where the individual recognizes the problem yet struggles to modify their use.

Complicated relationships, while often a consequence of substance dependence, are not classified as a symptom in the diagnostic criteria. Rather, they are more of a social or relational impact that can result from the substance use and may contribute to the individual's challenges, but they do not fall under the direct symptoms outlined in the DSM IV-TR. Understanding this distinction is crucial for recognizing the specific criteria that characterize substance dependence.