What are the dsm-5 criteria for substance use disorder

The DSM-5 establishes nine types of Substance-Related Disorders:

1. Alcohol
2. Caffeine*
3. Cannabis (e.g., marijuana)
4. Hallucinogens
5. Inhalants
6. Opioid (e.g., heroin)
7. Sedatives, Hypnotics, or Anxiolytics (e.g., valium, "qualudes")
8. Stimulants (cocaine, methamphetamine)
9. Tobacco

*Substance use disorder does not apply to caffeine.

Regardless of the particular substance, the diagnosis of a substance use disorder is based upon a pathological set of behaviors related to the use of that substance. These behaviors fall into four main categories:

1. Impaired control
2. Social impairment
3. Risky use
4. Pharmacological indicators (tolerance and withdrawal)

Let's review each of these key diagnostic criteria in greater detail.

1.A. Impaired control:

Impaired control may be evidenced in several different ways:

1) Using for longer periods of time than intended, or using larger amounts than intended; 2) Wanting to reduce use, yet being unsuccessful doing so; 3) Spending excessive time getting/using/recovering from the drug use; 4) Cravings that are so intense it is difficult to think about anything else.

2.B. Social impairment

You may recall our definition of addiction: Addiction is repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable. Social impairment is one type of substantial harm (or consequence) caused by the repeated use of a substance or an activity.

5) People may continue to use despite problems with work, school or family/social obligations. This might include repeated work absences, poor school performance, neglect of children, or failure to meet household responsibilities.

6) Addiction may also be indicated when someone continues substance use despite having interpersonal problems because of the substance use. This could include arguments with family members about the substance use; or, losing important friendships because of continued use.

7) Important and meaningful social and recreational activities may be given up or reduced because of substance use. A person may spend less time with their family, or they may stop playing golf with their friends.

3.C. Risky Use

The key issue of this criterion is the failure to refrain from using the substance despite the harm it causes.

8) Addiction may be indicated when someone repeatedly uses substances in physically dangerous situations. For instance, using alcohol or other drugs while operating machinery or driving a car.

9) Some people continue to use addictive substances even though they are aware it is causing or worsening physical and psychological problems. An example is the person who continues to smoke cigarettes despite having a respiratory disorder such as asthma or COPD.

4.D. Pharmacological indicators: Tolerance and Withdrawal

For many people, tolerance and withdrawal are the classic indicators of advanced addiction. As such, these are particularly important concepts. This criterion refers to the adjustment the body makes as it attempts to adapt to the continued and frequent use of a substance. This adjustment is called maintaining homeostatic balance.

10) Tolerance occurs when people need to increase the amount of a substance to achieve the same desired effect. Stated differently, it is when someone experiences less of an effect using the same amount. The "desired effect" might be the desire to avoid withdrawal symptoms. On the other hand, it may be the desire to get high. People experience tolerance differently; i.e., people vary in their sensitivities to different substances. Specific drugs will vary in terms of how quickly tolerance develops and the dose needed for tolerance to develop.

11) Withdrawal is the body's response to the abrupt cessation of a drug, once the body has developed a tolerance to it. The resulting cluster of (very unpleasant and sometimes fatal) symptoms is specific to each drug. We discuss these specific symptoms in each substance category. Although withdrawal is very unpleasant, it does not usually require medical assistance. However, withdrawal from some drugs can be fatal. Therefore, consult with a medical professional before attempting to stop drug use after a period of heavy and continuous use. This will ensure that quitting is as safe and comfortable as possible.

If a person is experiencing withdrawal symptoms at the time they are being evaluated for treatment, they will be diagnosed with both substance use and substance withdrawal.

A person needs to meet at least 2 of these criteria to be diagnosed with a substance-use disorder. The severity of addiction is determined by the number of criteria met.

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), substance-related disorders are categorized into 10 classes based on use of the following substances: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, tobacco, and other (or unknown) substances. There are two categories of substance-related disorders: (a) substance use disorders and (b) substance-induced disorders.

A. Substance Use Disorders Criteria:

There are 11 symptoms for each substance class (except for caffeine) that are used to make a substance use disorder diagnosis. The diagnosis is made along a continuum—mild, moderate, or severe—based on the number and severity of the symptoms.

Specify current severity based on the following guidelines:

Mild: Presence of 2 or 3 symptoms
Moderate: Presence of 4 or 5 symptoms
Severe: Presence of 6 or more symptoms

Symptoms include:

1. Substance is taken in larger amounts or over longer periods than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control substance use.
3. A great deal of time is spent in activities necessary to obtain substance, use substance, or recover from its effects.
4. Craving, or a strong desire or urge to use substance.
5. Recurrent use of the substance is resulting in a failure to fulfill major role obligations at work, home, or school.
6. Continued use of substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. Recurrent substance use in situations in which it is physically hazardous.
9. 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.
10. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either of the following:
    (Withdrawal does not apply for every substance.)
    
    • The characteristic withdrawal syndrome for that substance (see additional criteria in DSM-5).
    • The substance is taken to relieve or avoid withdrawal symptoms.

The information above is only an overview of the criteria used. Consult the DSM-5 before making a diagnosis.

B. Substance-induced Disorders

Substance-induced disorders include intoxication, withdrawal, and other substance/medication-induced disorders. See the DSM-5 manual for a complete description of criteria for each category.

The following conditions may be classified as substance-induced disorders:

Substance-induced disorders
Intoxication	Refers to a reversible set of symptoms occurring after the use or exposure to a drug Symptoms may vary based on substance used May occur in those without substance use disorders Symptoms are not attributable to another medical condition or mental disorder
Withdrawal	Diagnosed based on the behavioral, physical, and cognitive symptoms that occur due to the abrupt reduction or discontinuation of heavy and prolonged substance use Symptoms are not attributable to another medical condition or mental disorder Note, use and discontinuation of some drugs does not result in a withdrawal syndrome
Other substance/medication-induced mental disorders	This category includes: Psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive-compulsive and related disorders Sleep disorders Sexual dysfunctions Delirium Neurocognitive disorders

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