DSM-5 Criteria for Substance Use Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides healthcare professionals with standardized criteria for diagnosing mental health conditions, including Substance Use Disorders (SUDs).

This diagnostic framework helps clinicians accurately identify, assess, and treat individuals struggling with addiction to various substances, including alcohol, cannabis, opioids, stimulants, and more.

The DSM-5 represents a significant shift from previous editions by replacing the separate diagnoses of substance abuse and substance dependence with a single continuum of “Substance Use Disorders” with varying levels of severity.

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The History of the DSM-5

The American Psychiatric Association (APA) published the DSM-5 in May 2013, replacing the DSM-IV-TR, which had been in use since 2000. This revision was the result of a 12-year development process involving hundreds of mental health experts, researchers, and clinicians.

Key historical developments in the DSM’s approach to substance use include:

DSM-I (1952) and DSM-II (1968): Addiction was classified primarily as a personality disorder or symptom of underlying psychopathology.
DSM-III (1980): Introduced the concepts of “substance abuse” and “substance dependence” as separate disorders.
DSM-IV (1994): Refined criteria for substance abuse and dependence but maintained them as distinct diagnoses.
DSM-5 (2013): Combined abuse and dependence into a single “Substance Use Disorder” diagnosis with a severity spectrum, removing the problematic “abuse” terminology and eliminating the criterion related to legal problems while adding craving as a new criterion.

This evolution reflects growing scientific understanding of addiction as a spectrum disorder affecting brain function and behavior, rather than a moral failing or simply a matter of physical dependence.

DSM-5's 11 Criteria for Addiction

The DSM-5 defines a Substance Use Disorder through 11 potential symptoms, organized into four categories. The presence of at least two symptoms within a 12-month period indicates a diagnosable condition:

Impaired Control

Using larger amounts or for longer periods than intended: Consistently consuming more of the substance or using for a longer duration than originally planned.
Persistent desire or unsuccessful efforts to cut down or control use: Repeated failed attempts to reduce or stop substance use despite wanting to do so.
Spending excessive time obtaining, using, or recovering from substance use: Dedicating significant portions of time to activities related to the substance.
Craving: Experiencing intense desire or urge to use the substance.

Social Impairment

Failing to fulfill major role obligations: Substance use interfering with responsibilities at work, school, or home.
Continued use despite persistent social or interpersonal problems: Using substances even when it causes or worsens relationship issues.
Giving up important social, occupational, or recreational activities: Reducing or abandoning meaningful activities in favor of substance use.

Risky Use

Recurrent use in physically hazardous situations: Using substances in contexts where it increases risk of physical harm.
Continued use despite knowledge of physical or psychological problems: Persisting in substance use despite awareness it is causing or worsening health issues.

Pharmacological Criteria

Tolerance: Needing increased amounts of the substance to achieve the desired effect, or experiencing diminished effect with continued use of the same amount.
Withdrawal: Experiencing characteristic withdrawal symptoms when substance use is reduced or stopped, or using the substance to relieve/avoid withdrawal symptoms.

3 Levels of Severity

The DSM-5 classifies Substance Use Disorders on a continuum of severity based on the number of criteria met:

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

This dimensional approach acknowledges that addiction exists on a spectrum and allows clinicians to match treatment intensity to the severity of the condition. It also recognizes that individuals may move between severity levels throughout their recovery journey, allowing for more personalized and responsive care.

Find Help For Addiction Today

If you or someone you know is struggling with substance use, professional help is available.

Remember that substance use disorders are medical conditions, not moral failings. With proper diagnosis and treatment, recovery is possible at any stage of addiction.

Peachtree Wellness Solutions offers addiction treatment programs in Georgia for those that may be struggling.

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DSM-5 Criteria for Substance Use Disorders

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