The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) defines Substance Use Disorders (SUDs) as a problematic pattern of substance use that leads to significant impairment or distress. SUDs can involve a variety of substances, such as alcohol, cannabis, opioids, stimulants, and others. The criteria for SUDs are consistent across different substances but are adapted to the specific substance involved (e.g., Alcohol Use Disorder, Opioid Use Disorder).

Core DSM-5 Criteria for Substance Use Disorders

To diagnose a substance use disorder, at least 2 of the following 11 criteria must be met within a 12-month period:

1. Impaired Control:
   • The substance is often taken in larger amounts or over a longer period than was intended.
   • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
   • A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
   • Craving or a strong desire or urge to use the substance.
2. Social Impairment:
   • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences, poor work performance, neglect of children).
   • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with a spouse about intoxication, physical fights).
   • Important social, occupational, or recreational activities are given up or reduced because of substance use.
3. Risky Use:
   • Recurrent substance use in situations in which it is physically hazardous (e.g., driving a car or operating machinery when impaired by the substance).
   • 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 (e.g., continued drinking despite recognition that it is worsening a liver condition).
4. Pharmacological Criteria:
   • Tolerance: 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.
   • Withdrawal: Defined by either of the following:
     • The characteristic withdrawal syndrome for the substance (varies by substance).
     • The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Severity of Substance Use Disorders

The severity of the disorder is classified based on the number of criteria met:

• Mild: 2-3 symptoms.
• Moderate: 4-5 symptoms.
• Severe: 6 or more symptoms.

Substance-Specific Disorders

While the diagnostic criteria for substance use disorders are consistent, the specific symptoms and withdrawal syndromes can vary depending on the substance. Common substances associated with SUDs include:

• Alcohol Use Disorder
• Cannabis Use Disorder
• Stimulant Use Disorder (e.g., amphetamines, cocaine)
• Opioid Use Disorder (e.g., heroin, prescription opioids)
• Tobacco Use Disorder
• Hallucinogen Use Disorder
• Sedative, Hypnotic, or Anxiolytic Use Disorder (e.g., benzodiazepines)

Specifiers

1. In early remission: After full criteria for a substance use disorder were previously met, no criteria for substance use disorder have been met for at least 3 months but less than 12 months (except for craving).
2. In sustained remission: After full criteria for a substance use disorder were previously met, no criteria for substance use disorder have been met at any time during a period of 12 months or longer (except for craving).
3. In a controlled environment: The individual is in an environment where access to the substance is restricted (e.g., in prison, treatment centers).

Key Features of Substance Use Disorders

• SUDs involve a cycle of compulsive substance use, impaired control, social and occupational impairment, risky use, and physiological changes (e.g., tolerance and withdrawal).
• Individuals may experience changes in behavior and cognition, including denial or minimization of the problem, which complicates treatment.
• Treatment approaches typically include counseling, behavioral therapies, and in some cases, medication-assisted treatment (e.g., for opioid or alcohol use disorders).

Reference:

American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596

DSM Cover image source:

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