DSM-5 Criteria for Substance Use Disorder

Introduction

The DSM-5 defines Substance Use Disorder as "a problematic pattern of substance use leading to clinically significant impairment or distress." The diagnosis requires at least two of the following 11 diagnostic criteria within a 12-month period: 

Impaired Control 

1. Substance taken in larger amounts or over a longer period than intended 

2. Persistent desire or unsuccessful efforts to cut down or control substance use 

3. Great deal of time spent to obtain, use, or recover from effects of the substance 

4. Craving or a strong desire or urge to use the substance 

Social Impairment 

1. Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home 

2. Continued substance use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the substance 

3. Important social, occupational, or recreational activities given up or reduced because of substance use 

Risky Use 

1. Recurrent substance use in situations in which it is physically hazardous 

2. Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem likely caused or exacerbated by the substance 

Pharmacological Criteria 

1. Tolerance (need for markedly increased amounts to achieve desired effect or markedly diminished effect with continued use of the same amount) 

2. Withdrawal (characteristic withdrawal syndrome for the substance or substance taken to relieve or avoid withdrawal symptoms) 

Important Note: Symptoms of tolerance and withdrawal occurring during appropriate medical treatment with prescribed medications (e.g., opioid analgesics, sedatives, stimulants) are specifically not counted when diagnosing a substance use disorder. 

Severity Classification 

SUD severity is determined by the number of criteria met, not by the severity of substance use or any individual criterion: 

• Mild: 2-3 criteria 

• Moderate: 4-5 criteria 

• Severe: 6 or more criteria 

Key Differences from DSM-IV 

DSM-IV divided substance-related disorders into two separate diagnoses: substance abuse (requiring 1 of 4 criteria) and substance dependence (requiring 3 of 7 criteria). DSM-5 combined these into a single diagnosis—Substance Use Disorder—with dimensional severity ratings. DSM-5 removed the "legal problems" criterion and added "craving" as a new criterion. 

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 

2. Hasin DS, O'Brien CP, Auriacombe M, et al. DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. Am J Psychiatry. 2013;170(8):834-851.