A Guide to DSM 5 Criteria for Substance Use Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, often called the DSM-V or DSM 5, is the latest version of the American Psychiatric Association’s gold-standard text on the names, symptoms, and diagnostic features of every recognized mental illness—including addictions.

The DSM 5 criteria for substance use disorders are based on decades of research and clinical knowledge. This edition was published in May 2013, nearly 20 years after the original publication of the previous edition, the DSM-IV, in 1994.

The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances. Therefore, while some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.

The activation of the brain’s reward system is central to problems arising from drug use; the rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug. While the pharmacological mechanisms for each class of drug are different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

The DSM 5 recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders and that some people have lower levels of self-control that predispose them to develop problems if they're exposed to drugs.

There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders. Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result. Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorders.

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a mild substance use disorder; four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder. Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled environment.”

Substance intoxication, a group of substance-induced disorders, detail the symptoms that people experience when they are "high" from drugs. Disorders of substance intoxication include:

• Marijuana intoxication
• Cocaine intoxication
• Methamphetamine intoxication (stimulants)
• Heroin intoxication (opioids)
• Acid intoxication (other hallucinogen intoxication or "acid trip")
• Substance intoxication delirium

Substance/medication-induced mental disorders are mental problems that develop in people who did not have mental health problems before using substances, and include:

• Substance-induced psychotic disorder
• Substance-induced bipolar and related disorders
• Substance-induced depressive disorders
• Substance-induced anxiety disorders
• Substance-induced obsessive-compulsive and related disorders
• Substance-induced sleep disorders
• Substance-induced sexual dysfunctions
• Substance-induced delirium
• Substance-induced neurocognitive disorders

If you think you might have a substance use disorder or a substance-induced disorder, see your doctor. She may need to refer you to a specialist or an addiction clinic to determine whether you have a pre-existing mental disorder and to ensure that you receive the correct course of treatment.

Untreated substance use disorders can be harmful to your health, your relationships, and your life as a whole. They can even be fatal, so get help as early on in the process as possible.