DSM-5 Lists 11 Criteria for Diagnosing Substance Use Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), identifies 11 criteria that mental health professionals use to diagnose substance use disorders. These criteria help recognize harmful patterns involving drug and alcohol use that interfere with daily life and health.

These 11 criteria include taking substances in larger amounts or for longer periods than intended, unsuccessful attempts to reduce use, spending excessive time obtaining or recovering from substances, and experiencing cravings. Additional indicators are failing to meet responsibilities, continuing use despite relationship problems, abandoning important activities, using in dangerous situations, and persisting despite physical or psychological issues caused or worsened by substance use. The criteria also cover tolerance, requiring more of the substance to achieve effects, and withdrawal symptoms relieved by further use.

The DSM-5-TR groups these criteria into four main categories: physical dependence, risky use, social problems, and impaired control. It is important to note that tolerance and withdrawal can occur with prescribed medications for medical or mental health conditions without necessarily indicating a substance use disorder.

Substance Classes Recognized by DSM-5

The DSM-5-TR recognizes substance-related disorders linked to ten classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants (including amphetamines and cocaine), and tobacco. Disorders can also arise from the use of other or unknown substances.

Substance use activates the brain’s reward system, producing pleasurable sensations or euphoria often called a "high," which can lead individuals to neglect normal activities in favor of drug use. Although pharmacological mechanisms differ among substances, the activation of this reward system is a common factor.

Distinguishing Substance-Use and Substance-Induced Disorders

The DSM-5-TR differentiates between substance-use disorders, which involve ongoing problematic use despite negative consequences, and substance-induced disorders, which result from the effects of substances themselves. Substance-induced disorders include intoxication, withdrawal, and substance/medication-induced mental disorders.

Substance/medication-induced mental disorders encompass conditions such as psychotic disorders with delusions or hallucinations occurring within one month of substance use or withdrawal; bipolar and related disorders featuring manic or depressive symptoms during use or withdrawal; depressive disorders not related to intoxication or withdrawal; anxiety disorders including panic attacks; obsessive-compulsive and related disorders causing distress and impairment; sleep disorders like insomnia; sexual dysfunctions affecting arousal or performance; delirium from intoxication; and neurocognitive disorders involving mild or major impairments persisting beyond intoxication and acute withdrawal.

The 2022 text revision updated criteria for stimulant-induced mild neurocognitive disorder, recognizing research that prolonged stimulant use can cause lasting effects on learning, memory, and executive function.

Symptoms of Intoxication and Withdrawal

Substance intoxication disorders describe symptoms experienced while under the influence of drugs such as marijuana, cocaine, methamphetamine, heroin, acid, and include substance intoxication delirium. Withdrawal involves physical, cognitive, and behavioral symptoms after reducing or stopping substance use, which must not be attributable to other mental or medical conditions.

Withdrawal from substances like alcohol or barbiturates can be severe or life-threatening, whereas other substances may not produce withdrawal symptoms. Even short-term opioid use for medical purposes can lead to withdrawal. Withdrawal symptoms vary in severity and can be dangerous, so medical supervision is advised when discontinuing substance use.

Diagnostic Process and Severity Levels

Diagnosis of substance use disorders is conducted by psychiatrists, psychologists, or licensed counselors specializing in addictions. While blood or urine tests can detect current drug use, no laboratory test can confirm dependence or addiction. Diagnosis involves a physical exam, medical history, and detailed questioning about substance use frequency, amount, and duration.

The DSM-5-TR specifies severity levels based on the number of criteria met: mild (two or three symptoms), moderate (four or five), and severe (six or more). Clinicians may also indicate remission status, maintenance therapy, or controlled environment to describe the disorder’s current state, aiding treatment planning.

Treatment Approaches for Substance Use Disorders

Effective treatments exist for substance use disorders, and individuals suspecting they or a loved one may be affected should consult healthcare professionals. Treatment and recovery plans depend on the disorder’s nature and severity. Abrupt cessation can be risky; medically supervised detoxification and medications may be recommended to manage withdrawal and cravings.

Available treatment options include residential programs, outpatient care, day treatment or partial hospitalization, and sober living communities. Psychotherapies such as motivational-enhancement therapy and cognitive-behavioral therapy are commonly used, alongside support groups available in person or online.

Research highlights the importance of social support during recovery. Engaging trusted friends, family, mutual support groups, and 12-step programs can provide encouragement and resources. Treatment is individualized, and collaboration with healthcare providers is essential to develop a plan that addresses specific needs and supports long-term recovery.