A substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress. A person with this disorder will often continue to use the substance despite consequences.
The person must have at least two of the following for a given substance within the same 12-month period:
- Drinking or using a drug in an amount that is greater than the person originally sets out to consume (or using over a longer period of time on a given occasion).
- Worrying about cutting down or stopping; or unsuccessful efforts to control use.
- Spending a large amount of time using a substance, recovering from it, or doing whatever is needed to obtain it.
- Common use of a substance resulting in (1) failure to take care of things at home, work, school (or to fulfill other obligations); and/or (2) giving up once-enjoyed recreational activities or hobbies.
- Craving, a strong desire to use alcohol or another substance.
- Continuing the use of a substance despite problems caused or worsened by it — (1) in areas of mental (e.g., blackouts, anxiety) or physical health; or (2) in relationships (e.g., using a substance despite people’s objections or it causing fights or arguments).
- Recurrent alcohol/substance use in a dangerous situation (such as driving or operating machinery).
- Building up “tolerance” as defined by either needing to use noticeably larger amounts over time to get the desired effect or noticing less of an effect over time after repeated use of the same amount.
- Experiencing withdrawal symptoms (e.g., anxiety, irritability, fatigue, nausea/vomiting, hand tremor or seizure in the case of alcohol) after stopping use.
Severity and Specifiers
Substance use disorders occur in a broad range of severity, from mild to severe. As a general estimate of severity, a mild substance use disorder is suggested by the presence of 2-3 symptoms, moderate by 4-5 symptoms, and severe by 6 or more symptoms.
Severity can change across time with the person either reducing or increasing the symptoms for which they meet. In the case that an individual no longer meets for a substance use disorder (e.g., if a person had a past substance use disorder but became “clean & sober”), “in early remission,” “in sustained remission,” “on maintenance therapy,” or “in a controlled environment” may be added to the diagnosis (e.g., Alcohol use disorder in sustained remission).
This criteria has been adapted for 2013 DSM-5.
Medina, J. (2014). Revised Alcohol and Other Substance Use Disorders. Psych Central. Retrieved on February 27, 2015, from http://psychcentral.com/disorders/revised-alcoholsubstance-use-disorder/
Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Last reviewed: By John M. Grohol, Psy.D. on 9 Sep 2014
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