The newest revision of the diagnostic manual for mental disorders (the DSM-5) has updated the criteria commonly used to diagnose either an alcohol disorder (commonly referred to as alcoholism) or a substance use disorder.

According to the DSM-5, a “substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.” As with most addiction problems, despite any consequences a person who has a problem with either alcoholism or drugs suffers, they will generally continue to use their drug of choice. They may make half-hearted attempts to stop or cut back their use, usually to no avail.

The DSM-5 states that in order for a person to be diagnosed with a disorder due to a substance, they must display 2 of the following 11 symptoms within 12-months:

  • Consuming more alcohol or other substance than originally planned
  • Worrying about stopping or consistently failed efforts to control one’s use
  • Spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain them
  • Use of the substance results in failure to “fulfill major role obligations” such as at home, work, or school.
  • “Craving” the substance (alcohol or drug)
  • Continuing the use of a substance despite health problems caused or worsened by it. This can be in the domain of mental health (psychological problems may include depressed mood, sleep disturbance, anxiety, or “blackouts”) or physical health.
  • Continuing the use of a substance despite its having negative effects on relationships with others (for example, using even though it leads to fights or despite people’s objecting to it).
  • Repeated use of the substance in a dangerous situation (for example, when having to operate heavy machinery or when driving a car)
  • Giving up or reducing activities in a person’s life because of the drug/alcohol use
  • Building up a tolerance to the alcohol or drug. Tolerance is defined by the DSM-5 as “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 after stopping use. Withdrawal symptoms typically include, according to the DSM-5: “anxiety, irritability, fatigue, nausea/vomiting, hand tremor or seizure in the case of alcohol.”

This criteria has been adapted for the 2013 DSM-5.

Disorders involving use and abuse of alcohol and drugs range in severity, and so a person can be diagnosed with a “mild” form of one of these concerns, “moderate” or “severe.” Mild alcohol/drug use is characterized by a person meeting 2-3 or the previous symptoms; moderate use is meeting 4-5 symptoms, and severe use is by 6 symptoms or more.

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).

Substances for which a person can establish a substance use disorder:

  • Alcohol
  • Cannabis
  • Phencyclidine
  • Other Hallucinogen
  • Inhalants
  • Opioid
  • Sedative, hypnotic, or anxiolytic
  • Stimulant: Specify amphetamine or cocaine
  • Tobacco
  • Other (Unknown)

This criteria has been adapted for the 2013 DSM-5.