Recent changes to the DSM-5 guidelines for addiction, substance-related disorders, and alcohol use have made diagnosis and treatment more reliable and effective.

The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., or DSM-5 for short, is a reference guide the American Psychiatric Association (APA) developed to help healthcare and mental health professionals more accurately identify and diagnose mental health disorders.

Because mental health conditions can present differently in everyone, this tool was created as the go-to guide for mental health professionals in the United States.

The DSM-5 serves as the authority on diagnosing mental health conditions, which helps healthcare and mental health professionals develop a course of treatment that best fits your symptoms.

Currently, the DSM-5 guide contains diagnostic information — including symptoms, criteria, and risk factors — of over 150 mental health conditions.

After 13 years of collaboration from experts worldwide, the DSM-5 aims to encourage consistency and promote a universal language among healthcare and mental health professionals, scientists, and researchers.

Each diagnosis in the DSM-5 has a corresponding International Classification of Diseases (ICD) code used for billing purposes. In 2015, a newer version of the ICD was released (ICD-10) with a new and more expanded coding system.

An updated version of the ICD (ICD-11) will be released January 2022.

This allows mental health professionals to make a more accurate diagnosis and accounts for those conditions not previously covered in both the ICD-9 and the DSM-4.

Due to the evolution and prevalence of mental health disorders today, it was necessary to update the diagnosis guidelines for various mental health conditions.

Also, as research and evaluations continue, new conditions are being identified, creating the need for updates to the DSM-5 to ensure the most accurate information is available to clinicians.

One of the chapter revisions with the most substantial changes is substance-related disorders, addiction, and alcoholism, aka alcohol use.

Key changes


  • Abuse and dependence are combined and now under addiction and related disorders.
  • Gambling has been added to the list of behavioral addictive disorders.

Substance-use related disorders:

  • Substance use and dependence are combined under substance use disorder (SUD).
  • Symptoms of SUD are based on a continuum scale (mild, moderate, severe).

Alcohol use:

  • Alcohol use and alcohol dependence are combined into alcohol use disorder (AUD).
  • AUD is also now based on a continuum scale and requires 2-3 of 11 symptoms present for diagnosis.
  • Cravings added to the criteria for AUD, but legal problems were excluded.
  • A 12-month period of experiencing symptoms is now necessary for a diagnosis of AUD.
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Two significant changes are noted in the DSM-5 from the DMS-4 regarding addictive disorders.

First, abuse and dependence are no longer separate and are now classified under the addiction and related disorders category.

Next, gambling disorder has been added as the only behavioral addiction. Researchers found that gambling was clinically similar to substance-related disorders. So, they added it under addictive disorders.

The most notable change for substance-related disorders was combining the DSM-4 categories of substance use and substance dependence into a single category.

Now combined, substance use disorder is measured on a continuum scale from mild to severe, while each substance is specifically addressed by a specific condition.

Substances range from cannabis and alcohol to hallucinogens, heroin, and opioids.

Previously, substance-related disorders required only 1 symptom to be diagnosed, but since the revision, 2 to 3 symptoms need to be present from a list of 11.

The criteria necessary for diagnosis are based on impaired control, social impairment, risky use of a substance, and pharmacological necessity (i.e., tolerance and withdrawal).

Much like the changes to substance-related disorders, the DSM-5 combines the previous separate alcohol use and alcohol dependence into one single disorder.

Alcohol use disorder (AUD) can be classified as mild, moderate, or severe and is also based on how many criteria out of 11 are present within a 12-month period. The criteria include:

  • Alcohol is taken more often and in larger amounts than intended.
  • Multiple attempts at cutting back have been made but with no success.
  • An excessive amount of time is spent acquiring and recovering from alcohol and its effects.
  • Cravings to use alcohol are persistent.
  • Use of alcohol impacts an individual’s ability to fulfill necessary responsibilities.
  • Continued use after clear social and interpersonal problems.
  • Usual activities (i.e., social, occupational, and recreational) are replaced by alcohol and the desire to use.
  • Use despite physically hazardous conditions.
  • Continued use despite recurrent physical or psychological problems that were caused or exacerbated by alcohol.
  • A level of tolerance is present to achieve the effects of alcohol.
  • Symptoms of withdrawal are present when use is stopped.

The revision to alcohol use disorder added cravings to the new DSM-5 criterion and removed the presence of legal problems in the DSM-4.

Updates to the DSM-5 — the authoritative reference guide of mental health conditions — were necessary to provide clinicians with the most accurate information to identify and diagnose mental health disorders.

Substantial changes were made to criteria related to substance use, addiction, and alcohol use.

If you think you may have one of these conditions, consider reaching out to a healthcare or mental health professional. With the new changes, a more accurate diagnosis can be made, which means a more specific course of treatment can be developed that best fits you.