DSM criteria for substance use disorders
Key changes in substance use disorders in DSM-5
In 2013 the American Psychiatric Association (APA) released a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The DSM-5 reflects significant changes in how substance use disorders are defined and in the diagnostic criteria of certain disorders (APA, 2013b).
- The term addiction is no longer used to describe substance use disorders. It was felt that the term was so loaded with associations that it lacked precision.
- The substance abuse and substance dependence categories have been replaced with a single category: substance use disorder. In DSM-IV, the distinction between substance abuse and dependence was based on the concept of abuse as a mild or early phase and dependence as a more severe manifestation, but in practice, the abuse criteria were sometimes quite severe. The DSM-5 change reflects this clinical reality.
- The seven DSM-IV substance dependence criteria and three of the four substance abuse criteria have been combined to create 11 diagnostic criteria for substance use disorder.
- The DSM-IV recurrent legal problems criterion has been dropped because it was the least sensitive of the 11 criteria.
- A new criterion – craving or strong desire to use a substance – has been added to the substance use disorder criteria.
- Substance use disorder is measured on a spectrum from mild to severe. The level of severity is determined by the number of diagnostic criteria a person meets.
- Each specific substance (other than caffeine) is addressed as a separate disorder (e.g., alcohol use disorder, cocaine use disorder), but most substances are diagnosed based on the same overarching criteria.
- The substance-related and addictive disorders chapter has been expanded to include gambling disorder. This change reflects evidence that some behaviours activate the brain reward system with effects similar to those of drugs and that gambling disorder symptoms resemble substance use disorders in some ways.
DSM-5 criteria for substance use disorder
The 11 criteria for substance use disorder are divided into four categories of behaviour related to the substance use:
- impaired control
- social impairment
- risky use
- pharmacological indicators (tolerance and withdrawal).
The severity of the substance use disorder is determined by the number of criteria the person meets:
- Mild: 2 or 3 criteria out of 11
- Moderate: 4 or 5 criteria out of 11Severe: 6 or more criteria out of 11.
Alcohol Use Disorder: A Comparison between DSM-IV and DSM-5 (NIAAA, 2015) compares the DSM-IV and DSM-5 diagnostic criteria for substance use disorders.