A Guide to DSM 5 Criteria
for Substance Use Disorders
Symptoms Used to Diagnose Substance Use Disorders
By Elizabeth Hartney, PhD | Reviewed by Steven Gans, MD
Updated June 26, 2018
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, often called the DSM-
V or DSM 5, is the latest version of the American Psychiatric Association’s gold-standard text
on the names, symptoms, and diagnostic features of every recognized mental illness—including
addictions.
The DSM 5 criteria for substance use disorders are based on decades of research and clinical
knowledge. This edition was published in May 2013, nearly 20 years after the original
publication of the previous edition, the DSM-IV, in 1994.
What Are Substance Use Disorders?
The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes
of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting
arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives,
hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other
stimulants); tobacco; and other or unknown substances. Therefore, while some major groupings
of psychoactive substances are specifically identified, the use of other or unknown substances
can also form the basis of a substance-related or addictive disorder.
The activation of the brain’s reward system is central to problems arising from drug use; the
rewarding feeling that people experience as a result of taking drugs may be so profound that they
neglect other normal activities in favor of taking the drug. While the pharmacological
mechanisms for each class of drug are different, the activation of the reward system is similar
across substances in producing feelings of pleasure or euphoria, which is often referred to as a
“high.”
The DSM 5 recognizes that people are not all automatically or equally vulnerable to
developing substance-related disorders and that some people have lower levels of self-control
that predispose them to develop problems if they're exposed to drugs.
There are two groups of substance-related disorders: substance-use disorders and substance-
induced disorders. Substance-use disorders are patterns of symptoms resulting from the use of a
substance that you continue to take, despite experiencing problems as a result. Substance-
induced disorders, including intoxication, withdrawal, and other substance/medication-induced
mental disorders, are detailed alongside substance use disorders.
Criteria for Substance Use Disorders
Substance use disorders span a wide variety of problems arising from substance use, and cover
11 different criteria:
1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance
use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem
that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the
substance.
Severity of Substance Use Disorders
The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use
disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a
mild substance use disorder; four or five symptoms indicate a moderate substance use disorder,
and six or more symptoms indicate a severe substance use disorder. Clinicians can also add
“in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled
environment.”
Intoxication
Substance intoxication, a group of substance-induced disorders, detail the symptoms that people
experience when they are "high" from drugs. Disorders of substance intoxication include:
Marijuana intoxication
Cocaine intoxication
Methamphetamine intoxication (stimulants)
Heroin intoxication (opioids)
Acid intoxication (other hallucinogen intoxication or "acid trip")
Substance intoxication delirium
Substance/Medication-Induced Mental Disorders
Substance/medication-induced mental disorders are mental problems that develop in people who
did not have mental health problems before using substances, and include:
Substance-induced psychotic disorder
Substance-induced bipolar and related disorders
Substance-induced depressive disorders
Substance-induced anxiety disorders
Substance-induced obsessive-compulsive and related disorders
Substance-induced sleep disorders
Substance-induced sexual dysfunctions
Substance-induced delirium
Substance-induced neurocognitive disorders
A Word From Verywell
If you think you might have a substance use disorder or a substance-induced disorder, see your
doctor. She may need to refer you to a specialist or an addiction clinic to determine whether you
have a pre-existing mental disorder and to ensure that you receive the correct course of
treatment.
Untreated substance use disorders can be harmful to your health, your relationships, and your life
as a whole. They can even be fatal, so get help as early on in the process as possible.
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