Substance Use Disorders: DSM 5 Definitions
In This Article
What is the DSM-5?
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the reference guide psychiatrists and other mental health professionals use to diagnose a variety of mental illnesses.1
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the most up-to-date published information on mental disorders and diagnostic criteria. It also includes information on how racism and discrimination impact mental disorders.
The DSM-5 now categorizes substance use disorder (SAD) into a single continuum. There are no longer two separate definitions for “substance abuse” and “substance dependence.”
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What is a Substance Use Disorder?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the DSM-5 classifies someone as having a substance use disorder when the recurrent use of alcohol or drugs causes significant impairment.2
This can include problems such as:
- Health issues
- Disability
- Failure to meet work responsibilities
- Difficulties at school and at home
In addition, the DSM-5 now uses several classifications and criteria to determine the severity of SUD. People can be diagnosed with mild, moderate, or severe substance use disorder.
DSM-5 Criteria for Substance Use Disorders
The severity of SUD will depend on how many DSM-5 criteria people meet. 3
These criteria include:
- Hazardous substance use
- Social and interpersonal problems related to drug use
- Neglects major roles (in family, work, school) to use
- Legal problems due to drug abuse
- Withdrawal symptoms when stopping use
- Tolerance
- Uses larger amounts of for longer than intended
- Repeated unsuccessful attempts to quit or control use
- A lot of time spent using substances
- Physical health problems related to use
- Mental health problems due to substance abuse
- Giving up activities to use drugs instead
- Cravings for drugs or alcohol
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10 Types of Substance Use Disorders
There are currently 10 separate classes of drug and substance use disorders recognized in the DSM 5.4 They are:
1. Alcohol Use Disorder (AUD)
Alcohol is a toxic substance that acts as a stimulant and a depressant. AUD is described as the persistent use of alcohol despite deteriorating health, legal, and/or social problems.5
AUD is considered a chronic condition. However, it is treatable with medications, behavioral therapies, and addiction treatment.
2. Caffeine Use Disorder
Caffeine is a stimulant found commonly in coffee, energy drinks, and some carbonated beverages like soda. Caffeine use disorder is characterized by a desire to cut down on caffeine consumption due to adverse health effects, but the inability to do so.6
Excess caffeine consumption can lead to gastrointestinal issues, insomnia, anxiety, and tremors.
3. Cannabis Use Disorder (CUD)
Cannabis use disorder was first introduced into the DSM-5 in 2013. Cannabis use disorder is characterized by the problematic use of marijuana products. These include traditional marijuana, vape pens, and edibles. People with CUD might crave marijuana and find themselves unable to stop using it, despite its negative effects on relationships.
4. Hallucinogen Use Disorder
Hallucinogens are a class of drugs that cause audio or visual hallucinations. These include substances such as LSD, psychedelic mushrooms, and MDMA, also known as ecstasy.
People with hallucinogen use disorder can experience negative effects from using hallucinogens.7 These side effects include:
- Depression
- Anxiety
- Memory deficits
- Risky sexual behaviors
5. Inhalant Use Disorder
Inhalant use disorder is the continued use of hydrocarbon-based inhalant substances, leading to clinically significant impairment or distress.8 Hydrocarbon-based inhalants contain acetone benzene, toluene, turpentine, and gasoline.
This is an extremely dangerous substance use disorder that can lead to immediate death from cardiac arrest or pulmonary toxicity.9 It affects adults and adolescents alike.
6. Opioid Use Disorder (OUD)
OUD is the use of opioids and opiates despite negative legal and health consequences.
Opioids are a class of drugs made from the poppy plant originally used to treat pain. They are highly addictive because they release dopamine into the brain. Dopamine activates the reward system.
Opioids and opiates include prescription painkillers such as OxyContin, or naturally-derived substances such as heroin.
7. Sedative Hypnotic or Anxiolytic Use Disorder
Sedative-hypnotic and anxiolytic drugs slow down brain activity. These drugs include benzodiazepines such as Xanax and barbiturates such as phenobarbital. Quaaludes are another type of anxiolytic drug.
People with sedative hypnotic or anxiolytic use disorders misuse these drugs and experience withdrawal symptoms.
8. Stimulant Use Disorder
Stimulant use disorder is the use of non-medical stimulants such as cocaine and methamphetamine. These are highly addictive substances that release a flood of dopamine, creating a sense of intense pleasure.
People with stimulant use disorder can experience negative long-term effects, such as decreased dopamine output. This makes it difficult to feel pleasure without stimulants.10
9. Tobacco Use Disorder
Tobacco use disorder is addiction to nicotine in tobacco products. These include cigarettes, loose-leaf tobacco such as dip, hookah, and snus pouches. This is the most common substance use disorder in the United States.11
10. Other (Unknown) Use Disorder
The DSM-5 classifies substance use disorders that use other controlled substances as an “other use disorder.” This includes substances not otherwise specified in any other categories, but that still cause significant distress and disruption to a person’s life.
Substance Use and Mental Health Disorders
There is a significant correlation between mental health disorders and substance abuse. Studies have shown that 50% of people with a mental illness also have co-occurring substance use issue, and vice versa. 12
People with anxiety disorders such as generalized anxiety, depression, and post-traumatic stress disorder (PTSD) are more likely to be diagnosed with substance use disorder.13 Integrated treatment of the substance use disorder and co-occurring disorder(s) has been shown to decrease substance use and psychiatric functioning.
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- American Psychiatric Association. (n.d.). Diagnostic and statistical manual of mental disorders (DSM–5-TR). DSM-5.
- SAMHSA. (n.d.). Mental health and substance use disorders. SAMHSA.
- Hasin, D. S., O'Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013, August). DSM-5 criteria for Substance Use Disorders: Recommendations and Rationale. The American journal of psychiatry.
- Substance-related and addictive disorders. DSM Library.
- U.S. Department of Health and Human Services. (2021, April). Understanding alcohol use disorder. National Institute on Alcohol Abuse and Alcoholism.
- J. F. M. on. (2020, December 16). New insight into caffeine use disorder. New Insight into Caffeine Use Disorder.
- Wu, L.-T., Ringwalt, C. L., Mannelli, P., & Patkar, A. A. . Hallucinogen use disorders among adult users of MDMA and other hallucinogens. The American journal on addictions.
- Cojanu, A. I., RJ, T., Al., E., B, F., DK, E., LT, W., LM, T., K, I., & S, G. (2018, February 1). Inhalant abuse: The Wolf in Sheep's clothing. American Journal of Psychiatry Residents' Journal.
- Brown, K. W. (2021, July 20). Hydrocarbon inhalation. StatPearls [Internet].
- Abhishekh H. Ashok, M. B. B. S. (2017, May 1). Association of stimulant use with dopaminergic alterations. JAMA Psychiatry.
- American Academy of Addiction Psychiatry. (2015, May). Nicotine dependence.
- NIDA. (2021, April 13). Part 1: The Connection Between Substance Use Disorders and Mental Illness.
- Magidson, J. F., Liu, S.-M., Lejuez, C. W., & Blanco, C. (2012, May). Comparison of the course of substance use disorders among individuals with and without generalized anxiety disorder in a nationally representative sample. Journal of psychiatric research.
- The case for screening and treatment of co-occurring disorders. SAMHSA.
