10 Types of Substance Use Disorder (DSM-5)

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), offers a structured way to understand substance use that goes beyond stereotypes about addiction.

By exploring the DSM-5’s definition of substance use disorder (SUD), the specific diagnostic criteria, and supportive resources, you can be more prepared to recognize early warning signs and seek help if needed. Let’s discuss this further.

How Does DSM-5 Define Substance Use Disorder (SUD)?

Substance use disorder isn’t just about how often someone uses a substance; it’s about how that use impacts their everyday life.

The DSM-5 describes SUD as a chronic condition involving impaired control over substance use, social or personal disruption, risky behaviors, and sometimes signs of physical dependence.

Each substance—alcohol, cannabis, opioids, or stimulants—can be evaluated using these core features.

What are the Older vs. Current Definitions of SUD?

Older versions of the DSM separated substance problems into “abuse” (occasional harmful use) and “dependence” (physical or psychological reliance). The DSM-5 merges these into a single continuum called Substance Use Disorder.

This updated approach recognizes that the severity of substance misuse can range from mild to severe. It also emphasizes the patterns of behavior and resulting consequences rather than relying solely on physical dependence.

Key Diagnostic Criteria in the DSM-5 for SUD

Specific, observable patterns guide clinicians when determining whether a person meets the criteria for SUD. These criteria help separate casual or infrequent use from a condition that demands intervention.

The more criteria someone meets, the more severe their SUD is considered:

• Mild: 2 to 3 symptoms
• Moderate: 4 to 5 symptoms
• Severe: 6 or more symptoms

While each of the 11 criteria is distinct, they can be grouped into four major categories:

Impaired Control

• Taking substances in larger amounts or over a longer period than initially planned
• Ongoing desire or unsuccessful attempts to cut down or control use
• Spending significant time getting, using, or recovering from the substance
• Powerful cravings or urges to use

Social Problems

• Regular failures to meet major responsibilities at work, school, or home
• Using substances despite interpersonal or social conflicts that result directly from it
• Giving up important activities or hobbies because of substance use

Risky Use

• Using substances even when it’s physically dangerous (e.g., driving while intoxicated)
• Continuing use despite recognizing persistent or recurrent physical or psychological harm

Pharmacological Indicators

• Needing more of the substance to achieve the same high or effect (tolerance)
• Experiencing distressing symptoms when use is reduced or stopped, or taking the same (or a closely related) substance to relieve these symptoms (withdrawal)

Spotting just a few indicators, like increased secrecy about substance use and a decline in school performance, can serve as early warning signs. Addressing concerns while the issue is mild can help prevent progression to more serious involvement.

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How to Differentiate Teen Experimentation vs. SUD

Teenagers often experiment with new behaviors as part of growing up, and occasional substance experimentation might not automatically signify SUD. The key differences are:

• Frequency and escalation: Does casual use rapidly become regular or obsessive?
• Impact on responsibilities: Are grades dropping, or are important obligations neglected because of substance use?
• Risk to health and safety: Is the teen repeatedly engaging in high-risk behaviors (e.g., driving under the influence, using in unsafe settings)?

Adolescents may have shorter substance-use histories than adults, so physical tolerance or withdrawal might be less obvious.

Signs of SUD Among Teens

Clinicians look closely at how the use affects school performance, family relationships, and emotional well-being to decide whether typical teenage exploration is veering into a disorder.

More examples of behaviors that might signal SUD include:

• Repeated school absences: Missing classes due to hangovers or late-night substance use
• Abandonment of activities: Quitting sports teams or clubs because substance use becomes the main focus
• Hidden paraphernalia: Finding vape pens, pipes, or pill bottles in personal belongings
• Frequent emotional swings: Quick shifts from irritability to secrecy, especially around discussions of substance use

For young people, early experimentation can escalate rapidly due to ongoing brain development. Additionally, peer influences and a desire for social acceptance can overshadow an adolescent’s ability to self-regulate. The presence of even a few SUD criteria in a teenager warrants careful attention and possibly professional evaluation.

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What Should You Do?

If you suspect SUD, consider speaking with a pediatrician, school counselor, or mental health professional. They can conduct a preliminary evaluation and guide you to specialized treatment if necessary.

Other forms of support include:

• Family support groups: Groups like Al-Anon, Nar-Anon, and SMART Recovery Family & Friends provide a sense of community and coping strategies for those supporting a loved one with substance concerns.
• Therapeutic options: Evidence-based interventions include Cognitive Behavioral Therapy (CBT) for younger individuals, Motivational Interviewing to enhance willingness to change, and (in older adolescents) possibly medication-assisted treatment for certain substances.
• School and community programs: Many districts have early intervention initiatives that identify at-risk students. By coordinating with teachers, counselors, and local youth programs, families can find additional support and resources.

The DSM-5 framework for Substance Use Disorder reminds us that substance-related issues arise on a spectrum and can look different for each individual, especially within a teenage context.

By familiarizing yourself with the DSM-5 criteria and leveraging the wealth of resources available, you can approach potential substance use problems with greater understanding and empathy.

Resources and Support for Substance Use Disorder

Whether you’re a parent concerned about your child’s changing behavior or an educator wanting to offer support, reliable information and supportive measures are crucial.

Some credible sources of information include:

• National Institute on Drug Abuse (NIDA): Provides up-to-date research on various substances, prevention strategies, and treatment modalities
• Substance Abuse and Mental Health Services Administration (SAMHSA): Offers a national helpline (1-800-662-HELP) for referrals, plus online treatment locators
• American Academy of Child & Adolescent Psychiatry (AACAP): Features resources on adolescent mental health and substance use

How to Find Trustworthy Sources?

Here are a few things to keep in mind when learning about SUD:

• Stick to websites ending in “.gov” or from established health organizations.
• Look for articles referencing peer-reviewed research or citing recognized medical authorities.
• Be cautious with personal testimonials that lack scientific backing.

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