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 a reference guide for psychiatrists and other mental health professionals. Medical providers use it 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 (SUD) into a single continuum. There are no longer two definitions for “substance abuse” and “substance dependence.”
What is a Substance Use Disorder?
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 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.
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DSM-5 Criteria for Substance Use Disorders
The DSM-5 can determine the potential for a SUD depending on 11 criteria. The severity of SUD will depend on how many DSM-5 criteria people meet.3
These criteria include:
- Taking the substance in larger amounts or for longer than you're meant to
- Wanting to cut down or stop using the substance but failing to
- Spending a lot of time getting, using, or recovering from substances
- Intense cravings and urges to use the substance
- Not managing to do what you should at work, home, or school because of substance use
- Continuing to use substances, even when it causes problems in relationships
- Giving up important social, occupational, or recreational activities because of substance use
- Using substances again and again, even when it puts you in danger
- 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
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more of the substance
How to Determine the Severity of a Substance Use Disorder
The DSM-5 can help your doctor understand the severity of your SUD depending on how many criteria you meet.
- Mild: Two or three symptoms indicate a mild substance use disorder
- Moderate: Four or five symptoms indicate a moderate substance use disorder
- Severe: Six or more symptoms indicate a severe substance use disorder
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10 Types of Substance Use Disorders
The DSM-5 recognizes ten separate classes of drug and substance use disorders.4 They are:
1. Alcohol Use Disorder (AUD)
Alcohol is a toxic substance that acts as a stimulant and a depressant. AUD is the persistent use of alcohol despite deteriorating health, legal issues, and social problems.5
AUD is considered a chronic condition. However, it is treatable with:
2. Caffeine Use Disorder
Caffeine use disorder is desiring, but being unable, to reduce caffeine consumption due to adverse health effects.6 Caffeine is a stimulant found commonly in:
Excess caffeine consumption can lead to:
- Gastrointestinal issues
- Insomnia
- Anxiety
- Tremors.
3. Cannabis Use Disorder (CUD)
DSM-5 first introduced cannabis use disorder into the DSM-5 in 2013. The problematic use of marijuana products characterizes cannabis use disorder.
These include:
- Marijuana
- Vape pens
- Edibles
People with CUD might crave marijuana and are unable to stop using it. They’ll continue using it despite its adverse effects on their health and relationships.
4. Hallucinogen Use Disorder
Hallucinogens are a class of drugs that cause auditory or visual hallucinations. These include substances such as:
- LSD
- Psychedelic mushrooms
- MDMA, also known as ecstasy.
People with hallucinogen use disorder can experience adverse 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
- Gasoline.
Inhalant use disorder is a hazardous 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 using opioids and opiates despite negative legal and health consequences. Opioids and opiates include:
- OxyContin
- Hydrocodone (Vicodin)
- Morphine
- Methadone
- Naturally-derived substances such as heroin
- Synthetic opioids like Fentanyl
Opioids are drugs made from the poppy plant initially to treat pain. They are highly addictive because they release dopamine into the brain. Dopamine activates the reward system.
7. Sedative Hypnotic or Anxiolytic Use Disorder
Sedative-hypnotic and anxiolytic drugs slow down brain activity. These drugs include:
- Benzodiazepines such as Xanax
- Barbiturates such as phenobarbital
- Quaaludes
People with sedative-hypnotic or anxiolytic use disorders misuse these drugs and experience withdrawal symptoms.
8. Stimulant Use Disorder
Stimulant use disorder uses 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 adverse long-term effects, such as decreased dopamine output. This disorder makes it difficult to feel pleasure without stimulants.10
9. Tobacco Use Disorder
Tobacco use disorder is the most common SUD in the United States.11 It involves an addiction to nicotine in tobacco products.
These include:
- Cigarettes
- Dip
- Hookah
- Snus pouches
10. Other (Unknown) Use Disorder
The DSM-5 classifies substance use disorders that use other controlled substances as an “other use disorder.” This classification includes substances not otherwise specified in different categories but 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 issues, and vice versa.12
You are more likely to get diagnosed with a SUD if you have:13
- Generalized anxiety
- Depression
- Post-traumatic stress disorder (PTSD)
Integrated treatment of substance use and co-occurring disorder(s) effectively treats substance use and mental illness.
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Treatment Options for Substance Use Disorders
Although there is no cure for addiction, there are various treatment options. These treatment options have different methods and benefits. They can also cater to your specific needs.
Available treatment options for SUD include:
- Inpatient treatment: Involves checking yourself into a rehab facility for 24-hour medical supervision
- Outpatient treatment: A treatment program where you are freely allowed to leave the rehab facility
- Partial hospitalization program (PHPs): A treatment program where you stay at a rehab facility for a day and return home at night
- Dual diagnosis treatment: A treatment program that addresses co-occurring mental health conditions alongside addiction
- Cognitive behavioral therapy: A short-term therapy technique explores the link between thought patterns and addiction
- Support groups: Provide a much-needed community to help maintain sobriety after treatment
- 12-step programs: A support group designed to help guide you through the recovery process and maintain sobriety
Summary
The DSM-5 is the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders guide. It is a reference guide for psychiatrists and other mental health professionals.
The DSM-5 has 11 criteria that can determine the severity of a SUD. The severity is determined by how many of them you meet.
Currently, the DSM-5 recognizes ten drug and substance use disorder classes. Each substance is dangerous and can lead to short and long-term side effects.
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- American Psychiatric Association. “Diagnostic and statistical manual of mental disorders (DSM–5-TR).” DSM-5.
- “Mental health and substance use disorders.” SAMHSA.
- Hasin et al. “DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale.” The American Journal of Psychiatry, 2013.
- “Substance-related and addictive disorders.” DSM Library.
- U.S. Department of Health and Human Services. “Understanding alcohol use disorder.” National Institute on Alcohol Abuse and Alcoholism, 2021.
- Minkove, J. “New insight into caffeine use disorder.” New Insight into Caffeine Use Disorder, 2020.
- Wu et al. “Hallucinogen use disorders among adult users of MDMA and other hallucinogens.” The American Journal on Addictions, 2008.
- Cojanu et al. “Inhalant abuse: The Wolf in Sheep's clothing.” American Journal of Psychiatry Residents' Journal, 2018.
- Brown et al. “Hydrocarbon inhalation.” StatPearls, 2021.
- Abhishekh et al. “Association of stimulant use with dopaminergic alterations.” JAMA Psychiatry, 2017.
- American Academy of Addiction Psychiatry. “Nicotine dependence.” 2015.
- NIDA. “Part 1: The Connection Between Substance Use Disorders and Mental Illness.” 2021
- Magidson “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, 2012.
