Substance Use Disorders

Substance use disorder (SUD) is a complex condition in which there is the uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person's ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems. The most severe SUDs are sometimes called addictions.

The DSM-5-TR* recognizes substance-related disorders resulting from the use of 10 separate classes of drugs:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Hypnotics, or anxiolytics
  • Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
  • Tobacco

DSM-5-TR Substance Use Disorder Criteria

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

  • Taking the substance in larger amounts or for longer than you're meant to
  • Wanting to cut down or stop using the substance but not managing to
  • Spending a lot of time getting, using, or recovering from the use of the substance
  • 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 it, 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

The severity of Substance Use Disorders

The DSM-5-TR allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified.

  • 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.

Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy” for certain substances, and “in a controlled environment.” These further describe the current state of the substance use disorder.

*The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision, often called the DSM-V-TR or DSM-5-TR, 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.

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