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:
- Hypnotics, or anxiolytics
- Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
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.