The DSM-5 Criteria for Substance Use Disorders

psychologist writing diagnosis on a notebook

Living with a substance use disorder can shrink your world, limiting your capacity to be present in your life and with the people you love.

You may neglect essential parts of your life because of substance misuse or desperately want to stop (or at least reduce) your substance intake, the very ‘thing’ that seems to have so much agency over your life.

Accurate diagnosis

Fortunately, various treatments are available for those with substance use disorders and other types of addiction.

However, before treatment is even considered, there needs to be an accurate diagnosis of your condition. 

This is where the Diagnostic and Statistical Manual of Mental Disorders, fifth edition – also referred to as the DSM-5 – can help.

Why do mental health professionals use the DSM-5?

Elizabeth Hartney, psychologist and director at the Center for Health Leadership at Royal Roads University Canada, describes the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, as ”the latest version of the American Psychiatric Association’s gold-standard text.”

The DSM-5 includes the names, symptoms, and diagnostic features of every recognized mental illness, including addictions. (DSM 5 Criteria for Substance Use Disorders, Verywell mind, Elizabeth Hartney, BSc, MSc, MA, PhD, August 25, 2022.)

Mental health professionals and psychologists refer to the DSM-5 when working with client groups presenting with mental illness or substance use disorder symptoms.

How mental health professionals use the DSM-5

The DSM-5 comprehensively outlines symptoms, treatments, and procedures associated with various addictions and mental health disorders.

Therefore, it serves as an essential guideline for psychiatrists and mental health professionals, helping them further understand the fundamental concepts of specific mental disorders and addictions.

What are the DSM-5 criteria for a substance use disorder diagnosis?

If you are worried about your alcohol or drug intake, you may wonder whether you have a substance use disorder.

You can access proper treatment and diagnosis by speaking to a mental health professional.

However, before you receive a substance use disorder diagnosis, you must exhibit several criteria outlined in the DSM-5.

Research shows there are eleven criteria for substance use disorders in the DSM-5. These include the various challenges and features a person experiences due to substance misuse.

Mild, moderate and severe substance use disorder

The DSM-5 criteria for substance use disorders help mental health professionals understand the severity of your substance misuse by assessing the number of criteria (or symptoms) you exhibit.

This assessment is based on whether your symptoms are:

  • Mild – individuals must exhibit at least two or three symptoms to be diagnosed with mild substance use disorder.
  • Moderate – individuals must present with four or five symptoms to be diagnosed with moderate substance use disorder.
  • Severe – six symptoms or more indicate severe substance use disorder.

Substance use disorder criteria


Suppose you have any of the following symptoms. In that case, your physician or mental health professional can help determine the severity of your substance use based on the above assessment and the following criteria:

  • Spending a lot of time using, seeking, or recovering from substance use.
  • Trying to cut down or stop using the substance but not being able to.
  • Experiencing withdrawal symptoms when not using the substance.
  • Experiencing intense urges or cravings to use a substance.
  • Neglecting duties and responsibilities, including work, home, or school, due to substance abuse.
  • Continuing to use substances despite negative consequences, such as health or relationship problems.
  • Using substances in risky situations that put you or other people in danger.
  • Using more of a substance than intended or using substances for longer than recommended.
  • Withdrawing from social activities due to substance use.
  • Needing more of a substance to achieve desired effects or get the same ‘high.’ This is referred to as tolerance.
  • Continuing substance use despite any physical or mental health problems it may be causing.

What happens once a diagnosis has been made?

Understanding the severity of your substance use can help your treatment provider create a tailored treatment plan that may include various approaches based on your condition, history, and other factors.

At Tikvah Lake Recovery, we specialize in diagnosing and treating various addictions and mental health disorders.

We offer various therapies for addiction and mental health issues, such as luxury mental health treatment, residential treatment, and detox management.

If you are concerned that you may have a substance use disorder, speak to a friendly team member today who can advise you on the next steps.

The DSM-5: a brief history

You might be surprised to learn that it took over sixty years for mental health professionals to develop the DSM-5.

Decades of research and studies have gone into developing our understanding of the complexities of addiction and mental health disorders and how frequently these conditions co-occur.

Defining substance use can prove difficult when attempting to understand something as complicated as addiction. Addiction is a profoundly complicated disease, and defining it can be equally challenging. 

Therefore, knowing that it took sixty years to develop the DSM-5 may not come as much of a surprise after all!

Advantages of the DSM-5 in diagnosing mental health disorders 

Researchers have noted several beneficial factors related to the DSM-5.

If we look at how physical conditions are typically diagnosed, there is much more transparency involved than in conditions that affect mental health.

For instance, if you crack a rib, your physician can conduct a series of tests to establish how badly the bone is damaged, if other areas are affected, and what treatment route to go down.

However, diagnosing a mental health condition is a much more complicated process – there are no x-rays or scans to determine the presence of a mental health disorder.

Therefore, psychologists rely on different data and measures to determine a comprehensive mental health diagnosis.

The DSM-5 is an excellent tool since it creates a common language to describe mental disorders; developing consistency is essential because diagnoses are based primarily on family history and symptoms rather than more objective measures such as blood tests or brain scans. (DSM, Psychology Today.)

Additional benefits associated with the DSM-5 include the following:

  • The capacity to explore possible treatments and outcomes – diagnosis makes it possible to study treatments and outcomes for mental health disorders. The DSM-5 documents a collection of symptoms and treatments that can help professionals determine the course of treatment best suited for each individual based on their symptoms.
  • The ability to research causes and risk factors for mental illness – accurate diagnosis makes it easier to understand risk factors and causes of specific mental health conditions; for instance, research shows that depression has been linked to poverty in some communities.

Substance-induced disorders

Developing a sense of trust

As well as recognizing substance use disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) also includes substance-induced disorders, which are conditions caused by the effects of substance abuse. 

The DSM-5 documents several types of substance-induced disorders, including:

  • Substance-induced mental disorders
  • Intoxication
  • Withdrawal

Mental health professionals define substance-induced disorders as mental health problems that develop in those who did not have a mental health problem before using substances. (DSM 5 Criteria for Substance Use Disorders, Verywell mind, Elizabeth Hartney, BSc, MSc, MA, PhD, August 25, 2022.)

Substance-induced mental health disorders

According to the DSM-5, there are several substance-induced mental health disorders, including the following:

  • Substance-induced bipolar and related disorders – involve experiencing depression and manic (or hypomanic) symptoms, sometimes both, while using or withdrawing from substances.
  • Substance-induced depressive disorder – is a type of depression that occurs after someone uses alcohol, drugs or specific medications. A person’s depressive symptoms must not be related to withdrawal or intoxication to be diagnosed with this condition.
  • Substance-induced psychotic disorder – involves an individual experiencing hallucinations and delusions (or both) within four weeks of using or stopping substances, alcohol, or prescription medication.

Other substance-induced disorders include:

  • Substance-induced anxiety disorders
  • Substance-induced sleep disorders
  • Substance-induced sexual disorders
  • Substance-induced obsessive-compulsive and related disorders
  • Substance-induced delirium

What substances are classified as substance use disorders?

The DSM-5 categorizes ten separate classes of substances and substance-related disorders, including the following:

  • Cannabis
  • Opioids
  • Alcohol
  • Caffeine
  • Inhalants
  • Tobacco
  • Sedatives
  • Hallucinogens
  • Stimulant drugs – including cocaine and other stimulants
  • Hypnotic drugs

Summary of criteria for substance use disorders

stressed-man hand on forehead

To summarize the criteria for substance use disorders, we have included the following features and symptoms outlined within the DSM-5. They are as follows:

  • Tolerance – meaning an individual needs more of a substance to achieve desired effects.
  • Withdrawal.
  • Hazardous use of substances.
  • Interpersonal and social problems related to substance use.
  • Neglecting responsibilities to use substances.
  • Using more of a substance and for a longer duration.
  • Constant attempts to stop or reduce substance use without success.
  • Physical and mental health problems due to substance use.
  • Withdrawal from family, friends, and social activities to use substances.

Patients must meet two or more of the above criteria to be diagnosed with a substance use disorder.

If you (or someone you know) have any of the symptoms outlined in this article, you must seek advice and treatment from a professional as soon as possible.

Early intervention can help you abstain from substances sooner and allow you to get the support you need to overcome your addiction and achieve lasting sobriety.

Effective treatments for substance use disorders

If you are concerned that you or a loved one might have a substance use disorder, help and support are available, and various effective treatment options can help you get clean and sober.

Speak to your doctor or a mental health professional for advice and support about the next steps and treatment options.

Some of the most effective treatments for substance use disorder include:

Tikvah Lake Recovery can help

We specialize in treating substance abuse, addictions, and mental health at Tikvah Lake Recovery.

Our personalized treatment programs are designed to suit the unique needs of each individual. 

We understand the process of addiction and can diagnose and treat mental health conditions, which, in our experience, are often the root cause of substance abuse, such as drugs or alcohol.

People often use substances to distract or numb themselves from painful memories of past trauma. Our team recognizes the vital role unresolved trauma plays in addiction. 

Therefore, our dual-diagnostic treatment programs simultaneously address all aspects of addiction and mental health to give our clients the best possible outcome; an empowered life free from substance abuse.

Now is the time to kick-start your recovery. 

Contact our specialist team today.

Additional resources

  1. DSM 5 Criteria for Substance Use Disorders, Verywell mind, Elizabeth Hartney, BSc, MSc, MA, PhD, August 25, 2022
  2. DSM, Psychology Today 

About Adam Nesenoff

Adam Nesenoff has been working in recovery for over ten years.

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