The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, often called the DSM-V or DSM 5, 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.
The DSM 5 criteria for substance use disorders are based on decades of research and clinical knowledge. This edition was published in May 2013, nearly 20 years after the original publication of the previous edition, the DSM-IV, in 1994.
What Are Substance Use Disorders?
The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.
Therefore, while some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.
The activation of the brain's reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.
The pharmacological mechanisms for each class of drug are different. But the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a "high."
The DSM 5 recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders. Some people have lower levels of self-control that predispose them to develop problems if they're exposed to drugs.
There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders.
Substance-use disorders are patterns of symptoms resulting from using a substance that you continue to take, despite experiencing problems as a result.
Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorders.
Criteria for Substance Use Disorders
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 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, 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.
Severity of Substance Use Disorders
The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a mild substance use disorder; four or five symptoms indicate a moderate substance use disorder, and 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.
Substance/Medication-Induced Mental Disorders
Substance/medication-induced mental disorders are mental problems that develop in people who did not have mental health problems before using substances. They include:
Substance-induced psychotic disorder
Substance-induced bipolar and related disorders
Substance-induced depressive disorders
Substance-induced anxiety disorders
Substance-induced obsessive-compulsive and related disorders
Substance-induced sleep disorders
Substance-induced sexual dysfunctions
Substance-induced neurocognitive disorders
Substance intoxication, a group of substance-induced disorders, details people experience symptoms when they are "high" from drugs. Disorders of substance intoxication include:
Methamphetamine intoxication (stimulants)
Heroin intoxication (opioids)
Acid intoxication (other hallucinogen intoxication or "acid trip")
Substance intoxication delirium
Untreated substance use disorders can be harmful to your health, relationships, and life as a whole. They can even be fatal, so get help as early as possible. Your physician can refer you to a specialist or an addiction program to ensure that you receive the correct course of treatment.
If you or a loved one are struggling with substance use or addiction, contact Another Solution at www.anothersolution.org. We can help.
Article courtesy of A Very Well Mind
Elizabeth Hartney, BSc, MSc, MA, PhD
Updated on March 21, 2020
Medically reviewed by
Steven Gans, MD