Introduction
Have you ever wondered how doctors and mental health experts determine if someone has a problem using substances like alcohol or drugs?
The answer is a guidebook called the DSM-5.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,) is a comprehensive guidebook developed by mental health professionals through rigorous scientific research, expert consensus, and extensive field trials.
What Are Substance Use Disorders?
According to DSM-5, substance use disorder is a medical condition where a person has trouble controlling their use of drugs or alcohol, which causes problems in their life. These problems can be physical or psychological.
There are different levels of substance use disorder depending on how many symptoms a person has: mild, moderate, and severe.
These symptoms can manifest as physical or psychological problems like health complications or changes in mood or behavior.
People with severe substance use disorder often face serious issues, like not being able to fulfill their important obligations at work, school, or home. They might even give up other activities they used to enjoy.
What Is the Difference Between Substance-Use and Substance-Induced Disorders?
Substance use disorders and substance-induced disorders are distinct but related categories within the DSM-5 criteria.
Specifically, substance use disorders (SUD) primarily refer to long-term problematic substance use patterns characterized by impaired control, tolerance, withdrawal symptoms, and unsuccessful efforts to cut down.
In simpler terms, SUD can exist independently of substance use. A person diagnosed with SUD might have a persistent problem with substance use even when not actively using the substance.
In contrast, substance-induced disorders are temporary conditions caused directly by the immediate effects of substance use. They will generally resolve once the drug or alcohol wears off.
The diagnosis of Substance-Induced Disorders is based on the observation of physical or psychological symptoms caused by drug or alcohol use that would not have occurred without it.
What Are DSM-5's Criteria for Addiction?
To diagnose Substance Use Disorder, a person must meet specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
These diagnostic criteria are based on observable behaviors and experiences related to substance use. These diagnostic criteria for addiction include:
Impaired control or taking the substance in larger amounts or for longer periods than intended
Persistent desire to cut down or control drug or alcohol use but being unsuccessful in doing so
Spending a lot of time using, obtaining, or recovering from the substance's effects
Having cravings or a strong desire or urge to use the substances
Failing to fulfill major obligations due to substance use
Continuing to use drugs, alcohol, or other substances despite social or interpersonal problems caused or worsened by their effects
Giving up on important social, occupational, or recreational activities because of substance use
Risky use, or using the substance in situations where it's physically hazardous, like drinking and driving.
Recurrent substance use, knowing that it's causing or worsening a physical or psychological problem
Increasing tolerance or needing more of the substance to achieve the desired effect or experiencing reduced effects with the same amount
Developing withdrawal symptoms like anxiety, depression, irritability, and others when not using
What Are the Levels of Severity in DSM-5?
In DSM-5, Substance Use Disorders are classified into three levels of severity:
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Mild Substance Use Disorder occurs when an individual has two or three symptoms.
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Moderate Substance Use Disorder is diagnosed when four or five symptoms are present.
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Severe Substance Use Disorder indicates the presence of six or more symptoms.
The severity level is determined based on the number and intensity of a person's symptoms. A higher number of symptoms and their impact on daily life indicate a more severe Substance Use Disorder.
What Are Substance-Induced Disorders?
Substance-Induced Disorders, as described in DSM-5, are a group of mental health conditions that occur directly from using substances like drugs or alcohol.
These disorders directly result from the substances' effects on the brain and body. These symptoms usually disappear once the substance or medication is out of the system.
Here are several key categories of Substance-Induced Disorders:
Substance/Medication-Induced Mental Disorders
These are mental health disorders induced by substance use, such as substance-induced mood disorders or anxiety disorders.
Substance-Induced Psychotic Disorder
It occurs when substance use, such as drugs or alcohol, leads to symptoms like hallucinations (seeing or hearing things that aren't there) or delusions (false beliefs).
Substance-Induced Depressive Disorders
It happens when substances cause symptoms of depression, like feeling extremely sad or losing interest in things.
Substance-Induced Anxiety Disorders
This happens when substance use leads to anxiety symptoms, like excessive worry, restlessness, or panic attacks.
Substance-Induced Obsessive-Compulsive and Related Disorders
In this category, individuals may experience symptoms resembling obsessive-compulsive disorder (OCD) or related conditions due to substance use.
Substance-Induced Sleep Disorders
Substances can disrupt normal sleep patterns, leading to insomnia (difficulty falling asleep or staying asleep) or hypersomnia (excessive daytime sleepiness).
Substance-Induced Sexual Dysfunctions
This is when temporary sexual dysfunctions arise from substance use, such as desire, arousal, or performance changes.
Substance-Induced Delirium
Delirium is a sudden and severe state of confusion, often accompanied by hallucinations or delusions, and it can result from substance use.
Substance-Induced Neurocognitive Disorders
Substance use can lead to cognitive problems, like memory loss or difficulty thinking clearly.
Intoxication
According to DSM-5, intoxication is when a person's mental and physical state gets affected because they've used a substance like drugs or alcohol.
It can cause changes in thinking, feeling, and behavior, and it's often linked to the amount of the substance consumed. For example, feeling drunk after drinking alcohol is a type of intoxication.
Withdrawal
In the DSM-5, withdrawal refers to physical and psychological symptoms a person experiences when they stop using a substance they have become dependent on.
These symptoms vary depending on the substance but often include feeling anxious, shaky, or sick when trying to quit or cut down on the substance.
Withdrawal is a sign of physical dependence.
How Does the DSM-5 Differentiate Between Substance Abuse and Substance Dependence?
The DSM-5 doesn't use the terms substance abuse and substance dependence anymore. Instead, it combines them into Substance Use Disorder. This new term covers all sorts of substance-related concerns.
This means that if someone has substance-related problems and shows certain signs based on the DSM-5 diagnostic criteria, the DSM-5 says they have Substance Use Disorder.
This can be diagnosed as mild substance use disorder, moderate substance use disorder, or severe substance use disorder based on how many signs are present.
Before the recent text revision, substance abuse was about having bad things happen because of using substances.
Substance dependence was more about needing the substance and having withdrawal when not using it. But now, the DSM-5 looks at all these things together to decide if someone has a substance-related problem.
How Are Substance Use Disorders Diagnosed?
Substance use disorders are diagnosed by looking at certain signs and behaviors. If a person shows at least two out of eleven specific signs within a year, they might have a substance use disorder.
These signs include using more drugs or alcohol than intended, trying to stop but failing, and having problems at work, school, or home because of substance use.
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Written By
Dr Ryan Peterson