Bret S. Stetka, MD; Christoph U. Correll, MD


May 21, 2013

In This Article

Substance Use Disorder

The Change

In DSM-5, the DSM-IV criteria substance abuse and substance dependence have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category. Each substance use disorder is divided into mild, moderate, and severe subtypes. Whereas DSM-IV substance abuse diagnostic criteria required only 1 symptom, a DSM-5 diagnosis even for just mild substance use disorder now requires at least 2.

The Implications

The DSM-5 revisions are intended to (1) strengthen the reliability of substance use diagnoses by increasing the number of required symptoms and (2) clarify the definition of "dependence," which is often misinterpreted as implying addiction and has at its core compulsive drug-seeking behaviors. In contrast, features of physical dependence, such as tolerance and withdrawal, can be normal responses to prescribed medications that affect the central nervous system and that need to be differentiated from addiction. Moreover, although marijuana abuse can be functionally very impairing, physical dependence is not part of the clinical picture, even in severe cases. In this sense, the new DSM-5 criteria recognize that mental and behavioral aspects of substance use disorders are more specific to substance use disorders than the physical domains of tolerance and withdrawal, which are not unique to addiction.

Although the new criteria require an increased number of symptoms to qualify for a substance-related diagnosis, critics of the revision argue that chances of meeting the new criteria are now much greater. They further worry that many individuals who qualify for a substance use disorder diagnosis per the new criteria have only minor symptoms, making it more difficult for those with more severe symptoms and distress to access already scarce treatment resources.