I Think I Have a Problem. How Do I Know?

The previous edition of the DSM (the Diagnostic and Statistical Manual of Mental Disorders), DSM-IV, had two categories: substance abuse and substance dependence. DSM-5 combines these two categories into one, called substance use disorder.

If your substance use causes significant problems in your life, such as health issues, disability, or not meeting your responsibilities at work, home or school, you may have a substance use disorder.

The 11 official criteria for a substance use disorder

Substance use disorders are classified as mild, moderate or severe, depending on how many of the diagnostic criteria you meet. These are the DSM-5 criteria:

1. Hazardous use: You’ve used the substance in ways that are dangerous to yourself and/or others, such as overdosing, driving under the influence or blacking out.
2. Social or interpersonal problems related to use: Your substance use has caused relationship problems or conflicts with others.
3. Neglected major roles to use: You’ve failed to meet your responsibilities at work, school or home because of your substance use.
4. Withdrawal: When you’ve stopped using the substance, you’ve experienced withdrawal symptoms.
5. Tolerance: You’ve built up a tolerance, so you have to use more to get the same effect.
6. Used larger amounts or for longer: You’ve started to use larger amounts or use the substance for longer periods of time.
7. Repeated attempts to control use or quit: You’ve tried to cut back or quit entirely, but haven’t been successful.
8. Much time spent using: You spend a lot of your time using the substance.
9. Physical or psychological problems related to use: Your substance use has led to physical health problems like liver damage or lung cancer, and/or psychological issues such as depression or anxiety.
10. Activities given up to use: You’ve skipped or stopped doing activities you once enjoyed in order to use.
11. Craving: You’ve experienced cravings for the substance.

Two or three criteria indicate a mild disorder, four or five moderate, and six or more severe. A formal assessment can give you a clear answer and a recommendation for what to do next.