In a 2024 survey by the National Survey on Drug Abuse and Health (NSDUH), it’s estimated that over 48.4 million Americans aged 12 and above suffered from a substance use disorder (SUD).
About 27.9 million people also suffered from alcohol use disorder, or AUD, many of whom are teenagers aged 17 and under.
Drug addiction is a serious healthcare issue that continues to plague millions of individuals worldwide. As a condition that affects the brain, addiction leads to psychological or physical dependence on a particular substance.
People living with SUD are more likely to struggle with serious health problems and face disruptions in several aspects of their lives and relationships.
However, what actually constitutes addiction? How do clinicians diagnose and treat this mental health condition? What exactly is the DSM 5?
Here’s everything you need to know about the DSM 5 and addictive disorders.
Table of Contents
What Is the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a psychiatry book published by the American Psychiatric Association (APA) in 2013, serving as the standard reference for diagnosing mental health disorders.
Also called the DSM-5-TR, it contains a comprehensive list of mental illnesses alongside the set of symptoms associated with each of them. Its previous iteration, the DSM-IV, was published in 1994.
Key changes in the DSM 5 include revising the chapter for substance-related disorders. It combined substance dependence and abuse into a single condition, measured on levels of severity (mild, moderate, and severe).
The manual currently recognizes addictive dysfunctions on several drug classes, including the following:
- Hallucinogens
- Opioids (opioid use disorder)
- Caffeine (caffeine use disorder)
- Alcohol
- Sedatives
- Hypnotics
- Inhalants
- Tobacco
- Cannabis
- Stimulants (including cocaine, amphetamine, and prescription drugs)
The fifth edition further updated the diagnostic criteria for over 70 recognized mental health illnesses, and also now classifies pathological gambling disorder as a form of behavioral addiction.
Crafted by experts, the DSM 5 is an essential tool in the mental health field and is widely considered the gold standard in standardized addiction diagnosis. It’s vital for both SUD treatment planning and continuous mental health research.
DSM-5 Criteria For Substance Use Disorder
The Diagnostic and Statistical Manual of Mental Disorders identifies 11 criteria for diagnosing addiction. These symptoms fall into four categories or patterns of behaviors observed in people struggling with SUD.
1. Impaired Control
The first symptom involves using larger amounts of a substance or more often than intended. Someone who says to have a single drink but ends up binge drinking is an example of this.
This inability to limit drug use is a sign of impaired control due to the substance hijacking the brain’s reward center, a classic manifestation of substance use disorder.
The individual may feel or experience:
- That they need to use the drug regularly, sometimes multiple times a day
- Using without conscious decision-making, such as reaching for alcohol without thinking
- Difficulty stopping once they start drinking or using
- An intense urge to drink or use when stressed, bored, or when encountering triggers
Despite the desire to cut down or cease the drug intake, the intense cravings that follow usually make it difficult to stop using or drinking. This results in repeated failed efforts to recover and may cause feelings of shame and guilt.
Expert intervention is often required to regain control.
2. Social Problems
Someone living with drug addiction may find themselves excessively preoccupied with substance-related activities.
Making certain they have a supply of drugs or alcohol, they might start neglecting their responsibilities and commitments. They may withdraw from social gatherings and recreational activities.
They also often:
- Disregard their hygiene and appearance
- Show signs of noticeable physical changes (weight loss, red eyes, etc.)
- Perform poorly in school or work
- Frequently ask for money to buy alcohol or drugs
- Strain their relationships with friends and loved ones
With substance abuse skewing their priorities, individuals suffering from addiction could lose interest in things and hobbies they used to enjoy and love.
3. Dangerous Use
People dealing with substance use disorder often understand that it’s harmful. But because the drugs change how the brain functions, knowing the harm isn’t always enough to stop using.
Over time, without expert intervention, the compulsive behavior may even escalate to risky and potentially hazardous situations, such as:
- Driving under the influence of alcohol or drugs
- Binge drinking before swimming
- Going to work while drunk or high
- Engaging in unprotected sex
- Using while operating heavy machinery
Studies found that drugs and alcohol impair the frontal cortex, the part of the brain responsible for decision-making and impulse control.
As a result, an individual living with addiction may feel invincible or underestimate the danger they’re in when under the influence, raising the likelihood of accidents.
In the US, roughly 30% of all traffic crash fatalities involve alcohol and other substances. According to the National Highway Traffic Safety Administration (NHTSA), over 12,429 people died from impaired driving in 2023 alone.
Drug use is found to be a major contributor to the country’s high rate of sexually transmitted illnesses, including HIV and hepatitis, in a study published in the National Library of Medicine.
4. Physical Dependence
After long-term and heavy drug use, the body begins to adapt to functioning with the substance’s presence.
This means the person has become physically dependent, and withdrawal symptoms can appear when they reduce or cease using alcohol or drugs.
However, with continued abuse, the effect of the substance may diminish, as the body builds its tolerance. As a result, they could start taking more of the drug or drinking more to achieve similar effects.
Building tolerance is dangerous because it compels the individual to consume higher and higher doses of substances, increasing the risk of overdose and poisoning.
That said, it’s worth noting that dependence alone doesn’t necessarily mean you’ve become addicted. People on prescription medications can also show signs of dependency from prolonged intake.
Muscle relaxers, CNS depressants (benzodiazepines), and prescription opioids are all known to produce similar symptoms.
Levels of Severity
The DSM 5 outlines guidelines for determining the severity of SUD based on the number of symptoms a clinician can identify.
A mild substance use disorder involves two or three symptoms, while moderate cases indicate a moderate addiction. Severe substance use disorders typically exhibit six or more symptoms and could require immediate care.
Determining the severity of addiction is crucial for planning effective treatment and the right level of care. Multiple SUD symptoms generally demand intensive and personalized interventions.
People with any co-occurring disorder will also be simultaneously treated in an integrated approach.
Substance-Use vs Substance-Induced Disorders
The DSM 5 psychiatric manual differentiates between substance use and substance-induced disorders (SID).
Unlike SUD, substance-induced disorders involve health issues as a direct result of a particular medication or substance. This can include intoxication (from alcohol), withdrawal, and mental health disorders.
Some people may develop symptoms resembling serious mental illnesses after taking certain chemicals and drugs. Hormonal contraceptives, stimulants, and opioids, for instance, can cause depressive episodes.
Delirium, sleeping problems, and sexual dysfunction have also been observed in individuals taking antidepressants, benzodiazepines, and over-the-counter antihistamines.
Other examples of these substance-induced conditions are psychotic disorders, bipolar disorders, anxiety disorders, neurocognitive disorders, and obsessive-compulsive disorders.
Treatment For Substance Use Disorders
Managing withdrawal is often the first step in an SUD intervention. Withdrawal symptoms aren’t only uncomfortable but can also be fatal, so detoxing under expert supervision can be crucial to ensure safe and comfortable recovery.
Treatment centers employ various evidence-based treatment plans, designed based on the person’s unique needs.
Medication may also be prescribed in combination with treatment to manage severe withdrawal.
Counseling and talk therapy are standard and essential aspects of SUD treatment. They’re meant to address unhealthy behavior and thinking patterns, reinforcing drug use, as well as any co-occurring disorder that co-exists with the illness.
Cognitive behavioral therapy (CBT) is a popular mental health treatment employed in addiction treatment programs, alongside support groups and other initiatives.
Bottom Line: Conquering Substance Abuse With Expert Help
Like many chronic illnesses, addiction can spiral and get worse when left alone. If you or anyone you know has been living with substance use disorders, getting expert help is something you can’t delay.
Illinois Recovery Center offers holistic and individualized addiction treatment services and rehab programs across the Prairie State. Our team of accredited experts is ready and equipped to treat SUD and its co-occurring disorders as recognized in the DSM 5.
Reach out to us and find out how we can help you today
