DSM-5-TR Diagnostic Framework
Substance Related and Addictive Disorders are characterized by clinically significant patterns involving substance use or addictive behavior that lead to impairment, distress, or other meaningful consequences. Diagnosis should consider the substance involved, pattern and duration of symptoms, functional impact, medical and psychiatric context, and whether symptoms are better explained by another condition.
Substance Use Disorder
A Substance Use Disorder is conceptualized around a problematic pattern of substance use associated with clinically significant impairment or distress. DSM-5-TR criteria are organized into four broad areas: impaired control, social impairment, risky use, and pharmacological criteria. social or interpersonal consequences, risky use, and/or pharmacological features such as tolerance or withdrawal. The diagnosis is based on the overall pattern rather than on any single symptom.
Severity
Severity is generally described according to the number of applicable diagnostic features:
- Mild: 2–3 features
- Moderate: 4–5 features
- Severe: 6 or more features
Severity should be interpreted alongside clinical judgement, functional impairment, safety concerns, medical risk, and the patient's current clinical presentation.
Major Substance Categories
DSM-5-TR Substance-Related and Addictive Disorders include disorders related to:
- Alcohol
- Cannabis
- Phencyclidine
- Other hallucinogens
- Inhalants
- Opioids
- Sedatives, hypnotics, or anxiolytics
- Stimulants
- Tobacco
- Other or unknown substances
Substance-induced conditions may also occur, including intoxication, withdrawal, and substance-induced mental disorders when applicable.
Gambling Disorder
Gambling Disorder is the DSM-5-TR behavioral addiction diagnosis. It involves a persistent problematic pattern of gambling associated with impaired control, continued engagement despite negative consequences, and clinically significant distress or impairment.
Clinical Assessment Considerations
Assessment should distinguish substance use from substance-induced symptoms, independent mental health conditions, prescribed medication effects, and acute medical concerns. Clinicians should assess frequency and quantity of use, route when clinically relevant, cravings, attempts to cut down, consequences, withdrawal history, overdose risk, safety, recovery supports, and functional impairment.
Clinical note: DSM criteria should support clinical formulation rather than replace individualized assessment. When withdrawal, overdose risk, severe intoxication, or other medical complications are possible, appropriate medical evaluation should be considered.