The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) no longer uses the terms “substance abuse” and “substance dependence.” Rather, it refers to substance use disorders, patterns of symptoms resulting from the use of a substance that one continues to take, despite experiencing problems as a result.
A substance use disorder (SUD) is a chronic brain disease, and like other chronic diseases it involves periods of recovery and periods of relapse. Medication and/or behavior change are needed to manage and treat the disease.
SUD Symptoms
The DSM-5 identifies 11 criteria (symptoms) in 4 categories as shown below.
Impaired Control
- Take substance in larger amounts or over longer period than intended
- Repeatedly try without success to decrease or discontinue substance use
- Spend much time obtaining, using, and recovering from substance
- Craving—intense desire/urge for substance
Social Impairment
- Failure to fulfill major obligations because of repeated substance use
- Continued use of substance despite persistent social and interpersonal problems caused or exacerbated by use
- Give up important social, occupational, or recreational activities because of substance use
Risky Use
- Recurrent use when it is physically hazardous
- Recurrent use despite knowing that it has probably caused ongoing physical or psychological problems
Tolerance & Withdrawal
- Tolerance—need increased amount to achieve same effect
- Withdrawal—experience withdrawal symptoms or continue using to keep from having withdrawal
Food addiction is a term that is used to describe a pattern of eating consumption and behaviors with the same criteria for substance use disorder.
Substance use disorders are classed as mild, moderate, or severe, depending on the number of criteria met:
- Two or three symptoms indicate a mild disorder.
- Four or five symptoms indicate a moderate disorder
- Six or more symptoms indicate a severe disorder.
The prevalence of substance use disorders is similar to that of other chronic diseases.
- 8.1% of the US population aged 12 and over has a substance use disorder.*
- 9.3% of the US population has diabetes.*
- 7.7% of the US population has asthma.***
- 29% of American adults have high blood pressure.****
NIDA. “Preface.” National Institute on Drug Abuse, 30 May. 2023,
https://nida.nih.gov/research-topics/addiction-science/drugs-brain-behavior-science-of-addiction
https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50).
https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
**2014 National Diabetes Statistics Report. Centers for Disease Control and Prevention Web site.
https://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html
*** National Current Asthma Prevalence (2015). Centers for Disease Control and Prevention Web site.
https://www.cdc.gov/asthma/most_recent_data.htm
****High Blood Pressure Facts. Centers for Disease Control and Prevention Web site.
https://www.cdc.gov/bloodpressure/facts.htm. Updated November 30, 2016