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McNeely J, Adam A. Substance Use Screening and Risk Assessment in Adults [Internet]. Baltimore (MD): Johns Hopkins University; 2020 Oct.

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Substance Use Screening and Risk Assessment in Adults [Internet].

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Table 3DSM-5 Diagnostic Criteria for Diagnosing and Classifying Substance Use Disorders [a,b,c]

Criteria TypeDescriptions

Impaired control over substance use

(DSM-5 criteria 1 to 4)

  • Consuming the substance in larger amounts and for a longer amount of time than intended.
  • Persistent desire to cut down or regulate use. The individual may have unsuccessfully attempted to stop in the past.
  • Spending a great deal of time obtaining, using, or recovering from the effects of substance use.
  • Experiencing craving, a pressing desire to use the substance.

Social impairment

(DSM-5 criteria 5 to 7)

  • Substance use impairs ability to fulfill major obligations at work, school, or home.
  • Continued use of the substance despite it causing significant social or interpersonal problems.
  • Reduction or discontinuation of recreational, social, or occupational activities because of substance use.

Risky use

(DSM-5 criteria 8 and 9)

  • Recurrent substance use in physically unsafe environments.
  • Persistent substance use despite knowledge that it may cause or exacerbate physical or psychological problems.


(DSM-5 criteria 10 and 11)

  • Tolerance: Individual requires increasingly higher doses of the substance to achieve the desired effect, or the usual dose has a reduced effect; individuals may build tolerance to specific symptoms at different rates.
  • Withdrawal: A collection of signs and symptoms that occurs when blood and tissue levels of the substance decrease. Individuals are likely to seek the substance to relieve symptoms. No documented withdrawal symptoms from hallucinogens, PCP, or inhalants.
  • Note: Individuals can have an SUD with prescription medications, so tolerance and withdrawal (criteria 10 and 11) in the context of appropriate medical treatment do not count as criteria for an SUD.

Abbreviations: DSM-5, Diagnostic and Statistical Manual of Mental Disorders–5; PCP, phencyclidine; SUD, substance use disorder.



Adapted from [APA 2013].


SUDs are classified as mild, moderate, or severe based on how many of the 11 criteria are fulfilled: mild, any 2 or 3 criteria; moderate, any 4 or 5 criteria; severe, any 6 or more criteria.


Please consult the DSM-5 for substance-specific diagnostic information.

From: Substance Use Screening and Risk Assessment in Adults

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