The 11 Criteria to Define Substance Use Disorders

I think it is important that we, as an agency and as individual professionals do our diligence in getting information out about what addiction really is…

Max Liles, Senior Director, The Counseling Center

July 3, 2020

We have officially made it through the first 6 months of 2020 – it’s. lit. fam.

World War 3 potential; Impeachment Trials; Global Pandemic; Murder Hornets; No March-Madness tournament; Kim Jong Un died – maybe?; Resurgence of Global Pandemic; we lost Kobe.

Our news outlets and Facebook feeds have been overwhelmingly active – and, though you might not have known it before… Most of your friends are political scientists with a concentration in infectious disease. (My friends, too).

BUT, please – let me take you back to the good ol’ days; more simple times.

As a person in recovery, a professional in the field of substance use disorder treatment, and a co-insurer of a good internet argument – I wanted to drum up one of my favorite topics of debate… One that has been the focus of numerous social media influencers (qualified and otherwise), created and re-created in * LONG POST ALERTS * and 6 minute rants alike:

IS ADDICTION A DISEASE OR A CHOICE?

The DSM5:
The most used reference for diagnostic criteria, in regards to assessing and diagnosing mental health disorders, is the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AKA the DSM5.

As far as “Addiction” goes – it’s in there… in the Index; if you look up “Addiction” – it says: “See Substance-Related and addictive disorders.”

It should be noted:
-DSM5 is a catalog of Mental Disorders.
-Substance Use Disorders and Substance-Induced Disorders ARE part of the DSM5.
-That Substance Use Disorders based on this inclusion ARE a mental disorder.
-There are specific criteria that outline and define the presentation and severity of SUD’s.

The Criteria:
From what I’ve seen and heard – a lot of people, even folks who have a Substance Use Disorder, define SUD’s in a way that leaves some things out. Most times, people point to an “initial” decision/choice to use; using a specific drug; using drugs in a particular way; or suffering a certain set of consequences as “the problem”.

Below are the 11 Criteria that the DSM5 uses to define Substance Use Disorders:

(1) Use in larger amounts or for longer periods of time than intended.
What’s that look like?
-I said I was going to have 6 beers, I had 16.
-I said I was going to go to the bar for Happy Hour – I shut the place down.
-I said I was going to drink Friday night, I also drank Saturday and Sunday.

(2) Unsuccessful efforts to cut down or quit.
What’s that look like?
-I made a promise to my wife I would quit using; I tried but was unable to quit using.
-I made a decision to limit the amount of drugs I used in a day; I tried but was unable to limit my use.

(3) Excessive time spent getting, using, intoxicated, and recovering from effects:
What’s that look like?
-When asked about “How much time did you spend…?” a general response I have gotten is, “It’s like a full time job.”

(4) Craving or Intense desire/urge to use substance.
What’s that look like? For this, some analogies.
-You know every New Year, when you say you’re going to quit eating sweets, and you make it a few weeks, but then that thing just takes over and you obsess about ice cream – then you smash an entire pint of Ben and Jerry’s? It’s like that.
-Craving similar to that of your desire for water after working outside in the yard on a hot day.
-When the morning meeting ran over and you didn’t get to eat lunch until 2p.

(5) Failure to fulfill major obligations.
What’s that look like?
-Job performance suffers as a result of using substance(s).
-Inability to parent children.
-Got kicked out of school.
-Bills don’t get paid.
-Non-participation in family/friendship roles.

(6) Continued use despite social/interpersonal problems.
What’s that look like?
-Even though all the stuff in criteria 5 happened, I kept using anyway.

(7) Activities/hobbies reduced or given up.
What’s that look like?
-I used to play in the basketball rec league, now I don’t.
-I used to be heavily involved in the arts community, now I am not.
-I used to be an avid outdoorsmen, I haven’t been involved in those activities for over a year.

(8) Recurrent use in physically hazardous situations:
What’s that look like?
-Using abandoned houses and properties.
-I work with heavy equipment, and use it on the job.
-I often drink and drive.

(9) Recurrent use despite physical or psychological problems caused by or worsened by use.
What’s that look like?
-I have Hepatitis C, and use drugs intravenously.
-I have an abscess, but keep using anyway.
-I have Major Depressive Disorder, and use depressant substance.
-I have cirrhosis of the liver, and continue to drink.

(10) Tolerance.
What’s that look like?
-I used to use twice a day; now, to maintain the desired effect, I use 5 times a day.
-3 pills used to make me feel great; now, to achieve the desired effect I take 6 pills.

(11) Withdrawal.
What’s that look like?
-When I don’t have the substance, I am physically and psychologically affected. (Examples: Insomnia, nausea, vomiting, restlessness, tremors, seizures, depressed mood, anxiety.)

(BONUS) Severity.
Severity is designated according to the number of symptoms present:
0-1: No Diagnosis
2-3: Mild Severity
4-5: Moderate Severity
6 or More: Severe

What can you do?
Despite my affinity for scrolling through the 358 comments and reading the responses on the “Is Addiction a Disease or a Choice” posts (and maybe even hopping in there to a shoot a couple shots myself)… I think it is important that we, as an agency and as individual professionals do our diligence in getting information out about what addiction really is – a mental health problem; a healthcare problem.

Hopefully, this breakdown of the SUD criteria and subsequent illustrations can provide some straight forward examples in understanding this group of disorders.

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