Noticable Signs That Someone has a Substance Use Disorder

The most common diagnostic tool used in the United States is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Counselors, therapists, physicians, emergency medical providers, and addiction specialists all use this manual to diagnose whether someone is struggling with an addiction and how serious the condition may be.

The latest version of the DSM offers 11 criteria to determine if someone struggles with this condition. These criteria include: 

1. Consuming more of the drug than intended or for longer than intended

2. Trying to quit or expressing the desire to quit but being unable to do so

3. Spending a lot of time getting the drug, using it, and recovering from the aftereffects of use

4. Intense cravings for the drug or expressing a strong, frequent desire to use it

5. Failing to meet school, work, family, or social obligations

6. Regularly using the drug despite the social, personal, or emotional issues it causes

7. Giving up hobbies or fun activities to continue abusing the drug

8. Experiencing physical problems or psychological damage due to the drug but choosing to continue to abuse it anyway

9. Developing a tolerance, which leads to taking more to achieve the original intoxication level

10. Withdrawal symptoms when unable to take the drug

11. Putting oneself in unsafe situations, like driving while intoxicated, more than once

While these signs and symptoms can indicate if a problem exists, an official diagnosis requires a medical professional. To begin to understand if you have a substance use disorder (SUD) or an addiction, your doctor will ask you various questions and then assess your answers. You may also undergo certain medical tests and drug screenings.

If you recognize yourself in two or more of these 11 criteria, and you have experienced these sensations for more than a year (12 months), your doctor will diagnose you with addiction and begin to refer you to treatment programs. The specific programs you are referred to will depend on how many criteria you fulfill since three different levels of addiction are listed in the DSM-5. 

• Mild: If you experience two or three of the symptoms for a year, but no more, then you have a mild addiction to a substance. This means you may qualify for outpatient treatment to end your physical dependence through medical detox and outpatient group therapy for rehabilitation. This can also depend on your surroundings and other aspects of your life and needs.
  

• Moderate: The presence of four to five symptoms listed in the criteria means you have a moderate addiction. You will benefit from more intensive oversight during the detox and rehabilitation process, but again, the combination of inpatient and outpatient options can depend a lot on whether you are safe at home, need to take care of your family, and other factors.
  

• Severe: When you struggle with six or more of the listed symptoms for a year or more, you have a severe addiction and may need inpatient treatment. This is essentially a safety precaution because your body needs more medical help to overcome withdrawal symptoms during detox, and you will need support to focus fully on changing behaviors to avoid drugs or alcohol during rehabilitation. 

The particular detox and rehabilitation programs you attend also depend on which substances you abuse and if you have any co-occurring mental health conditions such as depression, anxiety, or bipolar disorder.

The DSM-5 recognizes several forms of substance abuse, including: 

• Alcohol use disorder
• Tobacco use disorder
• Cannabis use disorder
• Stimulant use disorder
• Hallucinogen use disorder
• Opioid use disorder 

The manual also now recognizes gambling addiction, but it has not yet included other types of compulsive behaviors such as binge eating or sex addiction.

When you are diagnosed with one or more of the substance use disorders above, this informs your doctor about what type of detox program you will need to attend. For example, if you have an opioid addiction, you may need buprenorphine treatment; however, if you abuse Adderall, you will need different types of management for your symptoms.

The course of detox, followed by at least 90 days of rehabilitation, will be determined based on something like the American Society of Addiction Medicine’s (ASAM) Continuum of Care. You may need intensive detox but can safely go to standard outpatient rehabilitation, for example, or you may be all right detoxing at home but need to enter residential rehabilitation for more than six months to change your behaviors. This is a very personalized process, and access to treatment is important.