Understanding the Diagnostic Criteria for Substance Use Disorder: What It Means and How to Seek Support

Substance use can impact many areas of life, from health and relationships to career and overall well-being. But how do you know when casual or habitual use has crossed into something more serious? The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides clear criteria to help identify a substance use disorder (SUD)—a medical condition characterized by the inability to control substance use despite negative consequences.

Whether you're evaluating your own relationship with substances or are concerned about a loved one, understanding these criteria can provide clarity and help guide the next steps. Let’s break down each of the 11 DSM-5 criteria for substance use disorder, what they mean in real life, and how you can seek support if you recognize these patterns in yourself or someone close to you. Below you will find the diagnostic criteria outlined, with a clearer explanation and some examples. This isn’t about keeping score, or even diagnosing yourself, but a resource to consider your relationship to drugs/alcohol and how problematic it might be.

1. Taking the Substance in Larger Amounts or for Longer Than Intended

What it means:
You find yourself using more of the substance than you planned, or you continue using it for a longer period than you intended. This could look like planning to have just one drink but ending up finishing a bottle of wine, or intending to only take medication when absolutely necessary, but taking it daily to cope with stress.

You might find yourself saying something like:

"I used to have a couple of drinks to unwind after work, but now I find myself having several and staying up late even when I planned to stop early."

"I planned to have just one glass of wine at dinner, but I ended up finishing the entire bottle without realizing it."

"I told myself I’d only use substances on weekends, but I find myself using multiple times throughout the week."

2. Unsuccessful Efforts to Cut Down or Control Use

What it means:
Despite wanting to reduce or stop substance use, attempts to do so have been unsuccessful. You might set rules for yourself, like only drinking on weekends, only to find yourself breaking those rules repeatedly. It’s difficult or impossible to stay within the guardrails you set, never able to drink or use less.

You might find yourself saying something like:
"I told myself I wouldn't smoke anymore, but every time I try to quit, I find an excuse to have just one more."

"I keep telling myself I’ll quit after this weekend, but it always becomes next weekend."

"I’ve deleted my dealer’s number several times, but I end up reaching out again when I feel stressed."

3. Spending a Lot of Time Obtaining, Using, or Recovering from the Effects

What it means:
Substance use takes up a significant portion of your time, whether it’s seeking the substance (buying, getting, picking up, etc.), using it, or recovering from its effects (e.g., hangovers or withdrawal symptoms).

You might find yourself saying something like:
"I plan my whole weekend around when I can use and how much time I'll need to recover before Monday."

"Most of my social plans revolve around drinking, and I spend a lot of time recovering from hangovers."

"I rearrange my schedule to fit in time for using, even if it means missing important work meetings."

4. Cravings or Strong Urges to Use the Substance

What it means:
Experiencing strong cravings or intense urges to use the substance, often at unexpected times or during stress. Cravings can feel like a mental preoccupation or a physical need. It’s not always a visceral need to drink or use, but it’s something that a lot of mental space is dedicated to thinking about.

You might find yourself saying something like:
"I can't focus on work sometimes because I keep thinking about when I can have my next drink or hit."

"Whenever I’m stressed, I immediately think about how good it would feel to have a drink."

"Just walking past my favorite bar triggers an urge I can't ignore."

5. Failure to Meet Obligations at Work, School, or Home Due to Use

What it means:
Substance use begins to interfere with responsibilities and commitments, leading to missed deadlines, neglected household duties, or struggles in fulfilling roles at home or work.

You might find yourself saying something like:
"I used to be on top of my work, but now I'm always late or missing deadlines because I’m recovering from the night before."

"I’ve been late to work several times because I was recovering from drinking the night before."

"My house is a mess because I just don’t have the energy to clean anymore."

6. Continued Use Despite Social or Interpersonal Problems

What it means:
Your substance use has caused issues in relationships with friends, family, or colleagues, yet you continue to use despite the tension it creates. You also might notice that the only people in your life who don’t have friction with you are the people you drink or use with.

You might find yourself saying something like:
"My partner and I argue constantly about my drinking, but I keep doing it anyway because I feel like I need it to relax."

"My partner is constantly upset with me for drinking, but I still can’t (or won’t) stop."

"I’ve lost friends because they’ve grown tired of my behavior when I’m using."

7. Giving Up Important Activities Due to Substance Use

What it means:
You start losing interest in hobbies, social engagements, or activities you once enjoyed because substance use has taken precedence.

You might find yourself saying something like:
"I used to love hiking and spending time with friends, but now I'd rather stay home and drink alone."

"I used to love painting, but I can’t remember the last time I did it, or even thougth about it."

"I skipped my best friend's wedding because I didn’t think I could get through it sober."

8. Using in Situations Where It’s Physically Hazardous

What it means:
Continuing to use substances in ways that put you in dangerous situations, such as drinking and driving, using heavy machinery while intoxicated, or engaging in risky behaviors while under the influence.

Real-life example:
"I’ve driven home after drinking more times than I can count. I know it’s risky, but I do it anyway."

"I’ve used drugs alone, even though I know it could be dangerous without someone around."

“I find myself in neighborhoods I wouldn’t ever go to if it wasn’t using.”

9. Continued Use Despite Physical or Psychological Harm

What it means:
Even when substance use is causing harm to your physical or mental health, such as worsening depression, anxiety, or medical conditions, you find it hard to stop.

You might find yourself saying something like:
"My doctor warned me about my liver, but I haven’t been able to stop drinking."

"I’ve noticed my anxiety is worse when I drink, but I can’t seem to stop."

10. Developing Tolerance (Needing More to Achieve the Same Effect)

What it means:
Over time, you need larger amounts of the substance to feel the desired effects, or you find that the usual amount doesn't have the same impact as before. It just takes more than it used to.

Real-life example:
"I used to feel a buzz after one or two drinks; now it takes five or six to get the same feeling."

"I need a higher dose of my prescription to get the same relief I used to."

11. Experiencing Withdrawal Symptoms When Not Using

What it means:
When you try to stop or cut back, you experience withdrawal symptoms such as shaking, nausea, anxiety, irritability, or even more severe physical symptoms depending on the substance.

Real-life example:
"When I skip a day, I feel shaky and anxious, and I can't function until I have a drink."

"I can’t sleep unless I have a drink or take something to relax."

“Just don’t talk to me until I’ve had my morning coffee.”

Understanding the Severity of Substance Use Disorder

The DSM-5 categorizes SUD based on how many criteria are met:

• Mild: 2-3 criteria

• Moderate: 4-5 criteria

• Severe: 6 or more criteria

Regardless of where you fall on the spectrum, acknowledging the signs is the first step in making meaningful changes.

Seeking Help: Therapy as a Path to Recovery

If you recognize yourself or a loved one in any of these signs, therapy can be a powerful resource for understanding and addressing substance use. Whether you are exploring harm reduction, moderation, or complete sobriety, working with a therapist in San Francisco—virtually or in person—can help you navigate your unique path. Therapy provides a non-judgmental space to explore your relationship with substances, identify triggers, and develop healthier coping strategies.

There are various options, including:

• Individual therapy for personalized strategies and support.

• Couples therapy to navigate relationship challenges related to substance use.

• Group therapy to connect with others on a similar journey.

A Hopeful Path Forward

Recognizing the signs of substance use disorder can be overwhelming, but it’s important to remember that change is possible, and you are not alone. Seeking help doesn't mean admitting defeat; it means taking control of your life and well-being. Whether you're considering moderation, harm reduction, or full sobriety, there are numerous paths to healing, and therapy can play a crucial role in exploring what works best for you.

Therapy in San Francisco, both in-person and virtually, provides a supportive space to address underlying issues, develop coping skills, and navigate the complexities of change. Individual, couples, and group therapy can all provide invaluable support, helping you rebuild relationships and rediscover your sense of self.

If you're unsure about the next step, consider speaking with a therapist to explore your options and create a plan that aligns with your goals. From developing coping strategies to connecting with community resources and peer support, therapy can be a powerful tool for long-term recovery and emotional well-being.

If you're ready to explore your relationship with substances and take control of your well-being, reach out to a qualified therapist in San Francisco today. Help is available, and recovery is possible.

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References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.