Diagnostic and Statistical Manual of Mental Disorders: DSM-5 Replaces DSM-IV

The previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) divided substance-related disorders into two categories: substance abuse and substance dependence. There were a number of problems with this system: the dividing line between abuse and dependence was not clear; substance dependence was often confused with physical dependence; and the term abuse has pejorative connotations. Published in May 2013, the DSM-5 replaces these with a single term: substance use disorder. There are two major changes to the diagnostic criteria: 1) Recurrent legal problems, which was a criterion for substance abuse, has been removed. 2) A new criterion has been added: craving or strong desire/urge to use a substance.

The DSM-5 defines a substance use disorder as the presence of at least 2 of 11 criteria, which are clustered in four groups:

**Criteria not displayed due to intellectual property and copyright regulations, but can be found for free online here**

Comments:

The DSM-5 suggests using the number of criteria met as a general measure of severity, from mild (2–3 criteria) to moderate (4–5 criteria) and severe (6 or more criteria). Defining substance use disorders on a single continuum makes sense, but will likely create confusion in the short term and the DSM provides no guidance on how to use these criteria to decide on who needs formal treatment.

Finally, new to DSM-5 are cannabis and caffeine withdrawal, and the criteria for tobacco use disorder are now the same as for all other substance use disorders.

Darius A. Rastegar, MD

Reference:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, VA: American Psychiatric Association, 2013.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association, 1994.