Substance use disorder

Diagnostic Criteria

DSM-5 criteria

• At least 2 of the following 11 criteria over a 12-month period:
  • Impaired control
    • The substance is used in larger amounts or for longer than intended
    • Unsuccessful efforts or desire to cut back or control substance use
    • Excessive amount of time spent obtaining, using, or recovering from the substance
    • Craving to use the substance
  • Social impairment
    • Failure to fulfill major role obligations at work, school, or home as a result of recurrent substance use
    • Persistent or recurrent social or interpersonal problems that are exacerbated by the substance or continued use of the substance despite these problems
    • Reduced or given up important social, occupational, or recreational activities because of the substance use
  • Risky use
    • Substance use in physically hazardous situations
    • Continued substance use despite knowledge of persistent physical or psychological problem that is likely caused by the substance
  • Pharmacological properties
    • Tolerance, as demonstrated by increased amounts of the substance needed to achieve desired effect; diminished effect with continued use of the same amount
    • Withdrawal, as demonstrated by symptoms of withdrawal syndromes; substances taken to relieve or avoid withdrawal
• Severity based on number of criteria
  • Mild: 2 to 3
  • Moderate: 4 to 5
  • Severe: 6 or more

Other terms

• Early remission: 3 to 12 months not meeting any above criteria (except craving)
• Sustained remission: 12 or more months not meeting any above criteria (except craving)
• Maintenance therapy: on prescription methadone or buprenorphine and non of the criteria are met for that medication
• Controlled environment: in an environment where substances are restricted

Management

• See specific substance use disorders for more information
• Breaking Free Online is a free online support tool designed to help Ontarians ages 16 and up reduce or stop the use of over 70 substances, such as tobacco, alcohol, opioids, and other recreational drugs