Understanding DSM-5 and Substance Use Disorders
Addiction doesn’t discriminate. Substance use disorders can affect individuals from all walks of life. At The Last Resort Recovery, we believe that understanding the clinical definition of addiction is the first step toward recognizing the need for help and beginning the journey to recovery.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, serves as the authoritative guide for diagnosing mental health conditions, including substance use disorders [1]. This comprehensive handbook represents decades of research and clinical experience from hundreds of international mental health and addiction medicine experts.
Do I Have a Substance Use Disorder? Take Our DSM-5 Self-Assessment Quiz
Understanding if you might have a substance use disorder starts with honest self-reflection. While only healthcare professionals can provide an official diagnosis, our brief self-assessment quiz based on DSM-5 criteria can help you evaluate your relationship with substances.
Take a few minutes to complete our confidential assessment below. Your responses will help determine whether professional evaluation might benefit your situation.
Remember, deciding to seek help is a sign of strength. If your results suggest a potential substance use disorder, our team at The Last Resort is here to help.
What is the DSM-5?
The DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a clinically validated framework used by healthcare professionals worldwide to diagnose and classify mental health conditions. Published in 2013, this edition marked a significant shift in how addiction is conceptualized and diagnosed.
Before the DSM-5, clinicians diagnosed “substance abuse” and “substance dependence” as separate conditions. The DSM-5 revolutionized this approach by integrating these categories into a single diagnosis: Substance Use Disorder (SUD) [2]. This change acknowledges that addiction exists on a spectrum of severity rather than as distinct categories.
The 11 Diagnostic Criteria for Substance Use Disorder
The DSM-5 identifies 11 specific criteria for diagnosing substance use disorders [2]. These criteria help clinicians and individuals recognize problematic patterns of substance use that indicate the potential presence of a disorder. Understanding these criteria can help you or your loved one identify when casual use has crossed into dependency or addiction.
[01] Loss of Control Over Use
Many individuals with substance use disorders find themselves using more of a substance than intended or for longer periods than planned. This might look like:
- “Just one drink” turning into several hours at a bar
- A weekend of recreational use extending into the workweek
- Running out of prescribed medication sooner than expected
- Using larger amounts over time to achieve the same effect
This loss of control is often one of the first signs that casual use has developed into a potential disorder.
[02] Persistent Desire to Cut Down or Control Use
Those struggling with substance use disorders typically make repeated unsuccessful attempts to quit or moderate their use. You might recognize this as:
- Making promises to yourself or others about cutting back
- Setting rules about when or how much you’ll use
- Multiple attempts to quit that don’t last
- Feeling frustrated by your inability to stop despite wanting to
These unsuccessful attempts to control use indicate that the relationship with the substance has become problematic.
[03] Time Spent Obtaining, Using, or Recovering from Use
When substance use begins to dominate your schedule, it’s a significant warning sign. This criterion involves:
- Spending hours or even days acquiring substances
- Structuring daily activities around substance use
- Dedicating increasing amounts of time to using
- Needing extended periods to recover from the effects
This preoccupation with substances often leads to neglect of other important life activities.
[04] Cravings and Urges to Use
Intense cravings are strong indicators of a substance use disorder. These manifest as:
- Intense, sometimes overwhelming desires to use the substance
- Intrusive thoughts about using that are difficult to redirect
- Physical sensations associated with wanting the substance
- Difficulty concentrating on other tasks due to thoughts of using
These cravings can be triggered by environmental cues, stress, or emotions related to past use.
[05] Failure to Fulfill Major Obligations
Substance use that interferes with work, school, or home responsibilities is a critical diagnostic criterion. This might include:
- Declining performance at work or school
- Excessive absences or lateness
- Neglecting childcare or household duties
- Failing to meet financial obligations
When drug or alcohol use takes precedence over essential responsibilities, it signals a larger problem that could indicate a substance use disorder.
[06] Continued Use Despite Social and Interpersonal Problems
When relationships suffer due to substance use but the use continues, this is another indicator of a potential disorder. This can look like:
- Arguments with family members about substance use
- Relationship difficulties or breakups related to substance use
- Social isolation or changes in friendship groups to favor those who use
- Continuing to use despite knowing it’s causing relationship problems
The persistence of use despite these negative social consequences is a hallmark of addiction.
[07] Important Activities Given Up or Reduced
Individuals with substance use disorders often withdraw from activities they once enjoyed. This includes:
- Abandoning hobbies or recreational activities
- Declining social invitations or family gatherings
- Reducing involvement in community or religious activities
- Giving up career or educational opportunities
This criterion reflects how substance use can narrow one’s life focus.
[08] Recurrent Use in Physically Hazardous Situations
Using substances in situations that could cause physical harm indicates a serious problem. Some examples of this may include:
- Driving while intoxicated
- Operating machinery under the influence
- Using substances while caring for children
- Combining substances in dangerous ways
This risk-taking behavior demonstrates how substance use can override concern for personal safety.
[09] Continued Use Despite Physical or Psychological Problems
When someone continues using despite knowing the substance worsens a physical or psychological condition, it suggests addiction:
- Using alcohol despite liver problems
- Continuing stimulant use despite heart issues
- Using substances that exacerbate depression or anxiety
- Ignoring doctors’ warnings about substance-related health risks
This criterion reflects how substance use can override self-preservation instincts.
[10] Tolerance
Tolerance occurs when the body adapts to a substance, requiring more to achieve the same effect:
- Needing increasingly more significant amounts to feel intoxicated
- Experiencing diminished impacts with the same amount
- Being able to consume amounts that would seriously affect others
- Escalating use patterns over time
Tolerance is a physiological indication that the body has adapted to the substance.
[11] Withdrawal
Withdrawal symptoms occur when substance use is reduced or stopped:
- Physical symptoms like sweating, shaking, or nausea
- Psychological symptoms like anxiety, irritability, or depression
- Using the substance specifically to avoid or relieve withdrawal symptoms
- Developing predictable symptom patterns when attempting to stop
Withdrawal symptoms indicate that physical dependence has developed.
Understanding the Severity Spectrum
One of the most valuable aspects of the DSM-5 approach is its recognition that substance use disorders exist on a spectrum of severity. Based on how many criteria an individual meets, clinicians can determine whether a person has a mild, moderate, or severe substance use disorder:
- Mild Substance Use Disorder: Meeting 2-3 criteria
- Moderate Substance Use Disorder: Meeting 4-5 criteria
- Severe Substance Use Disorder: Meeting 6 or more criteria
This spectrum approach allows for more precise diagnosis and targeted treatment planning, moving away from the all-or-nothing conception of addiction from previous diagnostic frameworks.
How Diagnosis Informs Treatment at The Last Resort
At The Last Resort Recovery, we use the DSM-5 criteria for diagnosis and as a foundation for creating personalized treatment plans. Understanding exactly which criteria are present helps our clinical team develop targeted interventions for each aspect of a client’s substance use disorder.
Comprehensive Assessment Process
Our admission process includes a thorough evaluation based on the DSM-5 criteria. This assessment helps determine:
- The severity of the substance use disorder
- The presence of any co-occurring mental health conditions
- The appropriate level of care needed
- Specific treatment components that will be most beneficial
This evidence-based approach ensures that each client receives care that addresses their unique circumstances and needs.
Individualized Treatment Planning
Based on the specific DSM-5 criteria that apply to each client, we develop personalized treatment plans that may include:
- Medical Detoxification: For clients experiencing withdrawal symptoms (Criterion 11)
- Cognitive Behavioral Therapy: To address thought patterns related to cravings and continued use (Criteria 3, 4, 9)
- Motivational Enhancement Therapy: For clients who recognize the need to change but struggle to maintain motivation (Criterion 2)
- Family Therapy: To address relationship impacts and build support systems (Criterion 6)
- Equine-Assisted Therapy: Our specialized approach that helps clients reconnect with activities beyond substance use (Criterion 7)
- Life Skills Training: To rebuild capacity to fulfill major obligations (Criterion 5)
- Relapse Prevention Planning: To develop strategies for high-risk situations (Criterion 8)
Levels of Care Based on Severity
The severity spectrum from the DSM-5 guides our recommendations for the appropriate level of care:
- Mild SUD (2-3 criteria): May benefit from our Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP)
- Moderate SUD (4-5 criteria): Often requires our Residential Treatment program, possibly followed by PHP or IOP
- Severe SUD (6+ criteria): Typically begins with Detoxification, followed by our comprehensive Residential Treatment program and a strong continuum of care plan
Getting Help at The Last Resort Recovery
At The Last Resort Recovery, we understand that recognizing a substance use disorder is just the beginning of the journey to recovery. Our men’s-only rehabilitation programs offer a comprehensive, evidence-based approach to healing from addiction, mental illness, and trauma.
Our Unique Approach
What sets The Last Resort apart is our commitment to treating the whole person, not just the symptoms of addiction. Located on a 55-acre ranch in Smithville, Texas, our facility provides:
- A secluded, tranquil environment away from triggers and stressors
- Comprehensive treatment programs ranging from 40 to 90 days
- Evidence-based therapies combined with innovative approaches like equine-assisted therapy
- A focus on both addiction recovery and addressing co-occurring mental health conditions
- The full spectrum of care from detoxification to aftercare
- A men’s-only environment that addresses the unique challenges men face in recovery
Our Levels of Care
We offer a complete continuum of care to support men at every stage of recovery:
- Detoxification: Medically supervised withdrawal management
- Residential Treatment: Intensive, structured therapeutic environment
- Partial Hospitalization Program (PHP): Comprehensive daytime treatment without overnight stays
- Intensive Outpatient Program (IOP): Flexible treatment that allows for work or school
- Sober Living: Transitional housing with structure and support
- Aftercare: Ongoing support to maintain recovery and prevent relapse
Our Treatment Modalities
Our comprehensive program includes various evidence-based and experiential therapies:
- Equine-Assisted Therapy: Building emotional regulation and self-awareness through horse interactions
- 12-Step Program: A structured approach to recovery with peer support
- Healing Heart Experience: Addressing underlying trauma and emotional wounds
- Family Program: Involving loved ones in the healing process
- Individual and Group Therapy: Including CBT, DBT, and other proven approaches
Take the First Step Toward Recovery
If you recognize the DSM-5 criteria for substance use disorder in yourself or someone you care about, know that effective, compassionate help is available. The diagnostic criteria aren’t just labels—they’re signposts pointing toward healing and recovery.
At The Last Resort Recovery, we’re committed to providing men with the highest quality care in their fight against addiction. Our ranch-style campus in Smithville, TX, offers the perfect environment for introspection, growth, and sustainable recovery.
Don’t let another day pass in the grip of addiction. Contact our admissions team today to take the first step toward a healthier, more fulfilling life. Insurance is accepted, and we’ll work with you to verify your coverage and explore payment options.
Contact our admissions team: (512) 750-6750
Every man deserves the chance to reclaim his life from addiction. Your new life is waiting. Reach out now, and let us help you start your transformation at The Last Resort.
This resource is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified mental health professional with any questions you may have regarding a medical condition or treatment options.
