DSM-5

Diagnostic Criteria

A. A problematic pattern of use of an intoxicating substance not able to be classified within the alcohol; caffeine; cannabis; hallucinogen (phencyclidine and others); inhalant; opioid; sedative, hypnotic, or anxiolytic; stimulant; or tobacco categories and leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. The substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control use of the substance.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. Craving, or a strong desire or urge to use the substance.
  5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
  8. Recurrent use of the substance in situations in which it is physically hazardous.
  9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:
    • a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    • b. A markedly diminished effect with continued use of the same amount of the substance.
  11. Withdrawal, as manifested by either of the following:

Specify if:

  • In early remission: After full criteria for other (or unknown) use disorder were previously met, none of the criteria for other (or unknown) use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the substance," may be met).
  • In sustained remission: After full criteria for other (or unknown) use disorder were previously met, none of the criteria for other (or unknown) use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the substance," may be met).

Specify if:

  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to the substance is restricted.

Note: If an other (or unknown) substance intoxication, other (or unknown) substance withdrawal, or another other (or unknown) substance-induced mental disorder is also present, the comorbid other (or unknown) substance use disorder is indicated in the other (or unknown) substance-induced disorder. For example, if there is comorbid other (or unknown) substance-induced depressive disorder and other (or unknown) substance use disorder, only the other (or unknown) substance-induced depressive disorder diagnosis is given, with the recording indicating whether the comorbid other (or unknown) substance use disorder is mild, moderate, or severe (e.g., mild other (or unknown) substance use disorder with other (or unknown) substance-induced depressive disorder; moderate or severe other (or unknown) substance use disorder with other (or unknown) substance-induced depressive disorder).

Specify current severity:

  • Mild: Presence of 2-3 symptoms.
  • Moderate: Presence of 4-5 symptoms.
  • Severe: Presence of 6 or more symptoms.

Specifiers

"In a controlled environment" applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment). Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units.

Differential Diagnosis

Use of other or unknown substances without meeting criteria for other (or unknown) substance use disorder

Use of unknown substances is not rare among adolescents, but most use does not meet the diagnostic standard of two or more criteria for other (or unknown) substance use disorder in the past year.

Substance use disorders

Other (or unknown) substance use disorder may co-occur with various substance use disorders, and the symptoms of the disorders may be similar and overlapping. To disentangle symptom patterns, it is helpful to inquire about which symptoms persisted during periods when some of the substances were not being used.

Other (or unknown) substance/medication-induced disorder

This diagnosis should be differentiated from instances when the individual's symptoms meet full criteria for one of the following disorders, and that disorder is caused by an other or unknown substance: delirium, major or mild neurocognitive disorder, psychotic disorder, depressive disorder, anxiety disorder, sexual dysfunction, or sleep disorder.

Other medical conditions

Individuals with substance use disorders, including other (or unknown) substance use disorder, may present with symptoms of many medical disorder. These disorders also may occur in the absence of other (or unknown) substance use disorder. A history of little or no use of other or unknown substances helps to exclude other (or unknown) substance use disorder as the source of these problems.

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