DSM-5

Diagnostic Criteria

A. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. The stimulant 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 stimulant use.
  3. A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects.
  4. Craving, or a strong desire or urge to use the stimulant.
  5. Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant.
  7. Important social, occupational, or recreational activities are given up or reduced because of stimulant use.
  8. Recurrent stimulant use in situations in which it is physically hazardous.
  9. Stimulant use 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 stimulant.
  10. Tolerance, as defined by either of the following:
    • a. A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect.
    • b. A markedly diminished effect with continued use of the same amount of the stimulant.
    • Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy.
  11. Withdrawal, as manifested by either of the following:
    • a. The characteristic withdrawal syndrome for the stimulant.
    • b. The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
    • Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy.

Specify if:

  • In early remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant 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 stimulant," may be met).
  • In sustained remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant 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 stimulant," may be met).

Specify if:

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

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

Primary mental disorders

Stimulant-induced disorders may resemble primary mental disorders (e.g., major depressive disorder). The mental disturbance resulting from the effects of stimulants should be distinguished from the symptoms of schizophrenia; depressive and bipolar disorders; generalized anxiety disorder; and panic disorder.

Phencyclidine intoxication

Intoxication with phencyclidine ("PCP" or "angel dust") or synthetic "designer drugs" such as mephedrone (known by different names, including "bath salts") may cause a similar clinical picture and can only be distinguished from stimulant intoxication by the presence of cocaine or amphetamine-type substance metabolites in a urine or plasma sample.

Stimulant intoxication and withdrawal

Stimulant intoxication with withdrawal are distinguished from the other stimulant-induced disorders (e.g., anxiety disorder, with onset during intoxication) because the symptoms in the latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.

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