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There are 11 criteria the fifth edition of the Diagnostic and Statistical Manual (DSM5) uses to define Substance Use Disorders for clinicians

The Chicago Recovery Coach

(1) Use in larger amounts or for longer periods of time than intended.
What’s that look like?
-I said I was going to have 6 beers, I had 16.
-I said I was going to go to the bar for Happy Hour – I shut the place down.
-I said I was going to drink Friday night, I also drank Saturday and Sunday.

(2) Unsuccessful efforts to cut down or quit.
What’s that look like?
-I made a promise to my wife I would quit using; I tried but was unable to quit using.
-I made a decision to limit the amount of drugs I used in a day; I tried but was unable to limit my use.

(3) Excessive time spent getting, using, intoxicated, and recovering from effects:
What’s that look like?
-When asked about “How much time did you spend…?” a general response I have gotten is, “It’s like a full time job.”

(4) Craving or Intense desire/urge to use substance.
What’s that look like? For this, some analogies.
-You know every New Year, when you say you’re going to quit eating sweets, and you make it a few weeks, but then that thing just takes over and you obsess about ice cream – then you smash an entire pint of Ben and Jerry’s? It’s like that.
-Craving similar to that of your desire for water after working outside in the yard on a hot day.
-When the morning meeting ran over and you didn’t get to eat lunch until 2p.

(5) Failure to fulfill major obligations.
What’s that look like?
-Job performance suffers as a result of using substance(s).
-Inability to parent children.
-Got kicked out of school.
-Bills don’t get paid.
-Non-participation in family/friendship roles.

(6) Continued use despite social/interpersonal problems.
What’s that look like?
-Even though all the stuff in criteria 5 happened, I kept using anyway.

(7) Activities/hobbies reduced or given up.
What’s that look like?
-I used to play in the basketball rec league, now I don’t.
-I used to be heavily involved in the arts community, now I am not.
-I used to be an avid outdoorsmen, I haven’t been involved in those activities for over a year.

(8) Recurrent use in physically hazardous situations:
What’s that look like?
-Using abandoned houses and properties.
-I work with heavy equipment, and use it on the job.
-I often drink and drive.

(9) Recurrent use despite physical or psychological problems caused by or worsened by use.
What’s that look like?
-I have Hepatitis C, and use drugs intravenously.
-I have an abscess, but keep using anyway.
-I have Major Depressive Disorder, and use depressant substance.
-I have cirrhosis of the liver, and continue to drink.

(10) Tolerance.
What’s that look like?
-I used to use twice a day; now, to maintain the desired effect, I use 5 times a day.
-3 pills used to make me feel great; now, to achieve the desired effect I take 6 pills.

(11) Withdrawal.
What’s that look like?
-When I don’t have the substance, I am physically and psychologically affected. (Examples: Insomnia, nausea, vomiting, restlessness, tremors, seizures, depressed mood, anxiety.)

A word about severity…
Severity is designated according to the number of symptoms present:
0-1: No Diagnosis
2-3: Mild Severity
4-5: Moderate Severity
6 or More: Severe


…and a word about words.

You probably noticed the lack of terms like ‘addict’ or ‘alcoholic.’ The terminology has changed to reflect that there’s a PERSON with a use disorder, e.g. Alcohol Use Disorder, Marijuana Use Disorder, Opioid Use Disorder. The Chicago Recovery Coach is going to use both the old terminology and the less-stigmatizing newer terminology.