Diagnostic criteria
DSM-5 TR
 the diagnosis of a substance use disorder can be applied to all
10 substance classes except caffeine
A problematic pattern of substance use leading to clinically
significant impairment or distress
occurring within a 12- month period
manifested by at least two of the following criteria
1) Substance is often taken in larger amounts or over a longer
period than was intended
2) persistent desire or unsuccessful efforts to cut down or
control substance use.
3) A great deal of time is spent in activities necessary to obtain,
use or recover from substance
4) Craving, or a strong desire or urge to use substance
5) Recurrent substance use resulting in a failure to fulfill major
role obligations at work, school, or home.
6) Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of substance
ICD-11
 under category of substance dependence for each substance
class
  features of dependence are usually evident over a period of
at least 12 months but the diagnosis may be made if
substance use is continuous (daily or almost daily) for at least
1 month
 disorder of regulation of substance use arising from
repeated or continuous use of substance
 impaired ability to control use of substance
 increasing priority given to use substance over other
activities
 strong internal drive to use substance
 subjective sensation of urge or craving to use cannabis
 Substance use continues or escalates despite the occurrence
of harm or negative consequences (e.g., repeated
relationship disruption, occupational or scholastic
consequences, negative impact on health)
 Substance use continues or escalates despite the occurrence
of harm or negative consequences (e.g., repeated
relationship disruption, occupational or scholastic
 consequences, negative impact on health)

7) Important social, occupational, or recreational activities are

given up or reduced because of substance use

8) Recurrent alcohol use in physically hazardous situations  Harmful pattern use of substance : Harm can occur due to
intoxication behavior, toxic effects or harmful route of
administration

9) Continued substance use despite knowing persistent or  persistence of use despite harm or negative consequences
recurrent physical or psychological problem is likely to have
been caused or exacerbated by substance

10) Tolerance – defined either:  tolerance to the effects of cannabis

- need for markedly increased amounts for desired effect
- markedly diminished effect with continued use same
amount

11) Withdrawal  withdrawal symptoms following cessation or reduction in use

of substance

Withdrawal

DSM-5 TR ICD-11
 A) Cessation or reduction in substance use that has been heavy  Occurs upon cessation or reduction of use of substance in
and prolonged individuals who have developed Cannabis dependence or
have used substance for a prolonged period or in large
amounts.

B) Substance-specific syndrome  Substance-specific syndrome

C) Symptoms in Criterion B cause clinically significant distress

or impairment in social, occupational, or other important
areas of functioning

D) Symptoms are not due to another medical condition and are  The symptoms are not better accounted for by another
not better explained by another mental disorder medical condition or another mental disorder

Specifiers
 DSM-5 TR
 In early remission:
After full criteria for substance use disorder were previously
met, none of the criteria for substance use disorder have
been met for at least 3 months but for less than 12 months
 In sustained remission:
After full criteria for substance use disorder were previously
met, none of the criteria for substance use disorder have
been met at any time during a period of 12 months or longer
 In a controlled environment:
This additional specifier is used if the individual is in an
environment where access to substance is restricted
Substance intoxication
ICD-11
 Under substance dependence section, not as a specifier
 Substance dependence - early full remission
After a diagnosis of substance dependence, and often
following a treatment episode or other intervention
(including self-help intervention), the individual has been
abstinent from substance during a period lasting from
between 1 and 12 months.
 Substance dependence - sustained partial remission
After a diagnosis of substance dependence, and often
following a treatment episode or other intervention
(including self-help intervention), there is a significant
reduction in substance consumption for more than 12
months, such that even though substance use has occurred
during this period, the definitional requirements for
dependence have not been met.
 Substance dependence - sustained full remission
After a diagnosis of substance dependence, and often
following a treatment episode or other intervention
(including self-intervention), the person has been abstinent
from substance for 12 months or longer
 DSM-5 TR
 Excception with tabacco and caffein use disorder
A) recent ingestion of a substance
B) clinically significant problematic behavioral or psychological
changes associated with intoxication developed during or
shortly after use of the substance
C) substance-specific signs and symptoms
D) The symptoms are not attributable to another medical
condition and are not better explained by another mental
disorder
Unspecified Substance-Related Disorder
ICD-11
 There is caffeine intoxication

 clinically significant transient condition that develops during
or shortly after the consumption of substance that is
characterised by disturbances in consciousness, cognition,
perception, affect, behaviour, or coordination
 substance-specific signs and symptoms
 Symptoms are not better accounted for by another medical
condition or another mental disorder
 These disturbances are caused by the known
pharmacological effects of substance and their intensity is
closely related to the amount of substance consumed.
 They are time-limited and abate as substance is cleared from
the body.
 DSM-5 TR ICD-11
 No description/detail for unspecified substance-related
disorder
 6C41.Z Disorders due to use of cannabis, unspecified
 symptoms characteristic of a substance-related disorder
that cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning
predominate but

 do not meet the full criteria for any specific substance-

related disorder or any of the disorders in the substance-
related and addictive disorders diagnostic class