Amber Hollingsworth (speaker) reads and explains the DSM-5 diagnostic criteria for substance use disorder (using alcohol as the exemplar). She lists 11 criteria (taken from the DSM-5), gives plain-language examples for each (e.g., using more than intended; unsuccessful attempts to cut down; spending a lot of time obtaining/using/recovering; craving; role impairment; interpersonal problems; giving up activities; hazardous use; continued use despite physical/psychological problems; tolerance; withdrawal). She notes the criteria must occur within the past 12 months and summarizes severity thresholds: 2–3 = mild, 4–5 = moderate, 6+ = severe. She also advises caution when sharing this with loved ones (don’t confront directly).
Questions this video answers
11 criteria.
Within the last 12 months.
2–3 criteria = mild; 4–5 = moderate; 6 or more = severe.
Chapters
Alright, so all the time clients come into my office and a lot of times I joke and I'll say something like, I think people really come in and they expect that I'm going to tell them that they're not an alcoholic drug addict. I don't really think they come in to get a diagnosis. They come in to sort of roll one out. And so pretty commonly I'll get the question, Amber, do you think I'm an alcoholic? Or Amber, do you think I'm a drug addict? And I know from the get go that's like a super loaded question. So the way I handle that is I pull out my handy dandy DSM 5. This is the latest version, only this is like the little handbook version. That's why it's so little. And I say, I don't know, let me get the book out and I'll read you the criteria and you tell me. So that's what I'm going to do here. I'm going to go through the criteria for substance use disorder and I'm going to let you count on your fingers how many you think you have. Or if you're watching this video for a friend or a loved one, you can count on your fingers how many you feel like your friend or loved one has. Now, disclaimer. Listen closely. If you are watching this video for a friend or loved one and you decide you're diagnosing them with substance use disorder, do not run directly to the person and say you meet this many criteria for substance use disorder. That's why I don't tell them that they have it. Maybe you have them watch the video themselves and let them count, but do not throw it in their face and tell them they have a substance use disorder. That's pretty likely to send them back a lot in the stages of change. So here we go. Now in the dsm, the way they do that, the way they do, the diagnosis is they actually break up substance use disorders into every category. So they have a list for alcohol and opiates and meth and cannabis and every single substance that there is. But they're all basically the same. The difference is insert name of substance. So I'm going to read to you out of the one for alcohol. But if your drug of choice or your family members drug of choice is a different substance. Literally when I say the word alcohol, insert name of other substance, it's the same. It's just easier if I just pick one and go through it. But literally the criteria are the same no matter what the particular Drug is. So basically it's a problematic pattern of alcohol use leading to significant clinical impairment or distress as manifested by at least two or more of the following within the last 12 months. So basically that means you got to have at least two of these things that I'm about to read to you in the last year. So both of them have to have occurred within the last year to count. Alright, so I'm gonna read you a list. You count on your fingers or in your head how many you have. Number one, alcohol or other drug is taken in larger amounts over a longer period of time that was intended. So that sort of means like, I went to the party and I told myself I was just gonna drink two beers, snort two limes, take six Xanaxes, whatever amount it was that you told yourself that you were going to do, and you broke your own sort of like promise or limit that you had set for yourself. So you used more than you intended to. Number two, there's a persistent desire or unsuccessful effort to cut down or control alcohol use. So pretty often people that come in to see me, they have already tried to cut it back or tried to stop, and they may have had success stopping for short periods of time, but there's been a lot of off and on. So a lot of times I'll see like teenagers or young adults and maybe they're smoking weed and they will like, they'll say, well, I quit smoking weed for like a month, like three months ago. Doesn't mean that means I don't have a problem. Right? And one of the things that I'll say to that is people that don't have alcoholism or addiction, they don't think about taking sobriety breaks. So the fact that you've had thoughts about maybe I'll stop for a while or I'll cut it back or try to do less. It's kind of like a symptom of alcoholism in and of itself. So if you've tried to cut it back or you've tried to do less, something's probably going on. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects. Remember, you can insert any word other than alcohol right there if you want to. So one of the things that I do is I make fun of my alcoholics because it's kind of the way I do therapy, is I just sort of tease you until you quit. But if I ask you, do you know where is the best place to buy beer on Sunday, or if you know exactly where to buy what and who's got it cheapest. And you know the cashier's names at like two or three or four stores, and they know who you are and what you're about to buy. You might have a problem. That's a lot of time spent activities necessary for alcoholics. A lot of times they have a lot of shame about how much alcohol they're buying. So they may do things like go to several different stores. Like they may have like a Tuesday store or a Wednesday gas station, but they don't like to show up at the same place over and over because they feel bad. They feel sort of like they're being judged about how much they're buying. So that's a great deal of time spent in activities to get it. Now, with drugs, you might look at even more time and energy spent in activities to get it, because you got to call people up, you got to meet people in sketchy places sometimes or maybe you're doctor shopping. And there's a lot of time that goes into that. So basically it consumes a lot of your time. Number four, a craving or strong desire or urge to use alcohol means I really want to. For most people, they have using patterns. So it's like if every day I use or I stop at the store and I get something to drink on my way home from work, then at about that time of day, my anxiety is going to go up, I'm going to start to feel uncomfortable. Some people will identify and recognize it as a craving, and other people might just identify it as the anxiety and gets really high and they feel like, oh, I need a drink or I need this to calm down, but that's a craving. Number five, recurrent alcohol use resulting in failure to fulfill a major role obligation such as work, school, or home. So if you're using substances and your family is upset with you and it's causing you arguments more than once with your family, that would count. If you're skipping class to go smoke up, that would count. If you're going to work but you're feeling so crappy from hangovers all the time that you're not functioning very well, that would count. If you're flat out missing work because of substance use, or if you're leaving early or if you're taking like really long lunch breaks, all of those things would count. So those major life areas like family, school, work, parenting, if it's interfering in those areas, continued alcohol use despite having a persistent or recurrent social or interpersonal problem caused or exacerbated by its effects Basically, interpersonal problem means your relationships. So if people are upset with you and they're on your case and you've been making promises, okay, I'm not going to drink that much anymore, or I'm only going to drink on the weekends, or just this or just that, then that probably counts. Number seven, important social, occupational or recreational activities are given up or reduced because of the use. So if you've already watched the dopamine video, then I talk some about that in there because basically you lose the biological capacity for joy in activities other than the substance use. So you might find that you used to be on the baseball team, or you used to be into collecting this, or used to go out with your friends all the time, and lately you're just not interested in doing that anymore. Unless maybe the substance use is involved in whatever that activity is. Number eight, recurrent alcohol use in situations where it's physically hazardous. So this might mean driving a car while intoxicated, or if you work in something that there's heavy equipment or machinery or something like that. Those kind of things would count. Number nine, alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by alcohol. For alcohol specifically, I can tell you most people that are drinking a lot are going to have high blood pressure, they're going to have high anxiety, and they're going to have a sleep problem. Usually what that looks like is they might go to sleep at a fairly decent time, but then they don't sleep very long and they'll wake up and their head is usually going 100 miles an hour and that sort of thing. Sometimes people know that the anxiety or depression or physical problem is being caused by the substance use, and sometimes they don't. If you know it and you continue to do it, then that meets this criteria. If you don't know it, a lot of people don't know it and they continue to do it anyway. That doesn't really meet this criteria. Number 10 is tolerance. And they give some definitions for tolerance, but they get like super clinical. But most people I talk to know what tolerance means. Basically, it means you need to use more than you used to use in the past to get the same effects. Or you need to use longer than you used to use in the past to get the same effects. That's what tolerance means. And the last criteria, it was withdrawal. And that one is the one that can get pretty complicated because depending on what substance you're using, you would have a different withdrawal symptom set or syndrome that goes with it. And you might, you would have to look at the different categories of withdrawal. But basically, if you haven't used your substance in a day or two and you feel uncomfortable and edgy and anxious and just crummy, you're probably having some level of withdrawal. And it can look a little different depending on the particular substance. But even if it's just you feel like you're coming out of your skin emotionally after a day or so, then you're probably having some withdrawal. Those are the 11 criteria. Now, hopefully you've counted on your fingers or in your head how many you think you have. And hopefully since you're by yourself right now, probably you're being super honest with you. I can't see you. No one else can see you. No sense in lying. Alright, ready? Here's your answer. If you have the presence of two or three of those symptoms, then you have a mild substance use disorder. If you have the presence of four or five of those symptoms, then you have a moderate substance use disorder. If you have the presence of six or more of the 11 criteria that I read to you, then you have a severe substance use disorder. Okay, I hope that clears it up for you. Those are the official big book in this case. Big book means dsm. This is like the go to guide for psychiatric stuff. That's the criteria. So I hope that helps you out. And now you know you have one or you don't. Thanks.
