I thought it might be helpful to do a mental health series where I highlight different mental health conditions and the types of therapy and treatment that are most effective. Whenever we are treating any condition, whether it is mental or physical, knowledge is always power. I thought I would highlight substance use disorders first.

What is a substance use disorder?

• A substance use disorder is a pattern of substance use that results in impairment in one’s ability to function and full-fill obligations at work, school, or home.

• There are 11 criteria used to determine the severity of the substance use disorder that include the following areas: inability to control use, social impairment, risky use, and physical components that include tolerance and withdrawal

• There are 3 classifications of a substance use disorder, mild, moderate, and severe depending on how many of the 11 criteria are met

• Moderate and severe classifications of a substance use disorder diagnosis means an addiction is present

• Different treatment interventions will be recommended depending on the classification, and especially if medical detoxification is necessary

The 11 Criteria in Plain Language

The DSM-5 criteria used to diagnose a substance use disorder are grouped into four categories. Understanding these can help someone evaluate their own relationship with substances more clearly.

Impaired control covers four criteria: using more of a substance or for longer than intended; wanting to cut back but being unable to; spending a significant amount of time obtaining, using, or recovering from the substance; and experiencing strong cravings or urges to use.

Social impairment covers three criteria: use that causes failure to meet obligations at work, school, or home; continued use despite ongoing social or interpersonal problems caused or worsened by it; and giving up or reducing important activities in order to use.

Risky use covers two criteria: using in situations where it is physically dangerous, and continued use despite knowing it is causing or worsening a physical or psychological problem.

Pharmacological criteria cover the final two: tolerance, meaning needing significantly more of the substance to achieve the same effect; and withdrawal, meaning physical or psychological symptoms when the substance is reduced or stopped.

Mild substance use disorder is diagnosed when two or three criteria are present. Moderate when four or five are present. Severe, which indicates addiction, is six or more.

Why This Distinction Matters for Treatment

The level of severity has direct implications for what kind of treatment is most appropriate. Someone with a mild substance use disorder may be well served by outpatient individual therapy focused on building insight into their patterns, identifying triggers, and making deliberate changes. Someone with a moderate or severe presentation may need a higher level of care, particularly if medical detox is needed or if home environment poses ongoing risk to sobriety.

Co-occurring mental health conditions, which are present in roughly half of people with a substance use disorder, also affect treatment recommendations significantly. Treating the substance use without addressing underlying anxiety, depression, or trauma often leads to relapse. Integrated treatment that addresses both at the same time tends to produce better outcomes.

What to Do If You Think This Applies to You

If you recognize yourself in the criteria above, the most important first step is to talk to someone qualified to evaluate what you are experiencing. A therapist with both mental health and addiction credentials can help you understand the full picture of what is going on and identify the level of care that makes sense for your situation.

At Silver Lining Counseling, Kristin Dickie holds both mental health and addiction licensure (LCMHC and LCAS), which means she can assess for co-occurring conditions and help you navigate the full continuum of care. Reach out to schedule a free phone consultation.