What's the difference between a mild, moderate, and severe substance use disorder?

I hope you had a change to join me for the Mental Health Hour on Facebook live this week, but if not, I wanted to share some of this information here as well.

I’m continuing my discussion of substance use disorders and addiction because I think it’s extremely important for the community to have more education on these topics so that we can ultimately reduce the stigma of mental illness and substance use disorders.

In this post I wanted to cover what the differences are between mild, moderate, and severe substance use disorder. In my previous post I shared an overview that there are 11 diagnostic criteria, divided into 4 groups. I’m going to list the criteria here:

Impaired Control Over Substance Use

  1. Consuming the substance in larger amounts and for a longer amount of time than intended.

  2. Persistent desire to cut down or regulate use. The individual may have unsuccessfully attempted to stop in the past.

  3. Spending a great deal of time obtaining, using, or recovering from the effects of substance use.

  4. Experiencing craving, a pressing desire to use the substance.

    Social Impairment

  5. Substance use impairs ability to fulfill major obligations at work, school, or home.

  6. Continued use of the substance despite it causing significant social or interpersonal problems.

  7. Reduction or discontinuation of recreational, social, or occupational activities because of substance use.

    Risky Use

  8. Recurrent substance use in physically unsafe environments.

  9. Persistent substance use despite knowledge that it may cause or exacerbate physical or psychological problems.


  10. Tolerance: Individual requires increasingly higher doses of the substance to achieve the desired effect, or the usual dose has a reduced effect; individuals may build tolerance to specific symptoms at different rates.

  11. Withdrawal: A collection of signs and symptoms that occurs when blood and tissue levels of the substance decrease. Individuals are likely to seek the substance to relieve symptoms. No documented withdrawal symptoms from hallucinogens, PCP, or inhalants.

Those are the 11 criteria we use to diagnose a substance use disorder. The diagnosis of mild, moderate, or severe depends on how many of the 11 criteria are met. Here is the breakdown of each:

Mild means 2-3 of 11 criteria are met

Moderate means 4-5 of 11 criteria are met

Severe means 6 or more of 11 criteria are met

A diagnosis of a mild substance use disorder typically means that returning to normal social use is possible. However, a diagnosis of moderate or severe normally means that returning to normal social use is not possible, because of the changes that have taken place in the brain.

My next Mental Health Hour is going to start to explain the types of treatment that is used for substance use disorders. I hope this post is helpful, and reach out anytime!