Alcohol and Other Substance Misuse

Abstract

Recently, the American Psychiatric Association (APA) published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with simplified diagnostic criteria for alcohol use disorder (AUD) and substance use disorder (SUD), eliminating the terms “abuse” and “dependence” and providing for a general estimate of severity, from mild to severe, based on the number of symptom criteria endorsed by the patient (American Psychiatric Association, 2013). As this change in criteria is relatively new, it is not yet widely reflected in how alcohol and drug use disorders are defined in the literature. Much of the current research on alcohol and other drug use is based on diagnostic criteria from the fourth edition of the DSM (American Psychiatric Association, 2000), which defined substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress occurring within a 12-month period, as manifested by one or more criteria related to negative consequences of use, including negative impact on major life roles, use in dangerous situations (e.g., driving), legal problems, and social and interpersonal problems. Dependence is defined in the DSM-IV as a maladaptive pattern of substance use leading to clinically significant impairment or distress occurring within a 12-month period, as manifested by three or more criteria including tolerance, withdrawal, using more or for longer than intended, and a persistent desire to use or unsuccessful efforts to cut down. The relationship between DSM-IV and DSM-5 disorders is not exact, but substance abuse is comparable to substance use disorder, mild subtype, whereas substance dependence is similar to the moderate to severe subtype.