DSM-5 and Addiction: What It Says


Published On: January 3, 2024

The DSM-5 (2013) is the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, which is a manual used to diagnose mental health conditions.

The DSM was introduced by the American Psychological Association (APA), but it is used in many countries around the world.

What Does the DSM-5 Say About Addiction?

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Below, we outline what the DSM-5 has to say about addiction:

1. The definition of addiction

The DSM-5 describes substance use disorders as conditions that cause individuals to continue to use damaging substances despite suffering from negative symptoms.

2. The types of addiction

The DSM-5 has a list of Substance-Related and Addictive Disorders, which includes both substance addictions and behavioural addictions.

The examples of addictive substances are: hallucinogens, tobacco, caffeine, opioids, hypnotics, alcohol, stimulants, cannabis, anxiolytics, inhalants and sedatives.

The behavioural addictions named in the DSM-5 are gambling disorder and internet gaming disorder (1).

However, there are plenty of addictions affecting people in the UK that are not listed in the DSM-5.

3. The criteria for addiction

According to the DSM-5, in order to diagnose addiction, the following four categories must be present: social problems, risky use, impaired control and physical dependence.

There are 11 key points to consider when diagnosing someone with addiction, which are:

  • Cravings and urges to use the substance
  • Giving up important social, occupational, or recreational activities because of substance use
  • Continuing to use, even when it causes problems in relationships
  • Development of withdrawal symptoms, which can be relieved by taking more of the substance
  • Taking the substance in larger amounts or for longer than you’re meant to
  • Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
  • Not managing to do what you should at work, home, or school because of substance use
  • Using substances again and again, even when it puts you in danger
  • Wanting to cut down or stop using the substance but not managing to
  • Spending a lot of time getting, using, or recovering from use of the substance
  • Needing more of the substance to get the effect you want (tolerance)

4. The severity of addiction

Addiction diagnosis falls under three levels of severity: mild, moderate and severe.

Mild diagnosis is given to people with 2-3 symptoms, moderate diagnosis is for 4-5 symptoms, and severe addiction requires 6+ symptoms.

Although addiction is something that affects people for life, it is possible to recover to the extent that you are in early remission or sustained remission. These labels can be attached to a patient’s diagnosis to indicate that they are in recovery.

How Does the DSM-5 View Of Addiction Differ From Previous DSM Editions?

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Perhaps the biggest difference between the DSM-5 and previous editions is that addiction is classed as a mental health disorder in the DSM-5.

Previously, it was thought to stem from a primary personality disorder, but it is now viewed in the same way as depression, anxiety, OCD, and other common mental illnesses.

There has also been recognition of the fact that substance dependence is a psychiatric problem. Along with substance abuse disorders, dependence has been listed under ‘substance-related disorders’.

The DSM-5 introduced 11 symptoms of addiction, as well as three severity levels. This has added more nuance to the diagnosis of addiction, as it was previously split into just two categories of substance dependence and abuse.

In previous editions of the DSM, legal issues were listed as a symptom of addiction, and it was not possible to diagnose a substance use disorder without this being present. However, it is now widely accepted that people with addiction do not have to get into legal trouble in order to have a serious problem.

How Do We Know That Addiction is a Mental Illness?

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For many years, the cause of addiction was not known, and it was often attributed to a lack of self-control or a personality flaw.

Though we are still researching the causes of addiction, it has become clear that substance use disorders and behavioural addictions are linked to mental illness.

One indication that addiction is an illness is the fact that it shares so much in common with other health conditions.

It has signs and symptoms, it has vulnerability traits (characteristics that make certain people more likely to develop it), and it produces neurobiological changes (2). According to Steadman’s Medical Dictionary, this makes addiction a disease (3).

Through the study of how the brain works with and without addiction, we have found that substance abuse can change the way we are wired.

For example, the prefrontal cortex, extended amygdala and basal ganglia can all become more sensitive through chronic drug use (4). This makes it extremely difficult for people with an established dependency or addiction to get sober.

From a non-scientific point of view, we could criticise the view that addiction is a choice by observing the lives of people with severe addiction.

Many of these people are struggling with financial issues, legal issues, relationship problems and mental health problems, all caused or aggravated by their drug use.

It could be argued that nobody would choose this lifestyle, so therefore addiction must be a form of illness.

We frequently see people attempting to get sober and feeling incredibly guilty when they relapse. If addiction was an active decision they had made, they would find it much easier to stop at any given point.

Are There Criticisms Of the DSM’s Description Of Addiction?

Though more and more people are accepting the DSM’s description of substance-related disorders, many people still believe that addiction is not an illness of the mind.

One reason for this belief is that there are so many factors that can cause addiction, so it could be deemed simplistic to give illness as the only factor.

We know that trauma, upbringing, mental illness and genetics can all be causes of substance use disorders, so some people would argue it is more complex than people developing an illness.

It could also be argued that describing addiction as a chronic illness insinuates you cannot recover from it. This could lead to higher relapse rates, as people would lose motivation to recover if they believed it wasn’t possible.

Finally, perhaps people who have achieved long-term sobriety are overlooked when we describe addiction as a disease.

They may feel as though this undermines the efforts they took to get sober, as it implies they were simply fortunate enough to make some sort of recovery.

What are the Implications Of Believing that Addiction is a Mental Illness?

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Though some people argue that we need to promote recovery from addiction, we would say that the long-term nature of addiction must be acknowledged in order for people to maintain sobriety.

Knowing that addiction is a disease does not have to stop people from getting sober, as we would still encourage patients to eat well and exercise often even if they had heart disease.

In fact, rehab centres that view addiction as a disease are often the most successful. By telling patients that they can make a full recovery if they choose to, we are indirectly blaming them when they relapse.

However, if they know that they are suffering from a disease that they need to learn how to manage, they may find it easier to stay sober.

When family members are told that their loved one has an illness, it can be easier for them to not take the addiction personally. This prevents them from developing low self-esteem as a result of believing that their loved one will not recover for their benefit.

Finally, we may be more inclined to provide resources for people with addiction when we accept that they haven’t chosen their lifestyle.

When there is less stigma in society surrounding self-help groups and addiction therapy, the risk of relapse is lowered, as people with addiction can follow many different routes in an attempt to stay sober.

How Can Rehab 4 Alcoholism Help Me?

A man sitting with a female therapist who is holding a clipboard

If you identify with the DSM criteria for substance-related disorders, you may be dealing with alcohol dependency or addiction.

This is extremely unlikely to get better on its own, so it is strongly advised that you seek professional help with an outpatient clinic or a private rehab clinic.

We can help you in your journey by investigating rehab centres in your area and liaising with the ones that match your personal criteria.

This includes finding a facility with a range of therapy types, a solid aftercare programme and a great reputation.

To get a referral as soon as possible, reach out to Rehab4Alcoholism on 0800 111 4108 or fill out our contact form.

FAQs About Addiction in the DSM-5

Below, we answer some frequently asked questions around the top of the DSM-5 and what it has to say about addiction:

1. Are legal substances included as part of addiction?

Yes, legal substances can be linked to addiction. Alcohol is one of the most common addictions in the UK, and yet it is a legal substance.

The reason legality is not included as part of the description of addiction is that it is strongly linked to cultural standards. Just because alcohol is currently legal in the UK does not mean that it is legal everywhere, or that it will always be legal.

What’s more, the damage that a substance can do, and the potential for addiction, is not dependent on its legality.

2. What is the distinction between a healthy behaviour and an addictive behaviour?

It is possible for people to use drugs without being addicted, or to gamble without it affecting their entire life. The distinguishing factor is whether the behaviour of the individual is in line with the DSM-5 criteria for substance-related disorders.

To give a clear example, Person A drinks alcohol every couple of weeks with friends. They enjoy the taste of alcohol and the way it makes them feel.

If a drinking occasion doesn’t occur for a few weeks or months, they are content with not drinking for a while. Person A is not addicted to alcohol.

Person B, on the other hand, drinks alcohol every day, and becomes incredibly anxious when they have to go a day without drinking.

They make friends based on the potential to drink with them, and they do not shy away from drinking alone to cope with loneliness. Person B is most likely dependent on, or addicted to, alcohol.

Please keep in mind that there is a spectrum for addiction. Some people drink alcohol every week but are not dependent on it, and others only ever drink on the weekends but are still suffering from dependency.

3. Does dependency always turn into addiction?

The most common end result of dependency is addiction – particularly when the dependency is not treated. However, this does not mean that dependency turns into addiction every time.

It is possible to reverse the effects of alcohol dependency by getting sober and investigating the reasons behind the dependency. The best settings for this are inpatient rehabs, outpatient rehabs and self-help groups.

4. Do you have to have a family history of addiction in order to develop alcoholism?

Lots of people with alcoholism have a family history of addiction, but this is not part of the criteria for addiction in the DSM-5.

It is certainly possible for someone to develop an addiction even if nobody in their family has struggled with alcohol or drugs, and/or they have never been exposed to unhealthy alcohol use.

This could be because they are genetically prone to developing addiction, but it could also be due to environmental factors such as mental health struggles, peer pressure, neglect, grief, trauma, etc.

References

[1] Non-substance addictive behaviors in the context of DSM-5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858502/

[2] Are addictions diseases or choices? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692718/

[3] Ibid.

[4] Drugs, Brains and Behaviour: The Science of Addiction https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain

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