Stimulant Use Disorder DSM-5 Criteria

What is stimulant use disorder?

Stimulant use disorder is a mental health condition characterized by the misuse of stimulants, such as amphetamines or cocaine, leading to clinically significant impairment. It involves problematic patterns of use, including cravings, an inability to control consumption and neglect of responsibilities. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the disorder's criteria include tolerance, withdrawal symptoms, and substance intoxication (American Psychiatric Association, 2013).

Severe stimulant use disorder can result in substance-induced mental disorders and physical harm. Treatment focuses on addressing substance dependence and mitigating the effects of stimulant abuse to support recovery.

How is stimulant use disorder diagnosed?

Stimulant use disorder is diagnosed when a person exhibits a pattern of stimulant use causing significant impairment or distress. According to the DSM-5, a diagnosis requires at least two of the disorder criteria to be met within a 12-month period. These criteria assess behaviors such as difficulties controlling use, neglect of responsibilities, physical or psychological consequences, and cravings.

Severity is determined based on the number of symptoms: mild (2–3 symptoms), moderate (4–5), or severe (6+). Healthcare professionals also consider tolerance, withdrawal symptoms, and whether use is medically supervised. Proper diagnosis helps guide treatment to address substance use and its broader impacts.

DSM-5 stimulant use disorder diagnostic criteria

Stimulant use disorder is defined in the DSM-5 as a problematic pattern of stimulant use leading to clinically significant impairment or distress. A diagnosis requires at least two of the following criteria within a 12-month period:

1. The stimulant is often taken in larger amounts or over a longer period than intended.
2. There is a persistent desire or unsuccessful attempts to cut down or control use.
3. A significant amount of time is spent obtaining, using, or recovering from stimulant use.
4. Craving or a strong desire to use the stimulant.
5. Recurrent stimulant use results in a failure to fulfill major obligations at work, school, or home.
6. Continued use despite persistent or recurring social or interpersonal problems caused by the stimulant.
7. Important social, occupational, or recreational activities are reduced or abandoned due to use.
8. Recurrent use in physically hazardous situations.
9. Continued use despite knowing it causes or worsens physical or psychological problems.
10. Tolerance, as evidenced by a need for significantly increased amounts to achieve the same effect or a diminished effect with continued use of the same amount.
11. Withdrawal symptoms or the stimulant (or a closely related substance) is used to relieve or avoid withdrawal.

Specifiers:

• Severity: Mild stimulant use disorder (2–3 symptoms), Moderate stimulant use disorder(4–5), Severe stimulant use disorder(6+).
• Remission: Early (3–12 months without symptoms, except cravings) or Sustained (12+ months).
• Environment: Diagnosed with “in a controlled environment” if access to stimulants is restricted.

How is stimulant use disorder treated and managed?

The following strategies are commonly used to treat and manage stimulant use disorders:

Behavioral therapies

Cognitive-behavioral therapy (CBT) is one of the primary treatments for stimulant use disorder. CBT helps individuals identify and change negative thought patterns and behaviors related to substance abuse. Contingency management, a therapeutic strategy that reinforces positive behavior through rewards, is also frequently used for stimulant use disorder. These therapies are vital for addressing the underlying addictive disorder and its impact on mental health.

Medications

Currently, there are no FDA-approved medications specifically for stimulant use disorder treatment. However, medications like antidepressants or anticonvulsants are sometimes used to manage withdrawal symptoms and substance-induced mental disorders, such as anxiety or depression. Individuals taking stimulant medications solely under appropriate medical supervision for conditions like attention-deficit hyperactivity disorder (ADHD) should be monitored closely to avoid misuse or dependency.

Support groups and rehabilitation

Support groups, including 12-step programs like Narcotics Anonymous (NA), can play a crucial role in recovery by providing peer support. Inpatient rehabilitation may be necessary for severe stimulant use disorder, particularly when withdrawal symptoms or a substance-induced mental disorder requires intensive monitoring. A controlled environment can reduce the temptation to engage in recurrent stimulant use, providing a stable foundation for long-term recovery.

Management of withdrawal symptoms

Managing stimulant withdrawal symptoms is a critical aspect of treatment. Symptoms can include fatigue, depression, and intense cravings, which, if left unaddressed, can contribute to relapse. Supportive care, therapy, and medications to manage symptoms are essential to prevent further substance abuse.

Long-term recovery and relapse prevention

Long-term recovery focuses on maintaining sustained remission, typically through continuous therapy and support systems. Relapse prevention strategies include identifying triggers, managing cravings, and developing coping skills to avoid recurrent stimulant use. For individuals with severe substance use disorder or those with a history of substance-related disorders, maintenance therapy may be required to help manage symptoms and avoid relapse.

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Pearson.