“Is this really an addiction, or am I just going through a hard time?” Many adults ask that question long before they ask for help. Families ask their own version late at night at the kitchen table: is my son just stressed, or is this something bigger? If you have been searching for an answer to the question “What are the criteria for substance use disorders according to the DSM-5?”, this guide walks through all 11 criteria for substance use disorders in everyday language. It also explains how severity is scored and what support options exist here in New Hampshire, including at New Hampshire Detox in Bethlehem, NH.
Take a breath. You don’t have to figure this out by yourself tonight. The criteria are a way to notice and describe what you are seeing. They are not a verdict on the person you love, and they are not a test you have to grade alone. At New Hampshire Detox, we don’t ask families to diagnose anything. Your job is to notice. A clinician’s job is to work out what it means.
What Are the 11 Criteria for Substance Use Disorders According to the DSM-5, in Plain Language?
The DSM-5 lists 11 criteria for a substance use disorder, grouped into four areas: loss of control, social problems, risky use, and physical changes called tolerance and withdrawal. A person who shows 2 or more of these within a 12-month period meets the threshold. No single criterion is required.
The American Psychiatric Association publishes the DSM-5. Its full name is the Diagnostic and Statistical Manual of Mental Disorders, sometimes shortened to the Diagnostic Statistical Manual, and a clinical overview from the National Library of Medicine summarizes how it is used. The current text revision of this fifth edition of the statistical manual, the DSM-5-TR, keeps the same 11-criteria framework. Older editions split problem substance use into two separate diagnoses, “abuse” and “dependence.” The DSM-5 merged them into one condition, substance use disorder, measured on a scale from mild to severe. As the National Institute on Alcohol Abuse and Alcoholism explains, the update also dropped “legal problems” as a criterion and added “craving.” Those two diagnostic changes reflect how clinicians understand the condition today: as a pattern of behavior and brain changes, not a legal or moral issue.
The CDC’s summary of the DSM-5 criteria is written for opioid use disorder, but the same 11 items apply to alcohol, stimulants, sedatives, and other substances. In plain language, they are:
Impaired control
1. Using more of the substance, or for longer, than intended.
2. Wanting to cut down or stop, but not being able to.
3. Spending a lot of time getting the substance, using it, or recovering from it.
4. Having cravings or strong urges to use.
Social problems
5. Falling behind on responsibilities at work, school, or home because of use.
6. Continuing to use even when it causes problems in relationships.
7. Giving up or cutting back on activities the person used to care about.
Risky use
8. Using in situations that are physically dangerous, such as driving.
9. Continuing to use even when it is causing or worsening a physical or mental health problem.
Pharmacological criteria
10. Tolerance: needing more of the substance to get the same effect, or feeling less effect from the same amount.
11. Withdrawal: feeling sick when the substance wears off, or using to avoid that sickness.
Withdrawal is not required. Someone can meet the criteria for a substance use disorder without ever having a single shaky morning. The CDC also notes that tolerance and withdrawal do not count toward a diagnosis when a person takes a medication, such as a prescribed opioid, exactly as directed under medical supervision. A body that has adapted to a medicine is not the same thing as a disorder.
For families, this means the question is never just “Are they physically hooked?” The more useful question is whether the pattern of use is affecting the person’s control, relationships, safety, or health.
How Is Severity Scored, and Why Isn’t a Self-Check a Diagnosis?
Severity depends on how many criteria a person meets: 2 to 3 is mild, 4 to 5 is moderate, and 6 or more is severe. Counting is only a starting point, because only a licensed clinician can make a diagnosis.
These severity levels help clinicians describe where a person is right now. They do not predict any individual’s treatment results, and they are not labels a person carries forever. A mild substance use disorder still deserves attention, because patterns can change over time. A severe one is not a hopeless case. Severity can change in either direction, which is one reason a clinical team checks it again as care goes on.
A count you do at home leaves out a lot of important data. People in active use often underreport, sometimes on purpose and sometimes because they honestly do not see the pattern. Family members, even close ones, see some behavior and miss the rest. The criteria also leave out important related details: other medications, past withdrawal reactions, heart or liver problems, and mental health conditions such as depression or anxiety that can show up alongside substance use. The NIH health topic page on substance use disorders describes a substance use disorder as a treatable condition that affects a person’s brain and behavior. Treatable conditions call for a proper assessment, not a guess.
At New Hampshire Detox in Bethlehem, NH, a person’s pattern is first reviewed during the intake safety screening. The admissions team will slow the conversation down and listen. Expect questions like these: What is being used? How much, and how often? When was the last use? Has there ever been a seizure, confusion, or hallucinations during withdrawal? What medications are being taken? Are there any thoughts of self-harm? Those answers help shape the safest next step far more than any total on a page. If you counted four or five criteria tonight, write them down, whether on paper or in a draft email, and share that note on the call. It gives the team a helpful starting point.
Why Do Withdrawal and Tolerance Make Stopping on Your Own Risky?
Tolerance and withdrawal mean the body has adapted to a substance, so stopping suddenly can bring on symptoms that range from uncomfortable to medically dangerous. With alcohol and benzodiazepines in particular, stopping abruptly without medical supervision can lead to serious complications, including seizures.
When a person drinks heavily or takes benzodiazepines every day, the brain adjusts to keep working with the substance on board. Take it away all at once, and the nervous system can swing into overdrive. A comprehensive clinical review of substance use disorders describes withdrawal from alcohol and sedatives as a condition that can become severe and that calls for medical management. This is why “just stop” is not safe advice for everyone. If your loved one has tried to quit cold turkey before and ended up sick, scared, or in the emergency room, that experience is information, not failure.
If withdrawal is already happening, ask yourself these questions. Is your loved one shaking, sweating, or vomiting hours after the last drink or pill? Are they confused, agitated, or seeing things that are not there? Have they had a seizure before when they tried to stop? Is their heart racing? If the answer to any of these is yes, call 911 now.
Opioid withdrawal is different. It is usually not life-threatening by itself, but it can be intensely painful. A greater danger often comes afterward. Tolerance drops during a break from use, so returning to a familiar dose can lead to an overdose.
New Hampshire Detox provides residential, medically supported detox in a non-hospital, home-like setting in Bethlehem, NH. Withdrawal is managed with medical support, so the person is not left to ride it out alone in a bedroom at home. Many families fear a cold hospital ward. That fear is understandable, and it is one reason this setting was designed to feel like a home rather than a clinic.
For some people, especially those using opioids, medication can be part of the plan. Medication-assisted treatment (MAT) uses specific FDA-approved medications to help ease withdrawal and cravings while the person also works on recovery skills. NIDA describes addiction treatment as often combining medications with behavioral therapies, tailored to the person. You can learn how the Medication-Assisted Treatment program at New Hampshire Detox fits into detox and residential care. Whether medication is right for your loved one depends on the substance, their health, and the clinical assessment, and no medication guarantees a particular outcome.
How Do the Criteria Look Different Across Substances and Levels of Care?
The same 11 criteria apply to every substance, but they can show up differently with alcohol, opioids, meth, and benzodiazepines. Understanding the pattern can help a clinical team match a person to an appropriate level of care.
With alcohol, the “time spent” criterion often looks like lost mornings: recovering from the night before, calling out of work, or planning the day around drinking. Tolerance can creep up over years until large amounts barely seem to register. Withdrawal can begin within hours of the last drink, and it can become dangerous.
With heroin and other opioids, tolerance tends to build quickly, cravings can be intense, and much of the day may be spent avoiding withdrawal.
With meth, physical withdrawal is usually less dramatic, but the crash can bring deep exhaustion, low mood, and strong cravings. Time spent often shows up as binge-and-crash cycles.
With benzodiazepines, use may have started with a legitimate prescription. The signs to watch for are taking more than prescribed, running out early, or using pills from other sources. Withdrawal here carries real medical risk.
Because the pattern differs from person to person, personalized care starts with understanding the individual rather than fitting them to a label. Our admissions team can walk you through which levels of care are available and which fit your path to personalized healing and recovery support.
- Detox (withdrawal management): medically supported care while the body clears the substance
- Residential care: live-in recovery support after withdrawal is stabilized
- Medication-Assisted Treatment (MAT): medication as part of the plan when it is clinically appropriate
- Partial hospitalization program (PHP): in general, a structured level of care with several hours of programming on most days, often used as a step down from residential
Programs at New Hampshire Detox include:
- Men’s Rehab Program
- Women’s Rehab Program
- Alcohol Addiction Treatment Program
- Drug Addiction Treatment Program
- Heroin Addiction Treatment Program
- Opioid Addiction Treatment Program
- Meth Addiction Treatment Program
- Benzo Addiction Treatment Program
- Medication-Assisted Treatment
Later in recovery, some people move on to intensive outpatient programs (IOP), standard outpatient counseling, or sober living with other providers closer to home. Those are general options a person may need down the road. New Hampshire Detox does not provide them. The first step New Hampshire Detox offers is detox.
How Can You Bring Up the Criteria With Someone You Love?
Talk about what you have seen, not about what you think the person is. Starting with “I have noticed…” and naming one specific sign or behavior can help keep the conversation calm and may lower the chance of a fight.
The criteria give you neutral, specific language. “You’re an alcoholic” invites an argument. “I have noticed you’ve missed three Mondays at work this month, and I’m worried” describes a real event without attaching a label. It also matches the criterion about falling behind on responsibilities. A few other ways to open the door:
- “I have noticed you stopped going on the weekend trips you used to love. I miss you.”
- “I have noticed you tried to quit last month and felt really sick. I don’t want you to go through that alone again.”
- “I have noticed it takes more than it used to. Can we talk to someone together, just to ask questions?”
Pick a calm moment, not right after a blowup or while your loved one is intoxicated. Expect pushback, and don’t argue the facts. If they say “I can stop anytime,” you can answer honestly: “I hope so. Would you be willing to talk to someone about how to stop safely?” The first conversation does not need to end in a confession. Aim to show them they aren’t alone with this, and keep the door open for the next talk.
Where Can You Find Help Right Now in New Hampshire?
If someone is in danger, call 911 for a medical emergency, or call or text 988 for a mental health or substance use crisis. When the person is safe and ready to start detox, call the New Hampshire Detox admissions team in Bethlehem, NH, at 833-649-1053.
New Hampshire Detox works with people and families from across New Hampshire. Here is how the first steps usually go. First, you or your loved one calls the admissions team, and the conversation starts with immediate safety. Next, the team walks through the screening questions about substances, last use, health history, and medications. Then the team verifies insurance benefits before arrival, so there are fewer surprises. Finally, the team talks through timing, travel, and what to pack.
Detox programs commonly ask people to bring a photo ID, an insurance card, current medications in their original bottles, names and numbers for doctors and emergency contacts, and a few days of comfortable clothing. Ask the admissions team to confirm New Hampshire Detox’s policy on exactly what is allowed, so nothing gets turned away when your loved one enters the program.
Insurance is often the first worry families raise. New Hampshire Detox accepts Aetna Commercial, Anthem Commercial, Evernorth (Cigna) Commercial, Curative Health, and New Hampshire Medicaid plans through AmeriHealth Caritas and Wellsense. Private pay is also accepted. Coverage depends on your specific plan. Cost depends on the level of care, the length of stay, and your plan’s deductible, copays, and coinsurance, so no single price fits every person. The admissions team can verify your benefits before arrival and walk you through what your plan may cover and what you may owe. If you don’t see your plan listed, call anyway and ask.
Why Do the Criteria Still Matter After Detox?
Detox addresses withdrawal, but on its own it does not address the other criteria tied to control, relationships, and risk. That is why many people choose to continue care once detox ends.
Look back at the 11 criteria. Only two, tolerance and withdrawal, are mostly physical. Cravings, failed attempts to cut down, strained relationships, and risky choices do not necessarily disappear when the body clears a substance. Those patterns took time to form, and changing them usually takes time, practice, and support. Detox can help a person become physically stable enough to start that work. It is the first step, not the whole of recovery.
You may be thinking, “We have tried before, and it did not last.” Many families carry that fear. A past attempt that did not hold does not mean a person cannot recover. Sometimes it means care ended earlier than the person needed, or the plan for going home was not ready. At New Hampshire Detox, residential care can give a person more time in a structured, home-like setting after withdrawal is stabilized. The aftercare and recovery planning built into a stay is meant to help map out what comes next.
That planning starts during the stay, not on the last day. For people heading home to small towns and rural communities around New Hampshire, the plan may include connecting with outpatient providers, recovery meetings, and supportive people closer to home. New Hampshire Detox frames recovery as rebirth, regrowth, and renewal: a fresh start that can continue with recovery support.
Questions Families Ask About the DSM-5 Criteria
These are the questions families raise most often when they start reading about the criteria.
What are the criteria for substance use disorders according to the DSM-5, in short?
There are 11 criteria covering loss of control, social problems, risky use, tolerance, and withdrawal. A person needs to meet 2 or more within 12 months. Meeting 2 to 3 is mild, 4 to 5 is moderate, and 6 or more is severe. A licensed clinician makes the actual diagnosis.
What is the difference between substance abuse and dependence in the DSM-5?
The DSM-5 no longer uses separate “abuse” and “dependence” diagnoses. It combined them into one condition, substance use disorder, rated by severity. Tolerance and withdrawal are only two of the 11 criteria, and neither is required.
Where can I find immediate substance use disorder help in New Hampshire?
Call 911 for a medical emergency, or call or text 988 for crisis support. To start detox, call the New Hampshire Detox admissions team in Bethlehem, NH, at 833-649-1053, and they will begin with a safety screening.
What types of substance use disorder treatment are available in New Hampshire?
Options across the state include:
- Medical detox (withdrawal management), offered at New Hampshire Detox
- Residential or inpatient treatment, offered at New Hampshire Detox
- Medication-assisted treatment (MAT), offered at New Hampshire Detox
- Partial hospitalization programs (PHP), available through other providers
- Intensive outpatient programs (IOP), available through other providers
- Standard outpatient counseling, available through other providers
- Sober living and peer recovery support, available through other providers
Which level fits depends on a clinical assessment.
Does insurance cover substance use disorder treatment in New Hampshire?
Many plans include some coverage for substance use disorder treatment, but the details depend on your plan. New Hampshire Detox accepts Aetna Commercial, Anthem Commercial, Evernorth (Cigna) Commercial, Curative Health, and Medicaid plans through AmeriHealth Caritas and Wellsense, along with private pay. The admissions team can verify your benefits before arrival.
How much does substance use disorder treatment cost in New Hampshire?
Cost varies with the level of care, how long a person stays, and the details of their insurance, such as deductibles, copays, and coinsurance. Because of that, there is no single price that fits everyone. The most reliable way to know is to have the admissions team check your benefits and explain what you may owe before your loved one arrives.
What is medication-assisted treatment (MAT), and is it available in New Hampshire?
MAT uses specific medications to help ease withdrawal and cravings, usually alongside counseling and other recovery support. It is most often used for opioid use, and sometimes for alcohol use. New Hampshire Detox offers MAT when it is clinically appropriate, and the decision is based on the substance, the person’s health, and the clinical assessment.
Is it safe to stop drinking or using benzodiazepines on my own?
It may not be. Withdrawal from alcohol or benzodiazepines can be dangerous, so medical supervision is strongly advised. If symptoms like seizures, confusion, or hallucinations appear, call 911.
Your Next Step: Bring What You Have Noticed to One Call
If your answers to the 11 criteria worry you, call the New Hampshire Detox admissions team in Bethlehem, NH, at 833-649-1053. The team can talk through a safety screening, verify your insurance benefits before arrival, and explain what the first step of medically supported detox could look like for your loved one.
Before you dial, jot down which of the 11 criteria you have actually seen, roughly when they started, what substance is involved, and when the last use was. You don’t need the right words or a diagnosis. Knowing what the criteria for substance use disorders are according to the DSM-5 is useful, but you don’t have to finish the count yourself. That short note gives the team a place to start as they help you explore the right level of care and a safe next step, so the person you love isn’t facing withdrawal alone.
If You Recognize Yourself in These Criteria
Reading through the DSM-5 criteria can bring up a quiet worry: maybe it isn’t “bad enough,” or maybe you’re only seeing the signs now. You don’t need a perfect label to ask for help, and a diagnosis is just a starting point for understanding what’s happening. If any of this sounds familiar, the team at New Hampshire Detox in Bethlehem, NH is here to talk through where you are and whether residential detoxification could be a good first step, so call the office when you’re ready.
- This article is for educational purposes only and is not a diagnosis or a substitute for professional medical advice.
- Individual experiences with treatment and recovery vary, and no outcome can be guaranteed.
- Only a licensed clinician can diagnose a substance use disorder.
- If you or someone you love is in a medical emergency, call 911.
