Southern New Hampshire University HSE 350 Worksheet for DSM-5 Criteria for Diagnosis of Substance Use Disorder
Note: Substance use disorder reguires that at least two criteria be met within a 12-month period
Diagnostic Criteria
Meets Criteria? Yes OR No
Evidence From the Case
1. Substance is often taken in larger amounts or over a longer period of time than intended. 2. There is a persistent desire or there are unsuccessful efforts to cut down or control substance use.
NO
This was not reported by Mr. Roy or his wife.
NO
No previous attempts to stop or cut back reported
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
NO
This is not reported.
4. There is a craving or a strong desire to use the substance.
NO YES
Mr. Roy does not report cravings currently It is reported that Mr. Roy misses his son's athletic games/obligations due to his drinking. Mr. Roy's drinking is causing problems between him and his wife.
5.
Recurrent substance use results in failure to fulfill major role obligations at work, school, or home. 6. Substance use continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
YES
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
YES
Mr. Roy misses his son's athletic games/obligations.
8. There is recurrent substance use in situations in which it is physically hazardous.
NO
This has not been reported.
9. There is continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
NO
No physical or psychological problems reported.
10. * Tolerance, as defined by either of the following:
NO
No discussion on tolerance.
a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect b) Markedly diminished effect with continued use of the same amount of the substance
Southern New Hampshire University 11. ** Withdrawal, as manifested by either of the following: NO No discussion on withdrawal
a)The characteristic (specific substance) withdrawal syndrome b) The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
* This criterion is not considered to be met for those individuals taking the substance solely under appropriate medical supervision.
** The DSM-5 contains separate criteria lists for each type of substance. However, all use the same 11 criteria except for criterion 11(a). Refer to the DSM-5 for specific withdrawal syndromes.
Severity: Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or more symptoms
Diagnosis: Alcohol Use Disorder-Mild
ICD-10-CM Diagnostic Code: 305.00 (F10.10)
Signed: Wanda Prince
Date: January 20, 2022
Criteria taken from the following source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Associat