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 yes
Evidence From the Case
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.
Mr. Roy admits to increasing his alcohol use but denies it is a problem.
no
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
no
4. There is a craving or a strong desire to use the substance. 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 interpersonalproblems caused or exacerbated by the effects of the substance.
no yes
Mr. Roy has stopped going to his sons soccer games because he is too drunk.
yes
Mr. Roy continues to drink despite his wife's complaints about it
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
yes
Mr. Roy has stopped going to son's soccer games.
8. There is recurrent substance use in situations in which it is physically hazardous.
no
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. 10. * Tolerance, as defined by either of the following:
no
no
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
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.
specific withdrawal syndromes.
Severity: Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or more symptoms
Diagnosis: Alcohol Use Disorder, Moderate
ICD-10-CM Diagnostic Code: 303.90 (F10.20)
Signed: Shayne Wickstrom
Date: 1/19/2022
Criteria taken from the following source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Associat