Registered Nurses' Association of Ontario

Classification Criteria for Substance Use Disorders

This table provides a summary of each criterion that contributes to the development of a substance use disorder, as found in DSM-5.  Substance use disorders are measured on a continuum from mild, moderate and severe dependent on the amount of criterion present.  

Impaired Control

  • Increase in substance use or over longer period of time than originally intended
  • Unsuccessful desire stated to regulate or reduce substance use. Great deal of time obtaining, using or recovering from effects of substance
  • Craving: urge for drug at any time of day, especially in environments where drug was previously obtained or used

Social Impairment

  • Failure to fulfill major role obligations due to substance use (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school, neglect of children or household)
  • Problems (social and interpersonal in nature) occur (persistent or recurrent) and are caused or aggravated by effects of substance use
  • Activities once considered important to the individuals (e.g., social, occupational or recreational) are reduced or discontinued due to substance use

Risky Use

  • Recurrent use of substances in situations where it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
  • Repeated substance use, even though physical and or psychological problems (caused or exacerbated by substance use) persist

Pharmacological Effects

  • Increased amount of substance consumed to achieve desired effects and /or diminished effect with use of the same amount of substance (Tolerance)
  • Occurrence of withdrawal marked by reduced blood and tissue concentrations of substances used; individual increases amount of substance used to relieve symptoms


For more information on diagnostic criteria for substance use disorders, please refer to:

American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders 5th edition, by the American Psychiatric Association, 2013, pp. 483-484.



Addiction and Mental Health
Engaging Clients who Use Substances
Background Information