The word “addiction” is not used as a formal diagnosis in the DSM-5. Instead, the manual uses the term “substance use disorder” to describe what most people think of as addiction. This was a deliberate choice by the American Psychiatric Association when the fifth edition was published in 2013, and it represented a significant shift from how earlier versions of the manual categorized these problems.
Why the DSM-5 Avoids the Word “Addiction”
Before 2013, the DSM split substance problems into two separate diagnoses: “substance abuse” and “substance dependence.” The DSM-5 collapsed both into a single diagnosis, substance use disorder, measured on a spectrum from mild to severe. Several factors drove this change. The old two-category system left some people in a diagnostic gap: they had a serious problem but didn’t neatly fit the criteria for either abuse or dependence. The term “dependence” was routinely confused with physical dependence, a normal bodily response that happens with many medications, including some that aren’t addictive at all. And the word “abuse” carried negative, stigmatizing connotations that could discourage people from seeking help.
The DSM-5 does use the word “addiction” in one narrow context: the chapter on behavioral addictions, which currently contains only gambling disorder. But as a clinical label applied to a patient, “addiction” doesn’t appear. The preferred framework treats substance problems as a continuum rather than an all-or-nothing label.
How Substance Use Disorder Is Diagnosed
A substance use disorder diagnosis is built from a checklist of 11 possible symptoms, evaluated over a 12-month period. These apply to nearly every substance class (caffeine is the exception). A person needs to meet at least two of the 11 to receive a diagnosis. The severity then scales with the count:
- Mild: 2 to 3 symptoms
- Moderate: 4 to 5 symptoms
- Severe: 6 or more symptoms
This spectrum approach is one of the biggest practical differences from older editions. Someone with two or three symptoms gets recognized and can access treatment earlier, rather than falling through the cracks of a binary system.
The 11 Diagnostic Criteria
The symptoms cover four broad areas of a person’s life: loss of control, social consequences, risky behavior, and physical changes. Specifically, they are:
- Using more than intended: Taking a substance in larger amounts or over a longer period than you planned.
- Wanting to cut down but failing: Repeated unsuccessful attempts to reduce or stop use.
- Time consumed: Spending a significant portion of your day obtaining, using, or recovering from a substance.
- Cravings: Experiencing strong urges to use.
- Failing responsibilities: Substance use interferes with obligations at work, school, or home.
- Social problems: Continuing to use despite ongoing relationship or interpersonal conflicts caused by the substance.
- Giving up activities: Dropping hobbies, social events, or other things you used to enjoy.
- Hazardous use: Repeatedly using in situations where it’s physically dangerous.
- Use despite harm: Continuing even when you know the substance is worsening a physical or psychological problem.
- Tolerance: Needing more of the substance to get the same effect, or getting less effect from the same amount.
- Withdrawal: Experiencing physical or psychological symptoms when the substance wears off, or using again specifically to avoid those symptoms.
Tolerance and withdrawal are included, but they aren’t weighted more heavily than the other symptoms. This is another intentional design choice. Physical dependence alone doesn’t equal a substance use disorder. Someone on long-term pain medication may develop tolerance and experience withdrawal without meeting any of the other nine criteria.
Behavioral Addictions in the DSM-5
Gambling disorder is the only behavioral condition with full diagnostic status in the DSM-5. It sits in its own category, “Non-Substance-Related Disorders,” within the broader substance-related chapter. Research showed that gambling disorder mirrors substance use disorders closely in brain activity, symptom patterns, and treatment response, which justified its inclusion.
Internet gaming disorder is not an official diagnosis. It’s listed in Section III of the manual, a holding area for conditions that need more research before they can be formally recognized. The proposed criteria include preoccupation with gaming, withdrawal-like symptoms (anxiety, irritability) when gaming stops, needing to spend increasing time gaming, and continuing despite negative consequences. Five or more of nine proposed symptoms within a year would meet the threshold. Notably, this proposed condition covers only gaming, not general internet overuse, social media, or smartphone habits.
Other behaviors people commonly call addictions, such as sex addiction, shopping addiction, or food addiction, do not appear anywhere in the DSM-5, not even in the research section.
What This Means in Practice
If you or someone you know is evaluated for a substance problem today, the clinician will use the substance use disorder framework. The diagnosis will specify both the substance involved (alcohol use disorder, opioid use disorder, cannabis use disorder, and so on) and the severity level. This matters for treatment planning: a mild disorder might be addressed with brief intervention or outpatient counseling, while a severe diagnosis typically calls for more intensive support.
The shift away from “addiction” and “abuse” as diagnostic labels was also meant to reduce stigma. Research has consistently shown that the language clinicians use shapes how patients are perceived and treated. Calling someone’s condition a “disorder” on a severity scale frames it as a medical problem, not a moral failing. That said, the word “addiction” remains widely used in everyday conversation, in support groups, and even by many treatment professionals. It just isn’t the term that appears on a formal diagnosis.