Addiction

Addiction is a condition characterised by compulsive engagement with a substance or behaviour despite ongoing negative consequences, driven by changes in brain circuits related to reward, motivation, and self-control. The clinical term used today, particularly for substances, is substance use disorder (SUD) terminology formalised in the DSM-5 (2013), which replaced the older, separately defined categories of “substance abuse” and “substance dependence” with a single, unified disorder assessed on a spectrum of severity.

Diagnostic framework — DSM-5-TR

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is considered the standard diagnostic reference for mental health conditions, including addiction. Under DSM-5-TR criteria, a substance use disorder is diagnosed when two or more of eleven criteria are met within a 12-month period, grouped into four broad categories:

Impaired control

• Using more of the substance, or for longer, than intended
• Persistent desire or unsuccessful efforts to cut down or stop
• Spending significant time obtaining, using, or recovering from the substance
• Craving or a strong urge to use

Social impairment

• Recurrent use causing failure to fulfil obligations at work, school, or home
• Continued use despite ongoing social or relationship problems it causes
• Giving up, Social phobia or reducing important activities because of use

Risky use

• Repeated use in physically hazardous situations
• Continued use despite knowing it’s causing or worsening a physical or psychological problem

Pharmacological criteria

• Needing more of the substance to get the same effect (tolerance)
• Developing withdrawal symptoms when not using the substance

Severity is classified by how many criteria are met: mild is 2–3 criteria, moderate is 4–5, and severe is 6 or more.

Why DSM-5 changed the framework

The DSM-IV previously separated “substance abuse” and “substance dependence” as distinct diagnoses, with dependence considered more severe. The DSM-5 combined these into a single substance use disorder, partly because the old distinction gave little guidance for treatment and created diagnostic inconsistencies where some people met partial criteria for both categories without qualifying for either. This shift reflects a broader clinical understanding of addiction as existing on a spectrum of severity, rather than as two separate, qualitatively different conditions.

Addiction beyond substances

While DSM-5’s formal substance use disorder criteria apply to specific substances (alcohol, stimulants, opioids, and others, each diagnosed separately but using the same overarching criteria), the same underlying compulsive pattern is increasingly recognised in behavioural contexts too - gambling disorder is included in the DSM-5’s “Substance-Related and Addictive Disorders” chapter as a formally recognised non-substance addiction, reflecting the same reward-and-compulsion mechanisms at work.

Position in this vault

This structural connects to Recovery, framing addiction as a clinically defined, severity-graded condition rather than a simple binary - relevant context for understanding what recovery is actually addressing, and why it’s commonly described as an ongoing process rather than a fixed endpoint.

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American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787