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    DSM-5 SUD Checklist

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    jade
    The document contains a substance use disorder assessment checklist with 11 criteria for diagnosing substance use disorders. It includes classifications for mild, moderate, and severe substance use disorder as well as remission statuses.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    DSM-5 SUD Checklist

    Uploaded by

    jade
    31 views1 page
    The document contains a substance use disorder assessment checklist with 11 criteria for diagnosing substance use disorders. It includes classifications for mild, moderate, and severe substance use disorder as well as remission statuses.

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    The document contains a substance use disorder assessment checklist with 11 criteria for diagnosing substance use disorders. It includes classifications for mild, moderate, and severe substance use disorder as well as remission statuses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views1 page

    DSM-5 SUD Checklist

    Uploaded by

    jade
    The document contains a substance use disorder assessment checklist with 11 criteria for diagnosing substance use disorders. It includes classifications for mild, moderate, and severe substance use disorder as well as remission statuses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Client name: Date:

    DSM-5 Substance Use Disorder Assessment


    A. A pattern of substance use leading to clinically significant impairment or distress as manifested by at least 2 of the following,
    occurring within a 12-month period:
    Met Symptom Substance(s) When Symptom Was Experienced
    1) The substance is often taken in larger amounts or
    ☐
    over a longer period than was intended.
    2) There is a persistent desire or unsuccessful efforts
    ☐
    to cut down or control the use of the substance.
    3) A great deal of time is spent in activities necessary
    ☐ to obtain the substance, use the substance, or
    recover from its effects.
    4) Craving, or a strong desire or urge to use the
    ☐
    substance.
    5) Recurrent substance use resulting in a failure to
    ☐ fulfill major role obligations at work, school, or
    home.
    6) Continued substance use despite having persistent
    or recurrent social or interpersonal problems
    ☐
    caused or exacerbated by the effects of the
    substance.
    7) Important social, occupational, or recreational
    ☐ activities are given up or reduced because of the
    use of the substance.
    8) Recurrent substance use in situations in which it is
    ☐
    physically hazardous.
    9) The substance use is continued despite knowledge
    of having a persistent or recurrent physical or
    ☐
    psychological problem that is likely to have been
    caused or exacerbated by the use of the substance.
    10) Tolerance, as defined by either of the following:
    a) A need for markedly increased amounts of the
    substance to achieve intoxication or desired effect;
    ☐
    and/or
    b) A markedly diminished effect with continued use
    of the same amount of the substance.
    11) Withdrawal, as manifested by either of the
    following:
    a) The characteristic withdrawal syndrome for the
    ☐
    substance; and/or
    b) The substance is taken to relieve or avoid
    withdrawal symptoms.
    ☐ Mild Substance Use Disorder (2-3 Symptoms): Substance(s):
    ☐ Moderate Substance Use Disorder (4-5 Symptoms): Substance(s):
    Severe Substance Use Disorder (6 or More Substance(s):
    ☐
    Symptoms):
    In Early Remission (no symptoms, except for craving, Substance(s):
    ☐
    for 3 to under 12 months)
    In Sustained Remission (no symptoms, except for Substance(s):
    ☐
    craving, for more than 12 months)
    ☐ In a Controlled Environment (if in an environment in which access to substances is limited)
    On Maintenance Therapy (if taking a prescribed agonist Medication:
    ☐ medication and none of the criteria have been met for
    the agonist medication except symptoms 10 and 11)

    * Symptoms 10 and 11 are not applicable if the client is using sedative/hypnotic/anxiolytic, opioid, or stimulant medication as prescribed consistent
    with physician’s orders (e.g. not combining with synergistic substances, not taking more frequently or in greater quantity than prescribed, not
    operating machinery, etc.)

    Developed by Aaron Norton, LMHC, CAP, CRC Integrity Counseling, Inc. www.anorton.com

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