What defines substance use disorder in terms of diagnostic criteria?

• A. Two or more criteria within a 12-month period define substance use disorder.
• B. A single instance of heavy use defines substance use disorder.
• C. Only withdrawal symptoms define substance use disorder.
• D. Substance use disorder is diagnosed only after seeking treatment.

Answer: (A)

Substance use disorder is diagnosed when there is a pattern of problematic substance use that causes clinically significant impairment or distress, and this pattern is identified by meeting at least two of the diagnostic criteria within a 12-month period. There are 11 criteria in total, including needing more of the substance to achieve the same effect (tolerance), experiencing withdrawal, using more or for longer than intended, unsuccessful attempts to cut down, spending a lot of time obtaining, using, or recovering, strong cravings, failure to fulfill major role obligations, continued use despite social or interpersonal problems, giving up important activities, using in hazardous situations, and recurrent legal problems. The number of criteria met determines severity: two to three is mild, four to five moderate, and six or more severe. This threshold captures a pattern over time rather than a single episode, and it emphasizes the impairment or distress side of the disorder, not just isolated use.