Opioid use disorder (OUD) is diagnosed using 11 criteria from the DSM-5-TR, the diagnostic manual clinicians use. It’s assessed on a spectrum — mild, moderate, or severe — not as a yes/no label.
The 11 criteria (over a 12-month period)
- Taking opioids in larger amounts or over a longer period than intended
- Persistent desire or unsuccessful efforts to cut down or control use
- Spending a lot of time obtaining, using, or recovering from opioids
- Craving, or a strong desire to use
- Failing to fulfill major obligations at work, school, or home because of use
- Continuing use despite social or relationship problems caused by it
- Giving up or reducing important activities because of use
- Using in physically hazardous situations
- Continuing use despite knowing it’s causing or worsening a physical or psychological problem
- Tolerance (needing more for the same effect, or reduced effect at the same amount)
- Withdrawal symptoms, or using to avoid withdrawal
How severity is scored
- 2–3 criteria: mild
- 4–5 criteria: moderate
- 6 or more: severe
An important note on criteria 10 and 11
If someone is taking opioids exactly as prescribed under medical supervision — including buprenorphine or methadone as treatment — tolerance and withdrawal alone do not count toward this diagnosis. This distinction exists specifically so that appropriate medical treatment isn’t mistaken for the disorder it’s treating. physical dependence vs. addiction article
This is a spectrum, not a label
Two people who both meet “moderate” criteria can look very different day to day. The number of criteria is meant to guide treatment intensity — see our [ASAM level of care navigator] — not to sort people into a fixed identity.
If you’re using this to think about your own situation
A formal diagnosis requires an evaluation by a clinician — this list is for understanding, not self-diagnosis. Our [self-assessment tool] walks through this in a private, non-judgmental way if you want a starting point before talking to someone.
Medically reviewed by [pending]. Source: DSM-5-TR (American Psychiatric Association).