One of the two most globally influential psychiatric diagnostic manuals is the International Statistical Classification of Diseases and Related Health Problems (ICD-10) published by the World Health Organisation (WHO). This classification system has been regularly revised and updated since its introduction. The current internationally binding revision ICD-11 entered into force on 1 January 2022, officially replacing the previously binding ICD-10. The ICD-10 was first published in 1994 and last updated in 2019.

In addition to the official translations of the international English version of ICD-10 into other languages, there are also nationally modified adaptations of ICD-10 that are better orientated to the national circumstances and requirements of the respective healthcare systems: In Germany, for instance, this is the ‘ICD-10 German Modification’ (ICD-10-GM), which is published by the Federal Institute for Drugs and Medical Devices (Ger.: Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM). While in Germany the WHO’s ICD-10 is primarily used as a classification system for mortality, the ICD-10-GM is used for the outpatient and inpatient areas of morbidity. However, due to the close and structural embedding of ICD-10 and its national adaptations within the national healthcare sectors, the BfArM in Germany, for instance, has conceded a transition period of about five years for the application and implementation of ICD-10 to the current ICD-11 version. Although ICD-11 is officially the current version, ICD-10 or its modified national versions remain the effective classification systems at national level.

Another internationally relevant diagnostic manual is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA). While the ICD includes all types of medical illnesses, the DSM only encompasses mental disorders. Since its creation, the DSM, like the ICD, has undergone various updates and revisions over the years. The DSM-5 was published in 2013, but replaced by the revised version DSM-5-TR (Text Revision) in March 2022. The DSM-5-TR is not to be understood as a completely new version in the sense of a DSM-6 of the diagnostic classification system, but as a revision that updates in particular the research and statistical data of the DSM-5, which can now be considered as outdated.

In 1964, the WHO replaced the term ‘addiction’ with the term dependence in the ICD in order to emphasise the character of the ‘dependence syndrome’, in relation to medication and other substances, as a disease and thus counteract the stigmatisation of those affected. If there are patterns of substance use that cause harm to physical or mental health without a dependence syndrome being present, the ICD-10 now refers to ‘harmful use’ of substances or medication (in previous ICD versions still referred to as substance abuse). While dependence primarily occurs in connection with the use of psychotropic drugs, i.e. drugs that have an effect on the psyche, such as sleeping pills and tranquillisers (hypnotics or sedatives) or stimulants, drugs that do not cause dependence, such as laxatives or appetite suppressants (anoretics), can also be harmfully used improperly.

In the DSM-5, the previous differentiation between dependence and abuse was discarded and the term ‘substance use’ was introduced, which now summarises substance dependence and substance abuse in the disorder ‘substance use disorder’. In addition, instead of the category of ‘substance-related disorders’, the new classification of ‘substance-related and addictive disorders’ has now been established in the DSM-5, as non-substance-related disorders or behavioural disorders such as the gambling disorder are now also included.

Both the ICD-10 and the ICD-11 describe the dependence syndrome on the basis of the following criteria:

1. Strong urge to consume
2. Loss of control
3. Development of tolerance
4. Physical withdrawal symptoms
5. Neglect of other interests in favour of substance us
6. Continued substance use despite evidence of clearly harmful consequences

The DSM-5-TR defines eleven criteria for the diagnosis of substance use disorder, which are divided into the following four categories:

1. Impaired control regarding use
2. Social impairment
3. Risky use
4. Pharmacological symptoms