Is a patient's self‑reported abstinence sufficient to change a substance‑related disorder diagnosis to remission?

Self-Reported Abstinence and Remission Diagnosis

No, self-reported abstinence alone is not sufficient to change a substance use disorder diagnosis to remission—the patient must fail to meet DSM-5 criteria for the disorder (except craving) for the specified time period, not simply report abstinence. 1

Key Distinction: Abstinence vs. Remission Criteria

The American Psychiatric Association defines remission based on absence of diagnostic criteria, not abstinence status:

• Early remission requires ≥3 months but <12 months without meeting DSM-5 substance use disorder criteria (except craving) 1
• Sustained remission requires ≥12 months without meeting DSM-5 substance use disorder criteria (except craving) 1

Critically, the American Psychiatric Association does not require complete abstinence for remission coding, instead focusing on whether the patient meets disorder criteria (substance-related difficulties). 1 This means a patient could be using substances but still qualify for remission if they no longer meet the diagnostic threshold for impairment.

What Must Be Assessed Beyond Self-Report

To properly code remission, you must verify the patient is not currently meeting the following DSM-5 criteria 2:

• No tolerance or withdrawal issues (unless on maintenance therapy)
• No loss of control over substance use (taking larger amounts or for longer than intended)
• No time spent obtaining, using, or recovering from substances
• No social/occupational consequences from use
• No continued use despite physical/psychological problems caused by the substance
• No failure to fulfill major role obligations at work, school, or home
• No recurrent use in hazardous situations
• No substance-related legal problems
• No persistent social/interpersonal problems from use

Craving alone can be present and still qualify for remission 1

Reliability of Self-Report in Clinical Context

While self-reported abstinence has shown high validity (92% agreement with collateral sources) in certain treatment settings 3, and can be highly valid in non-psychotic dually diagnosed outpatients when patients are in treatment and honest reporting is encouraged 4, self-report of abstinence does not equal verification that diagnostic criteria are no longer met.

Research demonstrates that approximately 50% of individuals who resolve a substance use problem continue some level of substance use 5, yet many still achieve functional remission because they no longer meet diagnostic criteria for the disorder.

Proper Documentation Requirements

When coding remission, you must 1:

• Include the original severity level (Mild: 2-3 criteria; Moderate: 4-5 criteria; Severe: ≥6 criteria)
• Use specific remission specifiers rather than historical diagnoses to maintain continuity of care
• Document the complete diagnosis as: "Substance Use Disorder, [Mild/Moderate/Severe], in [Early/Sustained] Remission"
• Add additional specifiers if applicable (e.g., "In a controlled environment" or "On maintenance therapy")

Common Pitfall to Avoid

Do not equate patient-reported abstinence with automatic remission status. 1 The American Psychiatric Association recommends using specific remission specifiers to acknowledge the chronic nature of substance use disorders, which requires systematic assessment of whether diagnostic criteria are currently met, not simply whether the patient reports stopping use. 1

For clinical trials specifically, the FDA guidance indicates that patients whose substance use disorder is not at least in partial remission should be excluded, emphasizing that remission status—not just abstinence—is the relevant clinical marker. 2