The 2/11 algorithm allows tremendous variation in severity, with a more than five-fold difference in the number of symptoms a diagnosed case can have. This variation in severity is addressed, in part, by the draft criteria: the presence of 4/11 symptoms would define ‘severe’ rather than ‘moderate’ SUD. However, some persons with four symptoms can have a heavy and heedless substance-use pattern rather than a presentation that clearly reflects compulsive use, raising questions as to the meaning of’ severe’. The variability in severity among those with SUD, and even among those with ‘severe’ SUD, would greatly limit the utility of these categories.
