AIMS: This article reviews the problems of cross-cultural applicability, which have been identified at the level of instrument items, at the level of criteria, and at the level of concepts and diagnoses. One near-universal appears to be that the diagnoses carry a weight of moral judgement and often of social stigma, whatever the clinician's intentions. METHODS: The findings of studies on variations between cultures in the meaningfulness and meaning of the main substance use diagnoses and criteria are described. RESULTS: Suggestions are made for directions of thinking and work to improve the cross-cultural applicability of five current diagnoses: intoxication, withdrawal, harmful use, abuse and dependence. CONCLUSIONS: It is argued that the possibility should be held open of bounded applicability of some diagnoses or criteria, in some societies but not in others.