Mason Delacroix
Alcohol abuse, also known as alcohol use disorder (AUD), is a mental health condition recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). AUD is characterised by a problematic pattern of alcohol use, which leads to clinically significant impairment or distress. The DSM-5 integrates the DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder, AUD, with mild, moderate, and severe sub-classifications. The severity of AUD is determined by the number of symptoms experienced in the previous 12 months, with 11 criteria in total. These criteria include continued drinking despite health and social problems, impaired control over alcohol intake, and the development of tolerance and withdrawal symptoms. AUD can cause alcohol-induced changes in the brain, making it difficult to quit drinking. However, with prolonged abstinence, some AUD-induced brain function changes may improve or even reverse.
| Characteristics | Values |
|---|---|
| DSM Version | DSM-5 |
| Disorder Name | Alcohol Use Disorder (AUD) |
| Previous Disorder Names | Alcohol Abuse, Alcohol Dependence, Alcohol Addiction, Alcoholism |
| Severity | Mild, Moderate, Severe |
| Diagnostic Criteria | 2 out of 11 criteria met in a 12-month period |
| Criteria Examples | Recurrent alcohol-related legal problems, continued alcohol use despite social or health problems, impaired control, tolerance, withdrawal symptoms |
| Remission | Early remission: no criteria met for 3-12 months; Sustained remission: no criteria met for 12+ months |
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What You'll Learn
Alcohol abuse and alcoholism
AUD encompasses a range of cognitions and behaviours that significantly impact individuals and their communities. The criteria for DSM-5 AUD include continued drinking despite experiencing social and health problems, impaired control over alcohol intake, and the development of tolerance and withdrawal symptoms when stopping alcohol use. These criteria are often composed of multiple symptoms, which serve as the basis for clinical assessment and diagnosis, providing a concrete framework for understanding AUD.
The DSM-5 criteria for AUD allow clinicians to determine the severity of the disorder depending on the number of symptoms present. For instance, one symptom may indicate that an individual is at risk, while two or three criteria indicate a mild substance use disorder. Six or more criteria indicate a severe substance use disorder, signalling an addiction to the substance.
AUD is characterised by a problematic pattern of alcohol use, which can include recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home, and continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol. As AUD progresses in severity, alcohol-induced changes in the brain can make it very difficult to cut down or quit. However, with prolonged abstinence, at least some AUD-induced brain function changes may improve and even reverse as other neurocircuits compensate for those compromised by alcohol.
Evidence-based treatment can help individuals achieve abstinence and facilitate these brain changes. A small proportion of patients with AUD will need a few days of "detox" to manage potentially dangerous withdrawal symptoms before starting a long-term care plan.
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DSM-5 diagnostic criteria
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) integrates the DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder (AUD). AUD is defined as "a problematic pattern of alcohol use leading to clinically significant impairment or distress".
The severity of AUD—mild, moderate, or severe—is based on the number of criteria met out of a possible 11 in the past 12 months. The more criteria met, the more severe the disorder. Two criteria indicate a mild substance use disorder, four or five a moderate disorder, and six or more a severe substance use disorder.
The 11 criteria used to diagnose AUD include:
- Alcohol is often taken in larger amounts or over a longer period than intended.
- There is a persistent desire or unsuccessful effort to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home.
- Recurrent alcohol use in situations in which it is physically hazardous.
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, defined as:
- A need for markedly increased amounts of alcohol to achieve intoxication or the desired effect.
- A markedly diminished effect with continued use of the same amount of alcohol.
Withdrawal, as manifested by either:
- The characteristic alcohol withdrawal syndrome.
- Alcohol is taken to relieve or avoid withdrawal symptoms.
- Use of alcohol is stopped or reduced because it is no longer physically accessible, or a persistent psychological or physiological problem is causing discomfort.
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
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AUD symptoms and diagnosis
Alcohol abuse and alcohol dependence were previously considered two distinct disorders in the DSM-IV. However, the DSM-5 integrates these into a single disorder called Alcohol Use Disorder (AUD). AUD is characterised by "a problematic pattern of alcohol use leading to clinically significant impairment or distress". It can be mild, moderate, or severe, depending on the number of symptoms experienced in the previous 12 months.
The severity of AUD is determined by the number of criteria met out of a possible 11. Here are some of the symptoms and diagnostic criteria for AUD:
- Craving beverages containing alcohol
- Spending a lot of time obtaining, consuming, or recovering from alcohol
- Repeatedly trying to reduce alcohol consumption but failing to do so
- Failing to fulfil major obligations at work, school, or home due to alcohol use
- Using alcohol in physically hazardous situations
- Continuing to drink despite knowledge of a persistent or recurrent physical or psychological problem likely caused or exacerbated by alcohol
- Increased alcohol tolerance, requiring larger amounts to achieve intoxication or the desired effect
- Experiencing withdrawal symptoms, such as alcohol withdrawal syndrome, or drinking to relieve or avoid these symptoms
- Alcohol-induced changes in the brain, making it difficult to cut down or quit
It is important to note that the terms "alcohol abuse" and "alcoholism" may carry stigma. Using the diagnostic term "alcohol use disorder" with patients may help reduce stigma and facilitate a more accurate understanding of the condition.
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Addiction and substance dependence
The DSM-5 integrates the DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder called Alcohol Use Disorder (AUD). AUD is characterised by a problematic pattern of alcohol use leading to clinically significant impairment or distress. The severity of AUD ranges from mild to moderate to severe and is based on the number of criteria met within a 12-month period.
The DSM-5 establishes 11 criteria that addiction counsellors and other professionals use to assess the extent of a patient's substance use disorder. These criteria fall under four basic categories: impaired control, physical dependence, social problems, and risky use. The severity of a substance use disorder can be determined by how many symptoms are present. For example, one symptom may indicate that an individual is at risk, while six or more symptoms indicate a severe substance use disorder and signal an addiction to that substance.
The 11 criteria include:
- Lack of control: The individual frequently consumes alcohol in larger quantities or for longer than intended.
- Unsuccessful attempts to quit: The individual wants to control their alcohol intake but has been unsuccessful in their attempts to do so.
- Significant time investment: A significant amount of the individual's time is spent pursuing, using, or recovering from alcohol use.
- Tolerance: The individual has developed a need for greater amounts of alcohol to reach their desired level of intoxication or has observed a reduced effect when using their usual amount.
- Continued use despite consequences: The individual continues to use alcohol despite having a persistent or recurrent physical or psychological problem likely caused or exacerbated by alcohol use.
The DSM-IV-TR criteria for substance abuse and dependence are also relevant to understanding addiction and substance dependence. Substance abuse is characterised by a maladaptive pattern of substance use leading to clinically significant impairment or distress, manifested by recurrent substance use resulting in failure to fulfil major role obligations, continued substance use in physically hazardous situations, and continued substance use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the substance. Substance dependence involves similar criteria but with a higher number of symptoms present.
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Treatment and recovery
Alcohol abuse, now referred to as Alcohol Use Disorder (AUD), is a diagnosable condition in the DSM-5. AUD is defined as "a problematic pattern of alcohol use leading to clinically significant impairment or distress".
AUD is a common medical condition that can happen to anyone. It is characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. Treatment and recovery from AUD are possible, and there are many options available to those seeking help.
The first step towards recovery is often to reach out to a healthcare provider, who can recommend treatments and resources to aid recovery. Evidence-based treatments are available, and change is possible, with most people with AUD recovering or markedly improving. A small proportion of patients with AUD will need a few days of "detox" to manage dangerous withdrawal symptoms before starting a long-term care plan. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing.
Mutual-support groups, such as Alcoholics Anonymous (AA), can provide valuable peer support for people quitting or cutting back on their drinking. Combined with treatment led by healthcare providers, these groups can offer an added layer of support. Support groups can help people make and sustain beneficial changes and promote recovery.
Behavioural treatments and medications can also help people develop skills to avoid and overcome triggers that might lead to drinking. It is important to note that setbacks are common among people overcoming alcohol problems, and a return to drinking can be seen as a temporary setback to full recovery rather than a failure.
To prevent alcohol use disorder, it is recommended that women consume no more than four drinks in one day or eight drinks per week, and men consume no more than five drinks in one day or 15 drinks per week.
For further support, individuals can contact SAMHSA's National Helpline, a free, confidential, 24/7 service providing treatment referrals and information for individuals and families facing mental and/or substance use disorders.
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Frequently asked questions
Alcohol abuse is now referred to as Alcohol Use Disorder (AUD) in the DSM-5. It is defined as "a problematic pattern of alcohol use leading to clinically significant impairment or distress".
Symptoms of AUD include continued drinking despite experiencing social and health problems, impaired control over alcohol intake, and the development of tolerance and withdrawal symptoms when stopping alcohol use.
The DSM-5 establishes 11 criteria for the diagnosis of AUD, which include lack of control, unsuccessful attempts to quit, and significant time investment in obtaining, using, or recovering from alcohol use.
