Vivian Marlowe
Alcohol abuse, also known as alcohol use disorder (AUD), is a problematic pattern of alcohol use leading to clinically significant impairment or distress. According to a 2023 national survey, about 1 in 7 men, 1 in 11 women, and 1 in 33 adolescents meet the diagnostic criteria for AUD. The severity of AUD can range from mild to moderate to severe, depending on the number of symptoms presented within the past 12 months. The criteria for diagnosing AUD include drinking larger amounts of alcohol than intended, unsuccessful efforts to cut down on alcohol use, spending a significant amount of time obtaining, using, or recovering from alcohol, and experiencing cravings or a strong urge to consume alcohol.
| Characteristics | Values |
|---|---|
| Medical Condition | Alcohol Use Disorder (AUD) |
| Previous Terminology | Alcohol abuse, alcohol dependence, alcohol addiction, alcoholism |
| Severity | Mild (2-3 criteria), Moderate (4-5 criteria), Severe (6 or more criteria) |
| Diagnosis | DSM-IV-TR, DSM-5 |
| Assessment | Alcohol Symptom Checklist |
| Risk Factors | Genetics, family history, mental health conditions, trauma |
| Treatment | Behavioral therapies, mutual-support groups, medications |
| Criteria | Tolerance, withdrawal, increased consumption, persistent desire, time spent on alcohol-related activities, craving, failure to fulfill obligations, continued use despite problems |
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What You'll Learn
Alcohol Use Disorder (AUD)
AUD is considered a brain disorder and can range from mild to moderate to severe. Lasting changes in the brain caused by alcohol misuse perpetuate AUD and make individuals vulnerable to relapse. However, no matter the severity, evidence-based treatment with behavioural therapies, mutual-support groups, and/or medications can help people with AUD achieve and maintain recovery.
The risk of developing AUD is influenced by a complex interplay of genetic and environmental factors. Genetics play a significant role, with hereditability accounting for approximately 60%. Additionally, parents' drinking patterns can influence their children's likelihood of developing AUD. Mental health conditions and a history of trauma also increase the risk of AUD. Various psychiatric disorders, including depression, post-traumatic stress disorder, and attention deficit hyperactivity disorder, are associated with an increased risk of AUD. Furthermore, individuals with a history of childhood trauma are also vulnerable to developing AUD.
Healthcare professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to assess and diagnose AUD. The DSM-5 integrates the previous distinct disorders of alcohol abuse and alcohol dependence from the DSM-IV into a single disorder, AUD, with mild, moderate, and severe sub-classifications. The severity of AUD is determined by the number of criteria met, with mild corresponding to two to three criteria, moderate to four to five criteria, and severe to six or more criteria.
Some of the criteria for diagnosing AUD include:
- Alcohol is consumed in larger amounts or over a longer period than intended.
- There is a persistent desire or unsuccessful attempts to cut down or control alcohol use.
- A great deal of time is spent obtaining, using, or recovering from the effects of alcohol.
- Recurrent alcohol use results in a failure to fulfil major obligations at work, school, or home.
- Alcohol use continues despite causing or exacerbating social or interpersonal problems.
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Severity of AUD
Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can be mild, moderate, or severe, with severity based on the number of criteria met out of 11. The 11 criteria for diagnosing AUD are:
- Alcohol is often consumed 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 obtaining, using, or recovering from the effects of alcohol.
- 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.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
- Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving, swimming, using machinery, etc.).
- Continued alcohol use 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 a desired effect, or a markedly diminished effect with continued use of the same amount of alcohol.
- Characteristic withdrawal symptoms (e.g., nausea, sweating, restlessness, etc.) when alcohol use is stopped or reduced.
- Alcohol (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
A mild diagnosis of AUD is given when 2-3 of these criteria are met, a moderate diagnosis when 4-5 are met, and a severe diagnosis when 6 or more are met.
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Drinking levels
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as: for women, 4 or more drinks on any day or 8 or more per week; and for men, 5 or more drinks on any day or 15 or more per week.
The severity of AUD is determined by the number of diagnostic criteria met. These criteria include:
- Tolerance: a need for increased amounts of alcohol to achieve intoxication or a diminished effect with continued use of the same amount.
- Withdrawal symptoms when reducing or stopping alcohol intake.
- Persistent desire or unsuccessful attempts to cut down or control alcohol use.
- Spending a lot of time obtaining, using or recovering from alcohol.
- Craving, or a strong urge to use alcohol.
- Continued alcohol use despite social or interpersonal problems caused or exacerbated by drinking.
- Recurrent alcohol use resulting in failure to fulfil obligations at work, school or home.
- Drinking despite alcohol causing or worsening health problems.
- Giving up or reducing other activities in order to drink.
- Drinking leading to increased chances of harm, such as drinking and driving.
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Risk factors
Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD risk is influenced by a complex interplay of genetic, environmental, and behavioural factors. Here are some key risk factors for AUD:
Genetics and Family History
Genetics play a significant role in AUD risk, with hereditability accounting for approximately 60%. Individuals with a family history of alcohol problems or parents who exhibit harmful drinking patterns are more likely to develop AUD.
Mental Health Conditions and Trauma
A range of psychiatric conditions, including depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD), are associated with an increased risk of AUD. People with a history of childhood trauma are also more vulnerable to developing AUD.
Drinking Patterns and Behaviour
The amount, frequency, and speed of alcohol consumption influence AUD risk. Drinking larger amounts than intended, experiencing a strong urge to drink, and spending a significant amount of time obtaining, consuming, or recovering from alcohol are all warning signs. Continued alcohol use despite social or interpersonal problems caused or exacerbated by drinking is also a risk factor.
Tolerance and Withdrawal
Developing tolerance, characterised by the need for increased amounts of alcohol to achieve the desired effect, and experiencing withdrawal symptoms when reducing or stopping alcohol consumption, are both indicators of AUD risk.
Gender and Age
According to a 2023 national survey, about 1 in 7 men, 1 in 11 women, and 1 in 33 adolescents (aged 12-17) meet the diagnostic criteria for AUD. These statistics highlight gender and age as potential risk factors, with men and adolescents being more susceptible.
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Diagnosis and treatment
Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD encompasses the conditions previously referred to as alcohol abuse, alcohol dependence, alcohol addiction, and alcoholism. To diagnose AUD, healthcare professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-5, published in 2013, integrates the two previous disorders of alcohol abuse and alcohol dependence into a single disorder, AUD, with mild, moderate, and severe sub-classifications. The severity of AUD is based on the number of criteria met, with mild corresponding to two to three criteria, moderate to four to five, and severe to six or more.
The 11 criteria for diagnosing 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 obtaining, using, or recovering from the effects of alcohol.
- A strong craving or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfil major obligations at work, school, or home.
- Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol.
- Tolerance, defined as a need for markedly increased amounts of alcohol to achieve intoxication or a diminished effect with continued use of the same amount.
- Withdrawal, manifested by the characteristic withdrawal syndrome for alcohol or alcohol taken to relieve or avoid withdrawal symptoms.
- Drinking is often accompanied by the failure to fulfil major role obligations or recurrent social or interpersonal problems.
- Continued alcohol use despite awareness of having a persistent or recurrent physical or psychological issue that is likely to have been caused or exacerbated by alcohol.
- Alcohol use has persisted despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
AUD is considered a brain disorder, and individuals with AUD are vulnerable to relapse due to lasting changes in the brain caused by alcohol misuse. However, no matter the severity, evidence-based treatment with behavioural therapies, mutual-support groups, and/or medications can help individuals with AUD achieve and maintain recovery. Healthcare professionals can use an Alcohol Symptom Checklist based on the DSM criteria to diagnose AUD and determine its severity. Integrating such a checklist into primary care can facilitate comfortable, patient-centred, non-judgmental conversations about alcohol that help destigmatise AUD and its treatment.
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Frequently asked questions
Alcohol abuse, now referred to as Alcohol Use Disorder (AUD), is a problematic pattern of alcohol use leading to clinically significant impairment or distress.
According to the DSM-5, there are 11 criteria for diagnosing AUD, including tolerance, withdrawal, drinking larger amounts or longer than intended, persistent desire or unsuccessful attempts to cut down, and craving. A mild diagnosis requires 2-3 criteria to be met, moderate is 4-5, and severe is 6 or more.
Healthcare professionals can use an Alcohol Symptom Checklist based on the DSM-5 criteria to diagnose AUD and determine its severity in patients who screen positive for heavy drinking.
Evidence-based treatments can help individuals with AUD achieve abstinence and facilitate brain changes. It is important to note that using the diagnostic term "alcohol use disorder" instead of "alcohol abuse" may help reduce stigma.
