Lena Savoie
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a vital diagnostic tool published by the American Psychiatric Association. The DSM-5, the fifth edition of the manual, was updated in 2013 and improved the approach to substance use disorders. It integrates the DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder called Alcohol Use Disorder (AUD) with mild, moderate, and severe sub-classifications. AUD is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, and is diagnosed based on the number of symptoms, out of a possible 11, experienced in the past 12 months.
| Characteristics | Values |
|---|---|
| Name of Disorder | Alcohol Use Disorder (AUD) |
| Previous Diagnosis | Alcohol abuse and alcohol dependence (DSM-IV) |
| Severity | Mild, Moderate, Severe |
| Time Period | Symptoms must occur within a 12-month period |
| Number of Symptoms | 11 possible symptoms |
| Risk Factors | Alcohol-related social problems, major role problems, using more or for longer than intended |
| Symptoms | Craving, compulsion, ignoring consequences, impairment in behavioral control, diminished recognition of problems, dysfunctional emotional response |
| Treatment | Evidence-based treatment, abstinence, detox, long-term care plan |
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What You'll Learn
Alcohol Use Disorder (AUD)
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 DSM-IV drew a distinction between abuse and dependence, with different diagnostic criteria for each. Anyone meeting one or more of the "abuse" criteria within a 12-month period would receive the "abuse" diagnosis, while anyone with three or more of the "dependence" criteria during the same period would receive a "dependence" diagnosis.
The DSM-5 modifies some of the DSM-IV criteria descriptions with updated language. The DSM-5 focuses less on withdrawal and more on the 11 criteria that characterise the severity of an individual's addiction. According to the DSM-5, a problematic pattern of alcohol use involves two or more of the following symptoms, occurring within a 12-month period:
- 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.
- There is a strong craving or urge to use alcohol.
- Recurrent alcohol use results 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 use.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
AUD can cause brain changes that make it difficult to stop drinking. However, with prolonged abstinence, at least some AUD-induced brain function changes may improve or even reverse as other neurocircuits compensate for those compromised by alcohol. AUD is a significant contributor to overall disease burden and is associated with adverse mental and physical health outcomes, including mental health disorders, illicit drug use, early-onset cardiovascular disease, cancers, liver disease, and cognitive impairments.
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AUD symptoms and severity
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a tool used by health professionals to assess and diagnose mental disorders, including substance addiction. 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 an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.
AUD symptoms can vary in severity, and the severity of AUD is determined by the number of symptoms present. The more symptoms a person has, the more urgent the need for change. The DSM-5 outlines 11 criteria or symptoms that characterise the severity of an individual's addiction. These include:
- Drinking more alcohol or for longer than originally intended
- Unsuccessfully trying to cut down or control alcohol use
- Spending a lot of time obtaining, using, or recovering from the effects of alcohol
- Craving alcohol, or having a strong desire or urge to use alcohol
- Drinking alcohol even when it interferes with responsibilities at home, work, or school
- Continuing to drink alcohol despite it causing problems in relationships or with family or friends
- Giving up or reducing important social, occupational, or recreational activities because of alcohol use
- Drinking in dangerous situations or continuing to drink despite health problems or feelings of depression or anxiety
- Needing to drink more to feel the effects of alcohol (developing a tolerance)
- Experiencing withdrawal symptoms when not drinking, such as trouble sleeping, shakiness, irritability, anxiety, or nausea
The severity of AUD can be classified as mild, moderate, or severe. Mild AUD is indicated by the presence of two to three symptoms, while moderate AUD is indicated by four to five symptoms. Six or more symptoms indicate severe AUD, also known as alcoholism or alcohol dependence. It is important to note that even moderate alcohol use can increase the risk of developing AUD.
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AUD treatment
Alcohol Use Disorder (AUD) is a problematic pattern of alcohol use leading to clinically significant impairment or distress. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a vital diagnostic tool that helps clinicians understand and address AUD. The DSM-5, published in 2013, integrates the DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder: AUD, with mild, moderate, and severe sub-classifications. This shift in focus from vague classifications to the severity of addiction has improved the DSM's approach to substance use disorders.
The Gateway Foundation, for example, is a recognized leader in evidence-based addiction treatment. They offer specific programs focusing on substance use disorders, trauma, depression, anxiety, and co-occurring issues.
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DSM-5 changes
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a diagnostic tool published by the American Psychiatric Association. The DSM-5, the fifth edition of the manual, was updated in 2013 with input from top experts in the mental health field.
DSM-5 integrates the two DSM-IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications. The severity of AUD is based on the number of criteria met out of a possible 11. According to DSM-5, a problematic pattern of alcohol use leading to clinically significant impairment or distress is diagnosed as AUD.
DSM-5 modifies some of the criteria descriptions with updated language. It also adds craving as a criterion for an AUD diagnosis, which was not included in DSM-IV. The manual focuses less on withdrawal and more on the 11 criteria that characterise the severity of an individual’s addiction. These criteria fall under four basic categories: impaired control, physical dependence, social problems, and risky use.
The substance use disorder criteria explained in the DSM-5 allow clinicians to determine how severe a substance use disorder has become depending on how many symptoms are present. For example, one symptom could indicate an individual is at risk, whereas six or more criteria indicate a severe substance use disorder, which signals an addiction to that substance.
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DSM-IV vs DSM-5
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication of the American Psychiatric Association that provides a standard criteria for the diagnosis of various mental disorders. The DSM-IV and DSM-5 are the fourth and fifth editions of the manual, respectively.
DSM-IV
The DSM-IV, published in 1994, described two distinct disorders: alcohol abuse and alcohol dependence, with specific criteria for each. Under the DSM-IV, anyone meeting one or more of the "abuse" criteria within a 12-month period would receive an "abuse" diagnosis. Anyone with three or more of the "dependence" criteria during the same 12-month period would receive a "dependence" diagnosis.
DSM-5
The DSM-5, published in 2013, integrates the two DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder called Alcohol Use Disorder (AUD). The DSM-5 outlines specific patterns and behaviours that indicate when someone's drinking may be more than just occasional. AUD is classified based on severity—mild, moderate, or severe—depending on how many of the DSM-5 criteria are met. The DSM-5 also adds craving as a criterion for an AUD diagnosis, which was not included in the DSM-IV.
The criteria for AUD in the DSM-5 were intended to result in a similar prevalence of AUD as in the DSM-IV. However, the DSM-5 requires two or more symptoms to be present for a diagnosis of substance use disorder, whereas the DSM-IV only required one symptom.
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Frequently asked questions
Alcohol addiction is diagnosed as Alcohol Use Disorder (AUD) in the DSM-5.
AUD is defined as "a problematic pattern of alcohol use leading to clinically significant impairment or distress". Symptoms include drinking larger amounts or for longer periods than intended, persistent desire or unsuccessful attempts to cut down on alcohol use, and giving up important activities in favour of alcohol use.
AUD is classified as mild, moderate, or severe based on the number of symptoms, out of a possible 11, experienced in the past 12 months. One symptom indicates a person is at risk, two or three symptoms indicate a mild disorder, four or five symptoms indicate a moderate disorder, and six or more symptoms indicate a severe disorder.
The DSM-IV described two distinct disorders: alcohol abuse and alcohol dependence. The DSM-5 integrates these into a single disorder, AUD, with mild, moderate, and severe sub-classifications.
