Theo Nash
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, published in 1994, described two distinct disorders: alcohol abuse and alcohol dependence, with specific criteria for each. However, the DSM-5, published in 2013, integrates these two disorders into a single disorder called Alcohol Use Disorder (AUD). This new classification system simplifies the diagnosis of alcohol-related issues, with mild, moderate, and severe sub-classifications. While the DSM-5 has removed legal problems as a criterion, it has added craving as a new criterion for an AUD diagnosis. So, while there is no specific code for nonproblematic alcohol usage, the absence of any AUD criteria would indicate nonproblematic usage.
| Characteristics | Values |
|---|---|
| DSM Version | DSM-IV, DSM-5 |
| Alcohol Usage Disorder | AUD |
| Alcohol Usage Disorder Severity | Mild, Moderate, Severe |
| Criteria | Abuse, Dependence |
| Abuse Criteria | 4 |
| Dependence Criteria | 7 |
| Craving | Mid-range of severity |
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What You'll Learn
- Alcohol Use Disorder (AUD) is a single disorder in DSM-5 with mild, moderate, and severe classifications
- DSM-IV described two distinct disorders: alcohol abuse and alcohol dependence
- DSM-IV criteria for substance dependence: a maladaptive pattern of substance use leading to significant impairment or distress
- DSM-5 criteria for substance use disorder: a problematic pattern of use leading to clinically significant impairment or distress
- History: The Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed to collect statistical information about mental disorders in the US
Alcohol Use Disorder (AUD) is a single disorder in DSM-5 with mild, moderate, and severe classifications
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed to collect statistical information about mental disorders in the United States. The DSM-5, issued in May 2013 by the American Psychiatric Association, 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".
AUD is classified as mild, moderate, or severe based on the number of symptoms experienced in the previous 12 months. A mild diagnosis requires 2 to 3 symptoms, a moderate diagnosis requires 4 to 5, and a severe diagnosis requires 6 or more. The symptoms include withdrawal, tolerance, increasing quantity or frequency of use, persistent desire or unsuccessful attempts to decrease or control use, and craving, among others.
The DSM-5 criteria for AUD have been well validated, but there is a lack of information on the extent of alcohol use, comorbidity, and impairment of the three severity levels. Studies have examined the association between diagnostic validators and DSM-5 AUD severity classifications, finding that validators of alcohol use severity, such as craving, problematic and harmful use, and binge drinking frequency, were associated with all classifications of AUD compared to no AUD. However, a different pattern emerged for impaired physical, mental, and social functioning, which were only associated with severe AUD.
The DSM-IV, the previous edition of the manual, had distinct criteria for alcohol abuse and dependence. Anyone meeting one or more of the "abuse" criteria within a 12-month period would receive an "abuse" diagnosis, while anyone with three or more of the "dependence" criteria during the same period would receive a "dependence" diagnosis. The DSM-5 eliminates legal problems as a criterion and adds craving as a new criterion for an AUD diagnosis.
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DSM-IV described two distinct disorders: alcohol abuse and alcohol dependence
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first introduced in 1952 by the American Psychiatric Association Committee on Nomenclature and Statistics. The DSM has since been revised and updated several times, with the fourth edition (DSM-IV) published in 1994 and its text revision (DSM-IV-TR) in 2000.
- 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.
- Recurrent alcohol-related legal problems.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
For a diagnosis of alcohol dependence, an individual had to meet three or more of the dependence criteria during the same 12-month period. These criteria included:
- Tolerance, as defined by either of the following:
- A. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
- B. Markedly diminished effect with continued use of the same amount of alcohol.
- Withdrawal, as manifested by either of the following:
- A. The characteristic withdrawal syndrome for alcohol.
- B. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
- Alcohol is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts 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.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- 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.
In 2013, the American Psychiatric Association issued the fifth edition of the DSM (DSM-5), which integrated the two disorders described in DSM-IV into a single disorder called Alcohol Use Disorder (AUD). Under DSM-5, anyone meeting any two of the 11 criteria during the same 12-month period would receive a diagnosis of AUD, with the severity (mild, moderate, or severe) based on the number of criteria met.
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DSM-IV criteria for substance dependence: a maladaptive pattern of substance use leading to significant impairment or distress
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders with specific diagnostic criteria, which was first published in 1952. DSM-IV, the fourth edition, was published in 1994 and describes two distinct disorders: alcohol abuse and alcohol dependence. The latter is characterised by a maladaptive pattern of substance use leading to significant impairment or distress.
DSM-IV-TR, a text revision of the fourth edition, outlines the following criteria for substance dependence:
> A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three or more of the following [criteria] in any 12-month period of time:
The first criterion is tolerance, which is defined as either a marked increase in the amount of the substance used or a diminished effect when the same amount of the substance is used. The second criterion is withdrawal, which is when the individual experiences the characteristic withdrawal syndrome associated with the substance or when the substance is taken to relieve or avoid withdrawal symptoms. The third criterion is related to the quantity and duration of substance use, with a large amount of the substance being consumed or the substance being used over a longer period than intended. The fourth criterion is about an individual's desire to cut down on their substance use, including unsuccessful attempts to do so. The fifth criterion is about the amount of time spent on activities related to substance use, including obtaining, using, and recovering from its effects. The sixth criterion is about recurrent substance use, resulting in a failure to fulfil major obligations at work, school, or home. The seventh criterion is about continued substance use despite social or interpersonal problems caused or exacerbated by the effects of the substance.
It is important to note that the latest edition of the DSM, DSM-5, integrates the two disorders of alcohol abuse and alcohol dependence into a single disorder called Alcohol Use Disorder (AUD) with mild, moderate, and severe sub-classifications.
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DSM-5 criteria for substance use disorder: a problematic pattern of use leading to clinically significant impairment or distress
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first published in 1952 by the American Psychiatric Association Committee on Nomenclature and Statistics. The DSM-5, published in 2013, integrates the DSM-IV disorders of alcohol abuse and alcohol dependence into a single disorder called Alcohol Use Disorder (AUD).
The DSM-5-TR criteria for substance use disorders are based on decades of research and clinical knowledge. The 11 criteria outlined can be grouped into four primary categories: physical dependence, risky use, social problems, and impaired control. To be diagnosed, symptoms must cause distress and impairment in a person's daily life.
The severity of AUD—mild, moderate, or severe—is based on the number of criteria met. A mild substance use disorder is indicated by two or three symptoms, a moderate disorder by four or five, and a severe disorder by six or more. Clinicians can also specify if the individual is in early or sustained remission, on maintenance therapy, or in a controlled environment.
The 11 criteria for substance use disorders include:
- Taking the substance in larger amounts or for longer than intended
- Wanting to cut down or stop using the substance but not managing to
- Spending a great deal of time obtaining, using, or recovering from the use of the substance
- Craving, or having a strong desire or urge to use the substance
- Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
- Continued substance use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance use
- Giving up or reducing important social, occupational, or recreational activities because of substance use
- Taking the substance in physically hazardous situations
- Continuing to use the substance despite knowing that it causes or exacerbates a physical or psychological problem
- Tolerance, or a need for increased amounts of the substance to achieve the desired effect
- Withdrawal symptoms when substance use is stopped or reduced
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History: The Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed to collect statistical information about mental disorders in the US
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. The DSM was initially developed to collect statistical information about mental disorders in the United States. The first official attempt to collect information on mental health was in the 1840 census, which used a single category: "idiocy/insanity".
In 1917, the Bureau of the Census began collecting uniform statistics from mental hospitals across the country. Together with the National Commission on Mental Hygiene (now Mental Health America), the American Medico-Psychological Association (which became the APA in 1921) developed a new guide for mental hospitals called the Statistical Manual for the Use of Institutions for the Insane. This guide, which included 22 diagnoses, was revised several times by the Association. By the tenth edition in 1942, it was titled the Statistical Manual for the Use of Hospitals of Mental Diseases.
In 1933, the American Medical Association (AMA) released a general medical guide called the Standard Classified Nomenclature of Disease, referred to as "the Standard". The APA Committee on Nomenclature and Statistics was then tasked with developing a version of the guide specifically for use in the United States, to standardize the diverse and confused usage of different documents. After a review and consultation process, the first edition of the DSM (DSM-I) was approved in 1951 and published in 1952.
DSM-I included a glossary describing diagnostic categories and included an emphasis on how to use the manual for making clinical diagnoses. The subsequent editions, DSM-II (published in 1968) and DSM-III (published in 1980), introduced several innovations, including explicit diagnostic criteria for the various disorders. A 1987 revision to DSM-III, called DSM-III-R, clarified some of these criteria and addressed inconsistencies in the diagnostic system. The latest edition, DSM-5-TR, was published in March 2022.
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Frequently asked questions
There is no specific DSM code for nonproblematic alcohol usage. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders, and alcohol usage would only be included if it were causing problems, in which case it would be classed as Alcohol Use Disorder (AUD).
AUD is a diagnosis given to someone who meets two or more of the eleven DSM-5 criteria during a 12-month period. The severity of AUD—mild, moderate, or severe—is based on the number of criteria met.
The criteria for an AUD diagnosis include craving, which was not included in the previous edition, DSM-IV. The DSM-5 also modified some of the criteria descriptions with updated language and removed legal problems as a criterion.
The DSM was first published in 1952 by the American Psychiatric Association Committee on Nomenclature and Statistics. The first edition included a glossary of diagnostic categories and guidance on how to use the manual for clinical diagnoses. The DSM has since been updated several times, with the fifth edition being published in 2013.
