What an Alcohol Use Disorder Diagnosis Means

Medical definitions of the spectrum of alcohol abuse and alcoholism

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There really is no official diagnosis of alcoholism. The human condition that has long been termed alcoholism is called "severe alcohol use disorder," as of the May 2013 publication of the 5th edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM–5) by the American Psychiatric Association. With the DSM-5, if a person exhibits two or more symptoms from a list of 11 criteria, they are diagnosed as having an alcohol use disorder, with classifications of mild, moderate, and severe.

The DSM-IV (published in 1994) likewise had no "alcoholism" diagnosis but instead described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each diagnosis. The DSM-5 combines those two disorders into one alcohol use disorder with sub-classifications of severity.

Mild, Moderate and Severe Alcohol Use Disorder

The severity of the alcohol use disorder is defined as:

  • Mild: The presence of two to three symptoms
  • Moderate: The presence of four to five symptoms
  • Severe: The presence of six or more symptoms

Although there is a lot of overlap between the criteria (list of symptoms) used by the DSM-IV and the DSM-5, there are two significant changes. The DSM-5 eliminates having legal problems as a result of drinking as a criterion for diagnosis but adds craving for alcohol as a criterion.

11 Symptoms Listed in DSM-5

The following are the 11 symptoms published in the DSM-5 which are used to determine if someone has an alcohol use disorder:

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  1. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  2. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  3. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  4. Recurrent alcohol use in situations in which it is physically hazardous.
  5. 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.
  6. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.
  7. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

DSM-5 Draws Some Criticism

The criteria of diagnosing alcohol use disorder came under some criticism because, under the DSM-5, any college student who occasionally engaged in binge drinking and admitting to craving a cold beer once in awhile could be diagnosed with the disorder and labeled an alcoholic.

Likewise, if tolerance and withdrawal symptoms are the only two necessary factors required for someone to be diagnosed, then "anyone drinking a couple of glasses of wine with dinner each evening will have measurable and noticeable tolerance and withdrawal. It won’t be present to the extent of causing significant dysfunction, but it will be quite evident on exam," according to Dr. Gitlow, president of the American Society of Addiction Medicine. "That person now has a mild alcohol use disorder."

Sources:

Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders.

Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5 NIH Publication No. 13–7999. National Institute on Alcohol Abuse and Alcoholism.  November 2013. https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf.

Gitlow S. Commentary: DSM-5: New Addiction Terminology, Same Disease. Partnership for Drug-Free Kids. June 2013. https://drugfree.org/learn/drug-and-alcohol-news/commentary-dsm-5-new-addiction-terminology-same-disease/.