Substance use disorders including alcohol use disorder are defined in the most recent edition of the Diagnostic and Statistical Manual (DSM-V) by the presence of several time-dependent subjective and behavioral criteria. Diagnostic criteria vary depending on the substance being used or abused. Alcohol abuse disorder is among the most significant of the diagnoses given the legality of alcohol and the prevalence of alcohol use in the general population.
According to the National Institutes of Health, the vast majority (upwards of 86%) of all people in the United States drink at least sometimes, with more than half drinking monthly (National Institute on Alcohol Abuse and Alcoholism, 2015). It is estimated that about seven percent of the adult population in the United States have an alcohol use disorder: more than 16 million people. Of those, only 1.3 million people receive formal treatment in a specialized facility (National Institute on Alcohol Abuse and Alcoholism, 2015). Alcohol use can be considered a serious and costly burden to society because of the high mortality rates associated with alcohol use including impaired driving.
The DSM-V has changed the operational definitions of alcohol use disorder to simplify the criteria for diagnosis and to help professionals provide more timely and effective interventions including counseling, cognitive-behavioral therapy, and pharmacological interventions. Among the most important updates to the DSM-V from previous editions include the amalgamation of alcohol abuse and alcohol dependence into the single designator, alcohol use disorder. Instead of classifying abuse and dependence separately, the DSM-V offers the potential to classify the alcohol abuse disorder as being mild, moderate, and severe based on the expression of specific criteria.
The criteria for alcohol use disorder include those related to subjective responses such as desire and craving, as well as more measurable indicators like behavior, to biological or physiological responses to withdrawal. Several of the criteria for diagnosing alcohol use disorder relate directly to the effects of alcohol on friendships and other social affairs, work, or physical safety. For example, a person might perform poorly or be absent from work directly due to alcohol use. Behavioral criteria also include time spent in alcohol-related activities and ingesting larger quantities of alcohol over a longer period of time than what was either desired or intended. Loss of friendships and other social problems may also be behavioral signs that the person has alcohol use disorder. One of the diagnostic criteria of alcohol use disorder is the cessation of participation in activities that once benefitted the individual or brought pleasure: such as sports or social events.
A cornerstone to the diagnosis is frequency of the behavioral patterns; alcohol use disorder is qualified by recurrence and persistence, and not by single isolated events or behaviors. Overall, there are eleven different criteria defining alcohol use disorder. According to the DSM-V, a person who expresses two or more of these criteria may be classified as having mild alcohol use disorder. A person expressing four or five symptoms would be classified with moderate alcohol use disorder, and persons exhibiting six or more symptoms would be classified as having severe alcohol use disorder.
As with other substance use disorders, alcohol use disorder is also qualified by the presence of tolerance, or increased resistance to the effect of the drug leading to increased intake in order to achieve desired effects. Another criteria of alcohol use disorder is interference in obligations or getting into legal trouble, although the latter is not an official feature of the DSM-V criteria. On the other hand, severe withdrawal symptoms may be present and are associated with alcohol use disorder at its most severe stages. Withdrawal can be characterized by nausea, sweating, tremors, and even hallucinations (American Psychological Association, 2015). Loss of appetite or loss of interest in food, uncharacteristically violent or aggressive behavior, neglect of personal hygiene, defensiveness when discussing the issue of alcoholism, and hiding alcohol are other behavioral markers that may indicate that alcohol abuse disorder is present (Burke, 2012).
Quantity of alcohol consumed is not part of the official criteria for diagnosis according to the DSM-V. However, substance abuse organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA, 2015) claims that moderate, binge, and heavy drinking can be classified according to the quantities of alcohol consumed. These quantities can be distinguished from the DSM-V diagnostic criteria for alcohol use disorder, and are simply guidelines that therapists may use when assessing or interviewing clients. SAMHA (2015) defines moderate drinking as one to two drinks per day; binge drinking as five or more drinks at the same occasion on at least...
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