DSM-IV

In DSM-IV, this is a category called Alcohol Use Disorders

Disorders

  1. Alcohol Dependence
  2. Alcohol Abuse

DSM-5

Diagnostic Criteria

A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  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.
  5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which it is physically hazardous.
  9. 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.
  10. Tolerance, as defined by either of the following:
    • a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
    • b. A markedly diminished effect with continued use of the same amount of alcohol.
  11. 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.

Specify if:

  • In early remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use alcohol," may be met).
  • In sustained remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use alcohol," may be met).

Specify if:

  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted.

Note: If an alcohol intoxication, alcohol withdrawal, or another alcohol-induced mental disorder is also present, the comorbid alcohol use disorder is indicated in the alcohol-induced disorder. For example, if there is comorbid alcohol intoxication and alcohol use disorder, only the alcohol intoxication diagnosis is given, with the recording indicating whether the comorbid alcohol use disorder is mild, moderate, or severe (e.g., mild alcohol use disorder with alcohol intoxication; moderate or severe alcohol use disorder with alcohol intoxication).

Specify current severity:

  • Mild: Presence of 2-3 symptoms.
  • Moderate: Presence of 4-5 symptoms.
  • Severe: Presence of 6 or more symptoms.

Specifiers

"In a controlled environment" applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment). Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units.

Severity of the disorder is based on the number of diagnostic criteria endorsed. For a given individual, changes in severity of alcohol use disorder across time are also reflected by reductions in the frequency (e.g., days of use per month) and/or dose (e.g., number of standard drinks consumed per day) of alcohol used, as assessed by the individuals's self-report, report of knowledgeable others, clinician observations, and, when practical, biological testing (e.g., elevations in blood tests).

Differential Diagnosis

Nonpathological use of alcohol

The key element of alcohol use disorder is the use of heavy doses of alcohol with resulting repeated and significant distress or impaired functioning. While most drinkers sometimes consume enough alcohol to feel intoxicated, only a minority (less than 20%) ever develop alcohol use disorder. Therefore, drinking, even daily, in low doses and occasional intoxication do not by themselves make this diagnosis.

Sedative, hypnotic, or anxiolytic use disorder

The signs and symptoms of alcohol use disorder are similar to those seen in sedative, hypnotic, or anxiolytic use disorder. The two must be distinguished, however, because the course may be different, especially in relation to medical problems.

Conduct disorder in childhood and adult antisocial personality disorder

Alcohol use disorder, along with other substance use disorders, is seen in the majority of individuals with antisocial personality and preexisting conduct disorder. Because these diagnoses are associated with an early onset of alcohol use disorder as well as a worse prognosis, it is important to establish both conditions.

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