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Alcohol use disorder is a mental health condition listed in 2013 in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM 5) a prominent resource for diagnosing psychological/psychiatric problems in the US. It replaces two other conditions, called alcohol abuse and alcohol dependence, contained in the previous edition of the manual (DSM IV).
According to the results of a study published in 2013 in the journal Alcoholism: Clinical and Experimental Research, the guidelines for the newly created alcohol use disorder accurately identify the vast majority people with severe alcohol-related mental health issues. However, doctors will need to safeguard against the possibility of misdiagnosing people with relatively moderate alcohol-related issues.
The American Psychiatric Association (APA), which produces each edition of the Diagnostic and Statistical Manual, created alcohol use disorder as part of a wider reorganization of the chapter in the manual dedicated to defining substance-related mental health conditions. Before the publication of DSM 5, all substances listed as a potential source of psychological/psychiatric problems had two separate entries: one for non-addictive abuse of the substance in question and one for dependence on the substance in question. However, after reviewing research findings and information submitted by practicing mental health professionals, a committee of APA specialists concluded that there is no scientifically valid reason for strictly separating abuse-related mental health concerns from dependence-related mental health concerns. In line with this conclusion, the APA eliminated each substance’s separate listings for abuse and addiction and replaced them with a single “use disorder” listing that addresses both abuse and addiction at the same time.
According to the outdated guidelines listed in DSM IV, people with diagnosable alcohol abuse have at least one symptom that indicates the presence of a harmful pattern of alcohol consumption. Potential symptoms include a repeated failure to meet important personal or social commitments, repeated involvement with police and/or the legal system, repeated use of alcohol in dangerous situations, and a failure to quit drinking when the unwanted consequences of alcohol consumption become obvious. The affected individual must experience his or her symptom(s) within a single 365-day period; he or she must also fall short of the minimum requirements for making a diagnosis of alcohol dependence.
In order to meet the alcohol dependence (alcoholism) guidelines listed in DSM IV, a drinker must have at least three symptoms that indicate a physical/psychological reliance on alcohol’s presence in the body. Potential symptoms include developing a tolerance to alcohol’s effects that leads to an increase in consumption, experiencing withdrawal when alcohol intake drops or ceases, repeatedly failing to curb alcohol intake, drinking more or more often than planned, devoting excessive amounts of time to alcohol-related activities, experiencing significant social or personal problems as a result of drinking, and continuing to drink in the face of obvious physical and/or mental harm related to alcohol consumption. These symptoms must appear in the affected individual within a single 365-day period of time.
The new DSM 5 definition for alcohol use disorder closely follows the guidelines previously established for diagnosing both alcohol abuse and alcohol dependence. However, there are several important distinctions between the new and old definitions. First, a person with alcohol use disorder must have two or more of the symptoms once listed separately for alcohol abuse and alcohol dependence. This stipulation creates a diagnostic middle ground between alcohol abuse—which required at least one symptom for a diagnosis—and alcohol dependence, which required at least two symptoms. In addition, one of the alcohol-related symptoms contained in DSM IV—repeated involvement with police and/or the legal system—was dropped in DSM 5. Finally, the DSM 5 guidelines direct doctors to list the exact number of symptoms found in each patient, then use those numbers to make a diagnosis of mild, moderate or severe alcohol use disorder.
In the study published in Alcoholism: Clinical and Experimental Research, a team of researchers used an analysis of previous studies to determine how many people diagnosed with alcohol dependence under the old DSM IV guidelines would meet the definition for severe alcohol use disorder under the new DSM 5 guidelines. The researchers used the same methods to determine how many people diagnosed with alcohol abuse under the DSM IV guidelines would meet the DSM 5 definition for moderate alcohol use disorder. After reviewing their findings, the study’s authors concluded that fully 80 percent of people formerly diagnosed with alcohol dependence would meet the criteria for severe alcohol use disorder. However, less than 60 percent of people formerly diagnosed with alcohol abuse would meet the criteria for moderate alcohol use disorder. These findings strongly suggest that doctors will need to closely review borderline alcohol-related cases in order to avoid missing the presence of an alcohol use disorder in moderately affected individuals.