Alcohol Use Disorder DSM-5 Criteria

What is alcohol use disorder (AUD)?

Alcohol use disorder (AUD) is one of the substance use disorders characterized by a harmful drinking pattern that leads to clinically significant impairment (American Psychiatric Association, 2013). This is associated with lifelong adverse physical and mental health outcomes, such as illicit drug use, mental health disorders, cognitive impairments and early onset cancers, liver disease, and cardiovascular disease (Slade et al., 2024).  

AUD is commonly confused with alcoholism, alcohol abuse, alcohol dependence, and alcohol addiction (National Institute on Alcohol Abuse and Alcoholism, 2024); in recent years, there has been increased support to classify it as AUD, as it is a less stigmatizing term that captures it as being a disease rather than a personal choice.

Three stages can be used as a model for translating brain changes associated with AUD to the clinical domain (Kwako et al., 2016; Koob et al., 2020).:

1. Binge drinking/intoxication: Involves the development of incentive salience neurocircuits that are linked with the rewarding and pleasurable experience of drinking. These cues develop and strengthen habitual drinking.
2. Withdrawal/negative affect: This is associated with states such as dysphoria, irritability, and anxiety. The person feels that alcohol is needed for relief from emotional pain and discomfort.
3. Preoccupation/anticipation: This is associated with executive function deficits in the individual.

Alcohol use disorder symptoms

There are a number of symptoms that are associated with AUD. These include but are not limited to (American Psychiatric Association, n.d.):

• Increased alcohol consumption or consuming alcohol over a longer period of time than originally intended.
• Recurrent alcohol use, despite trying to cut down or control alcohol use.
• Craving, or a strong desire or urge to obtain alcohol.
• Drinking that interferes with responsibilities at home, work, or school.

It is important to note that just because the patient has some of these symptoms does not necessarily mean that they have AUD. If patients present two or more of these symptoms within the last year, it is important to clinically diagnose them using the DSM-5 criteria to reach an accurate diagnosis. This is to prevent further harm and determine the necessary treatment methods to support the patient with recovery.

Alcohol Use Disorder DSM-5 Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is developed by the American Psychiatric Association to aid mental health professionals in diagnosing mental health and brain-related conditions.

According to the DSM-5, diagnosis is based on at least 2 of 11 symptoms within a 12-month. These symptoms are as follows:

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, defined by either of the following
11. a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
12. b. A markedly diminished effect with continued use of the same amount of alcohol.
13. Withdrawal, defined by either of the following
14. a. The characteristic withdrawal syndrome for alcohol
15. b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

For the full DSM-5 criteria for alcohol use disorder, please access our template by clicking the "Use template" button.

How is alcohol use disorder treated and managed?

The treatment of AUD is personalized for each individual. There are two evidence-based options for AUD: behavioral healthcare and medication. These can be combined and tailored to the individual, with both approaches demonstrating similar effectiveness (Witkiewitz et al., 2019).

Behavioral healthcare for AUD includes cognitive behavioral therapy, motivational enhancement therapy, contingency management, and mindfulness-based therapy, as well as couples or family therapy (National Institute on Alcohol Abuse and Alcoholism, 2024).

Addiction medication for AUD is another treatment option. Acamprosate, naltrexone, and disulfiram are FDA-approved medications that are non-addictive and easy to prescribe.

Many AUD patients also benefit from active participation in mutual support groups, such as Alcoholics Anonymous (AA), which can be used alongside professionally offered treatment or on its own (Witkiewitz et al., 2019). These groups vary significantly in beliefs and demographics, so it is important for patients to explore multiple options to find one that resonates with them (National Institute on Alcohol Abuse and Alcoholism, 2024).

Alcohol withdrawal, which occurs when someone who chronically engages in heavy drinking suddenly stops, can be life-threatening (National Institute on Alcohol Abuse and Alcoholism, 2024).

Some AUD patients experience withdrawal symptoms when they stop drinking, with a small percentage requiring continued medical monitoring and care, often referred to as detox, to manage potentially dangerous symptoms (Mirijello et al., 2015).

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 5th edition. American Psychiatric Publishing; 2013.

American Psychiatric Association. (n.d.). Alcohol use disorder. https://www.psychiatry.org/patients-families/alcohol-use-disorder

Koob, G. F., Powell, P., & White, A. (2020). Addiction as a coping response: hyperkatifeia, deaths of despair, and COVID-19. American Journal of Psychiatry, 177(11), 1031-1037.

Kwako, L. E., Momenan, R., Litten, R. Z., Koob, G. F., & Goldman, D. (2016). Addictions neuroclinical assessment: a neuroscience-based framework for addictive disorders. Biological psychiatry, 80(3), 179-189.

Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M., Caputo, F., ... & Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75, 353-365.

National Institute on Alcohol Abuse and Alcoholism. (2024, February 27). Alcohol use disorder: From risk to diagnosis to recovery | National Institute on alcohol abuse and alcoholism (NIAAA). https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-use-disorder-risk-diagnosis-recovery#pub-toc0

Slade, T., O'Dean, S. M., Chung, T., Mewton, L., McCambridge, J., Clare, P., ... & Kypri, K. (2024). The key role of specific DSM‐5 diagnostic criteria in the early development of alcohol use disorder: Findings from the RADAR prospective cohort study. Alcohol: Clinical and Experimental Research, 48(7), 1395-1404.

Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), eaax4043.