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Diagnostic and statistical manuals of mental disorders (DSM) classification of alcohol use disorder

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diagnostic and statistical manuals of mental disorders (DSM) classification of alcohol use disorder

DSM-IV described two distinct disorders under AUD

  • alcohol abuse - anyone meeting one or more of the following "abuse" criteria
    • recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household
    • recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol abuse).
    • recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct). (not included in DSM V)
    • continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about the consequences of intoxication, physical fights)
  • alcohol dependence - anyone with three or more of the following "dependence" criteria
    • tolerance, as defined by either of the following:
      • a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
      • markedly diminished effect with continued use of the same amount of alcohol
    • withdrawal, as manifested by either of the following:
      • the characteristic withdrawal syndrome for alcohol
      • alcohol is taken to relieve or avoid withdrawal symptoms
    • alcohol is often taken in larger amounts or over a longer period than was intended
    • there is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
    • a great deal of time is spent in activities necessary to obtain alcohol (e.g., driving long distances), use alcohol, or recover from its effects
    • important social, occupational, or recreational activities are given up or reduced because of alcohol use.
    • 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 the substance (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

DSM-5 integrates the two DSM-IV disorders, alcohol abuse and alcohol dependence, under alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.

  • anyone meeting any two of the following 11 criteria during the same 12-month period would receive a diagnosis of AUD.
    • alcohol is often taken in larger amounts or over a longer period than was intended
    • there is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
    • a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
    • craving, or a strong desire or urge to use alcohol (new to DSM 5)
    • recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
    • continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
    • important social, occupational, or recreational activities are given up or reduced because of alcohol use.
    • 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.
    • tolerance, as defined by either of the following:
      • a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
      • a markedly diminished effect with continued use of the same amount of alcohol
    • withdrawal, as manifested by either of the following:
      • the characteristic withdrawal syndrome for alcohol
      • alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
  • the severity of AUD is defined as:
    • mild - presence of 2 to 3 symptoms
    • moderate - presence of 4 to 5 symptoms
    • severe ­ - presence of 6 or more symptoms (1)

Reference:

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