Alcohol Use Disorder

The Diagnostic and Statistical Manual (DSM) is published in order to have a standardized language in the mental health community. Any change to a classification or criterion of a diagnosis is fretted over and fought over for months and years. There is a diagnosis that will be changing which must be discussed.

In May of 2013 the fifth edition of the Diagnostic and Statistical Manual (DSM V) will be dispersed. This publication will essentially eliminate two diagnoses from its predecessor. The classifications of alcohol abuse and alcohol dependence will be replaced by the term, Alcohol Use Disorder.

Alcohol Use Disorder is derived from many of the same basic premises of the two terms it eliminates. The most important of these include: increasing tolerance to alcohol, withdrawal symptoms if alcohol is stopped, larger amount of time spent procuring alcohol, and daily activities are impaired by it. Below is the full diagnostic criteria.

Alcohol Use Disorder
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:
  1) Recurrent substance 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 substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
  2) Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
  3) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
  4) Tolerance, as defined by either of the following:
     a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect
     b) Markedly diminished effect with continued use of the same amount of the substance
  5) Withdrawal, as manifested by either of the following:
     a) The characteristic withdrawal syndrome for the substance
     b) The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
  6) The substance is often taken in larger amounts or over a longer period than was intended
  7) There is a persistent desire or unsuccessful efforts to cut down or control substance use
  8) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
  9) Important social, occupational, or recreational activities are given up or reduced because of substance use
  10) The substance 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.
  11) Craving or a strong desire or urge to use a specific substance.

The degree of severity is determined by the number of criteria that the patient meets:
Moderate if he/she meets 2 to 3 of the criteria.
Severe if he/she meets 4 or more of the criteria.

The diagnosis is further broken down in to whether or not the patient is physiologically dependent on the drug. Physiological dependence is determined to be evidence of tolerance or withdrawal (i.e., either Item 4 or 5 is present).

Thus, a diagnosis may look like:
Alcohol Use Disorder, Severe, With physiological dependence
or
Alcohol Use Disorder, Moderate, Without physiological dependence

The most interesting part for most that read my blog is that the DSM V will define the stages of recovery. I will have to elaborate on them in a different post, but I can list the categories here:

Early Full Remission
Early Partial Remission
Sustained Full Remission
Sustained Partial Remission
On Agonist Therapy
In a Controlled Environment

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6 comments
  1. nnkato said:

    I look forward to more information regarding the stages of recovery. Thanks for the informative post!

    • Thank you for the positive encouragement. It means a lot!

  2. Heidi said:

    Very interesting. Do you think this will help people face reality any differently than they do using the old terms?

    • Heidi, that’s a great question!
      The area that these changes would have the most impact for the patient would be the ‘degree of severity’ component. The old terms were very black and white, the person either did or didn’t have alcohol abuse/dependence. With the new diagnosis, patients will be determined to be either moderately or severely affected by alcohol based on how many criteria they meet. Thus, supposing the patient is told that he/she falls in to the severe range, he/she may be more likely to change.

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