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Dsm 5 alcohol use disorder diagnostic criteria


Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5

In May 2013, the American Psychiatric Association issued the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Although there is considerable overlap between DSM–5 and DSM–IV, the prior edition, there are several important differences:

Changes Disorder Terminology

  • DSM–IV described two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each.
  • DSM–5 integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.

Changes Diagnostic Thresholds

  • Under DSM–IV, the diagnostic criteria for abuse and dependence were distinct: anyone meeting one or more of the “abuse” criteria (see items 1 through 4 below) within a 12-month period would receive the “abuse” diagnosis. Anyone with three or more of the “dependence” criteria (see items 5 through 11 below) during the same 12-month period would receive a “dependence” diagnosis.
  • Under DSM–5, anyone meeting any 2 of the 11 criteria during the same 12-month period would receive a diagnosis of AUD. The severity of AUD—mild, moderate, or severe—is based on the number of criteria met.

Removes Criterion

  • DSM–5 eliminates legal problems as a criterion.

Adds Criterion

  • DSM–5 adds craving as a criterion for an AUD diagnosis. It was not included in DSM–IV.

Revises Some Descriptions

  • DSM–5 modifies some of the criteria descriptions with updated language.

DSM History and Background

The Diagnostic and Statistical Manual of Mental Disorders (DSM) initially developed out of a need to collect statistical information about mental disorders in the United States. The first attempt to collect information on mental health began in the 1840 census. By the 1880 census, the Bureau of the Census had developed seven categories of mental illness. In 1917, the Bureau of the Census began collecting uniform statistics from mental hospitals across the country.

Not long afterward, the American Psychiatric Association and the New York Academy of Medicine collaborated to produce a “nationally acceptable psychiatric nomenclature” for diagnosing patients with severe psychiatric and neurological disorders. After World War I, the Army and Veterans Administration broadened the nomenclature to include disorders affecting veterans.

In 1952, the American Psychiatric Association Committee on Nomenclature and Statistics published the first edition of the Diagnostic and Statistical Manual: Mental Disorders (DSM–I). The DSM–I included a glossary describing diagnostic categories and included an emphasis on how to use the manual for making clinical diagnoses. The DSM–II, which was very similar to the DSM–I, was published in 1968. The DSM–III, published in 1980, introduced several innovations, including explicit diagnostic criteria for the various disorders, that are now a recognizable feature of the DSM. A 1987 revision to the DSM–III, called the DSM–III–R, clarified some of these criteria and also addressed inconsistencies in the diagnostic system. A comprehensive review of the scientific literature strengthened the empirical basis of the next edition, the DSM–IV, which was published in 1994. The DSM–IV–TR, a revision published in 2000, provided additional information on diagnosis. Since 1952, each subsequent edition of the DSM aimed to improve clinicians’ ability to understand and diagnose a wide range of conditions.

A Comparison Between DSM–IV and DSM–5

For screen readers, use this accessible text version.

DSM–IV
In the past year, have you:
Any 1 = ALCOHOL ABUSE

Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
**This is not included in DSM–5**

Continued to drink even though it was causing trouble with your family or friends?
Any 3 = ALCOHOL DEPENDENCE

Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

Had times when you ended up drinking more, or longer, than you intended?

More than once wanted to cut down or stop drinking, or tried to, but couldn’t?

Spent a lot of time drinking? Or being sick or getting over other aftereffects?

Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

 

DSM–5
In the past year, have you:

The presence of at least 2 of these symptoms indicates Alcohol Use Disorder (AUD).
The severity of the AUD is defined as:

Mild: The presence of 2 to 3 symptoms


Moderate: The presence of 4 to 5 symptoms


Severe: The presence of 6 or more symptoms

Had times when you ended up drinking more, or longer, than you intended?

More than once wanted to cut down or stop drinking, or tried to, but couldn’t?

Spent a lot of time drinking? Or being sick or getting over other aftereffects?

Wanted a drink so badly you couldn’t think of anything else?
**This is new to DSM–5**

Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

Continued to drink even though it was causing trouble with your family or friends?

Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

 

All permissions requests regarding the DSM should be directed to the American Psychiatric Association.

Understanding The DSM-5 Criteria For Alcohol Use Disorder (AUD)

  • The DSM-5
  • DSM-5 AUD Criteria
  • DSM History & Background

Given the widespread prevalence of problem drinking, heavy drinking, and binge drinking among young adults and the general public, healthcare providers must rely on a standardized manual for defining alcohol use disorder (AUD). 

AUD is a term that encompasses both alcohol abuse and alcohol dependence. It has also colloquially been known as alcoholism.

Today, the manual most commonly used to diagnose alcohol use disorder is the DSM-5.

The Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition

The first step to dealing with any problem in a structured way is to define the problem as clearly as possible.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines the problem by creating a taxonomy, or classification system, for mental health disorders. Conditions range from anxiety disorders and schizophrenia to substance use disorders and many more.

With the DSM-5, psychiatry and addiction medicine professionals across the United States can use the same terms, assign the proper ICD-10 medical codes, and administer the best recommended treatments for each case.

DSM-5 Alcohol Use Disorder Criteria

According to the DSM-5, alcohol use disorder is “a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following [criteria], occurring within a 12-month period.”

In other words, if you experienced any two of the symptoms from the following criteria/questionnaire in the past year, you can be diagnosed as having an AUD:

  1. Alcohol is often taken in larger amounts or over a longer period than was intended. [Do you drink more than you mean to?]
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. [Do you want to stop, but can’t?]
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. [Is drinking taking over your life?]
  4. Craving, or a strong desire or urge to use alcohol. [If you can’t drink, are you thinking about drinking?]
  5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. [Is your drinking getting in the way of day-to-day activities?]
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. [Is drinking getting in the way of your relationships?]
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. [Are you sitting things out because of alcohol?]
  8. Recurrent alcohol use in situations in which it is physically hazardous. [Are you drinking in risky settings, or doing risky things while drinking?]
  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. [Do you know drinking isn’t good for you, but you do it anyway?]
  10. Tolerance, as defined by either of the following: a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol. [Do you need to drink more than you used to?]
  11. Withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for alcohol, or alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid alcohol withdrawal symptoms. [Do you feel it when you stop drinking?]

Mild, Moderate, & Severe AUDs

The DSM-5 further classifies AUDs by severity, determined by how many of the eleven diagnostic criteria are met. 

  • mild AUDs – defined as the presence of 2-3 criteria
  • moderate AUDs – defined as the presence of 4-5 criteria
  • severe AUDs – defined as the presence of 6 or more criteria

These levels of severity are often used by clinicians when determining risk, eligibility for certain treatment programs, recommended treatment options, and even cost.

DSM History & Background

The American Psychiatric Association and the New York Academy of Medicine published the original “Diagnostic and Statistical Manual: Mental Disorders” in 1952 to establish a unified terminology for mental health diagnoses.

The DSM-II, an updated second edition, followed in 1962, and was followed by the DSM-III in 1980, and the DSM-IV in 1994.  Each was intended to improve clinicians’ and public health professionals’ ability to understand and properly manage an ever-increasing range of mental-health conditions.

The 5th edition, published in May 2013, is the first “living document” version of the DSM, meaning that it has received and will receive updates and revisions as needed until a sixth edition is eventually released.

Professional Substance Abuse Treatment

Chronic or compulsive alcohol consumption and drug use puts you and your loved ones at increased risk for health problems, legal problems, financial jeopardy, and more. Fortunately, treatment is available. 

Ark Behavioral Health hosts a variety of inpatient and outpatient treatment programs for substance use disorders, as well as other related conditions and comorbidities. To learn if Ark Behavioral Health is the right option for you, please contact a representative today.

Written by Ark Behavioral Health Editorial Team
©2022 Ark National Holdings, LLC. | All Rights Reserved.

This page does not provide medical advice.

Sources

National Institutes of Health (NIH) - Post by Former NIMH Director Thomas Insel: Transforming Diagnosis
National Institute on Alcohol Abuse and Alcoholism (NIAAA) - Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5
Psychiatry Online - Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition

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