From the Guidelines
Alcohol use disorder (AUD) is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the specified criteria occurring within a 12-month period, according to the most recent guidelines 1. The definition of AUD involves a range of criteria, including:
- Alcohol is often taken in larger amounts or over a longer period than 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
- 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
- Recurrent alcohol use in situations in which it is physically hazardous
- 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, defined as either 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
- Withdrawal, as manifested by either the characteristic alcohol withdrawal syndrome or alcohol (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. The severity of AUD is categorized as:
- Mild: 2-3 symptoms
- Moderate: 4-5 symptoms
- Severe: 6 or more symptoms, as stated in the 2020 practice guidance from the American Association for the Study of Liver Diseases 1. It is essential to note that the diagnosis and treatment of AUD should be based on the most recent and highest-quality evidence, prioritizing the patient's morbidity, mortality, and quality of life as the primary outcomes.
From the Research
Definition of Alcohol Use Disorder
Alcohol use disorder (AUD) is characterized by:
- Excessive habitual drinking and loss of control over alcohol intake despite negative consequences 2
- Compulsive heavy alcohol use and loss of control over alcohol intake 3
- Impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial 4
Key Features
- Often progressive and fatal 4
- Associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury 3
- Can affect nearly every organ system 5
Diagnosis and Treatment
- AUD is defined as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations 4
- Effective and cost-effective psychosocial and pharmacological interventions exist, but AUD is often undertreated due to high stigma and insufficient systematic screening in primary health care 3
- Pharmacologic treatment of AUD is underutilized despite the availability of multiple effective medications 5