From the Guidelines
The DSM-5 criteria for Alcohol Use Disorder (AUD) require meeting at least 2 of 11 specific criteria within a 12-month period, as outlined in the most recent guidance from 2020 1. These criteria include:
- drinking more or longer than intended
- unsuccessful attempts to cut down
- spending significant time obtaining, using, or recovering from alcohol
- experiencing cravings
- failing to fulfill major obligations due to drinking
- continued use despite social problems
- giving up important activities for alcohol
- using in physically hazardous situations
- continued use despite physical or psychological problems
- developing tolerance
- and experiencing withdrawal symptoms. The severity is classified as mild (2-3 criteria), moderate (4-5 criteria), or severe (6+ criteria), according to the 2020 guidance from the American Association for the Study of Liver Diseases 1. This diagnostic framework represents a shift from the previous DSM-IV, which separated alcohol abuse and dependence into distinct diagnoses, and is supported by earlier studies 2, 3. The criteria focus on behavioral patterns, physical dependence, and negative consequences, reflecting our understanding that alcohol use disorder exists on a spectrum of severity rather than as a simple yes/no condition. Early identification using these criteria is crucial for appropriate intervention and treatment planning, as emphasized in the 2020 guidance 1. Key points to consider in diagnosis include:
- The presence of at least 2 of the 11 criteria
- The classification of severity based on the number of criteria met
- The importance of considering the patient's overall clinical presentation and history when making a diagnosis.
From the Research
Diagnostic Criteria for Alcohol Use Disorder (AUD)
The Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for Alcohol Use Disorder (AUD) are as follows:
- A pattern of alcohol use leading to significant impairment or distress, as manifested by at least two of the following criteria within a 12-month period: + 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 or use alcohol, or to recover from its effects + Craving, or a strong desire or urge to use alcohol + Recurrent alcohol use resulting in 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, as defined by 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 withdrawal syndrome for alcohol, or the use of alcohol (or a closely related substance) to relieve or avoid withdrawal symptoms 4, 5, 6, 7, 8
Severity of AUD
The severity of AUD can be classified into three categories: