What is the definition of Alcohol Use Disorder (AUD)?

Definition of Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, diagnosed when a person exhibits at least two of eleven specific criteria within a 12-month period. 1

Diagnostic Criteria

AUD is diagnosed based on the following 11 criteria occurring within a 12-month period:

1. Alcohol is often taken in larger amounts or over a longer period than intended
2. Persistent desire or unsuccessful efforts to cut down or control alcohol use
3. A great deal of time spent in activities necessary to obtain, use, or recover from alcohol effects
4. Craving or strong desire/urge to use alcohol
5. Recurrent alcohol use resulting in failure to fulfill major role obligations
6. Continued use despite persistent/recurrent social or interpersonal problems
7. Important activities given up or reduced because of alcohol use
8. Recurrent use in physically hazardous situations
9. Continued use despite knowledge of physical/psychological problems likely caused by alcohol
10. Tolerance (need for increased amounts or diminished effect)
11. Withdrawal (characteristic syndrome or alcohol taken to relieve/avoid symptoms) 1

Severity Classification

AUD severity is classified based on the number of criteria met:

• Mild: 2-3 criteria
• Moderate: 4-5 criteria
• Severe: 6 or more criteria 1, 2

Screening Tools

Two validated screening tools are commonly used to identify AUD:

AUDIT (Alcohol Use Disorders Identification Test)

• Gold standard screening tool developed by WHO
• 10-question assessment evaluating:
  • Alcohol consumption patterns
  • Dependence symptoms
  • Alcohol-related problems
• Scores range from 0-40 points
• Score of 8+ generally indicates harmful or hazardous drinking 1, 2

CAGE Questionnaire

• Simple 4-question screening tool:
  • Cut down: Have you ever felt you should cut down on drinking?
  • Annoyed: Have people annoyed you by criticizing your drinking?
  • Guilty: Have you ever felt bad or guilty about drinking?
  • Eye-opener: Have you ever had a drink first thing in the morning?
• Two or more "yes" responses indicate probable AUD 1, 2

Clinical Implications

• AUD is associated with high mortality and disease burden, primarily due to medical consequences like liver cirrhosis and injuries 3
• Despite effective treatments, AUD remains undertreated due to stigma and insufficient systematic screening 3
• Proper documentation using appropriate diagnostic codes is essential for treatment planning 2
• Biomarkers (GGT, CDT) may support diagnosis but should not be used alone to confirm or refute alcohol use 1

Paradigm Shift in Understanding

The DSM-V introduction of AUD as an overarching concept represents an important advancement by:

• Overcoming arbitrary differentiation between alcohol abuse and dependence
• Introducing a dimensional perspective rather than a categorical distinction
• Reducing stigmatization associated with the term "alcoholism" 1

AUD diagnosis requires careful assessment using validated tools and clinical judgment, with recognition that this condition exists on a spectrum of severity requiring appropriately tailored interventions.