What is Alcohol Use Disorder (AUD)?

Alcohol Use Disorder (AUD): Comprehensive Definition

Alcohol Use Disorder (AUD) is a problematic pattern of alcohol use leading to clinically significant impairment or distress, diagnosed when at least two of eleven specific criteria are present within a 12-month period, with severity classified as mild (2-3 criteria), moderate (4-5 criteria), or severe (6+ criteria). 1

Diagnostic Criteria

AUD is diagnosed based on the DSM-V criteria, which requires meeting at least two of the following within a 12-month period:

1. Consumption Patterns

   • Alcohol consumed in larger amounts or over longer periods than intended 1
   • Persistent desire or unsuccessful efforts to cut down or control alcohol use 1
   • Great deal of time spent obtaining alcohol, using alcohol, or recovering from its effects 1

2. Psychological and Physical Dependence

   • Craving or strong desire/urge to use alcohol 1
   • Tolerance (needing increased amounts for same effect or diminished effect with same amount) 1
   • Withdrawal symptoms when alcohol use is discontinued or alcohol is taken to relieve/avoid withdrawal 1

3. Social and Functional Impairment

   • Recurrent alcohol use resulting in failure to fulfill major role obligations 1
   • Continued use despite persistent/recurrent social or interpersonal problems caused by alcohol 1
   • Important activities given up or reduced because of alcohol use 1
   • Recurrent use in physically hazardous situations 1
   • Continued use despite knowledge of persistent/recurrent physical or psychological problems likely caused by alcohol 1

Severity Classification

• Mild AUD: Presence of 2-3 criteria 1
• Moderate AUD: Presence of 4-5 criteria 1
• Severe AUD: Presence of 6 or more criteria 1

Screening Tools

Several validated screening tools are available to identify AUD:

1. AUDIT (Alcohol Use Disorders Identification Test)

   • Gold standard screening tool developed by WHO 1
   • 10-question assessment with high sensitivity and specificity 2
   • Comprehensive evaluation of drinking patterns, dependence symptoms, and alcohol-related problems 1

2. CAGE Questionnaire

   • Brief 4-question tool with 85% sensitivity and 89% specificity 2
   • Asks about Cut-down attempts, Annoyance with criticism, Guilt feelings, and Eye-openers 1
   • Two or more "yes" responses indicate an alcohol use disorder 1

3. AUDIT-C

   • Shortened 3-question version focusing on consumption patterns 2
   • Maintains good sensitivity while requiring less time to administer 2

Clinical Significance

• AUD affects over 29 million individuals and causes more than 140,000 deaths annually in the United States 3
• Prevalence has increased by 50% between 2001 and 2013, with greater increases among women, minorities, and those of lower socioeconomic status 2
• Only about 8% of affected individuals receive treatment in specialized facilities 4
• Medications are prescribed to less than 9% of patients who would likely benefit from them 4

Conceptual Evolution

• The DSM-V concept of AUD represents an important advancement over previous categorical distinctions between alcohol abuse and dependence 1
• This dimensional approach recognizes varying levels of severity rather than the arbitrary distinction of who is or isn't an "alcoholic" 1
• The categorical distinction is not clinically useful and may be damaging due to stigmatization 1

Common Pitfalls in Diagnosis

• Underdiagnosis: Only 1 in 6 US adults report ever being asked by a health professional about their drinking behavior 4
• Undertreatment: Despite evidence-based treatments being available, most patients with AUD do not receive appropriate care 3
• Stigmatization: The term "alcoholic" can be stigmatizing and should be avoided in favor of the clinical diagnosis of AUD 1
• Comorbidity Oversight: AUD frequently co-occurs with other psychiatric conditions that may complicate diagnosis and treatment 2

Bio-Psycho-Social Model

AUD is best understood through a multidimensional framework that includes:

• Biological factors: Genetic predisposition, neurobiological changes 5
• Psychological factors: Coping mechanisms, personality traits, mental health comorbidities 5
• Social factors: Cultural norms, peer influence, socioeconomic status 5

This comprehensive understanding of AUD as defined by current diagnostic criteria provides the foundation for effective screening, diagnosis, and treatment planning.