Is alcoholism considered a mental health disorder?

Alcoholism is Definitively Classified as a Mental Disorder

Yes, alcoholism (alcohol use disorder) is officially classified as a mental disorder in modern psychiatric classification systems. 1, 2

Definition and Classification of Alcohol Use Disorder

• Alcohol use disorder (AUD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a problematic pattern of alcohol use leading to clinically and functionally significant impairment 1
• The DSM-5 combines the previously separate diagnoses of "alcohol abuse" and "alcohol dependence" under the umbrella term "alcohol use disorder" with mild, moderate, and severe designations 1
• AUD is diagnosed based on meeting specific criteria related to psychological, social, and physical problems caused by alcohol consumption, rather than solely on the amount consumed 1
• Severity is determined by the number of criteria met: 2-3 criteria indicate mild AUD, 4-5 indicate moderate AUD, and 6 or more indicate severe AUD 1

Historical Context and Evolution of Understanding

• Historically, alcoholism was viewed as a moral failing or character defect, which led to policies emphasizing punishment rather than treatment 1
• In 1956, the American Medical Association first described alcohol addiction as an illness, and in 1987 officially classified addiction as a disease 1
• The National Institute on Drug Abuse established that addiction is a chronic, relapsing brain disease with genetic components that affects behavior and can lead to altered brain structure and function 1
• In 1992, a joint committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine defined alcoholism as "a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations" 3

Diagnostic Criteria and Assessment

• The DSM-5 criteria for AUD include symptoms such as:

  • Loss of control over alcohol consumption
  • Persistent desire or unsuccessful efforts to cut down
  • Significant time spent obtaining, using, or recovering from alcohol
  • Craving or strong urges to use alcohol
  • Failure to fulfill major role obligations due to alcohol use
  • Continued use despite social or interpersonal problems
  • Giving up important activities because of alcohol use
  • Using alcohol in physically hazardous situations
  • Continued use despite physical or psychological problems
  • Tolerance (needing increased amounts for the same effect)
  • Withdrawal symptoms 1, 2

• Validated screening tools for AUD include:

  • AUDIT (Alcohol Use Disorders Identification Test) - a 10-question assessment
  • AUDIT-C - a shortened 3-question version
  • CAGE questionnaire - a brief 4-question tool 2

Scientific Basis for Classification as a Mental Disorder

• AUD affects multiple neurotransmitter systems in the brain, including gamma-aminobutyric acid, serotonin, dopamine, and opioid receptors 4, 5
• Genetic factors account for approximately half of the risk for developing AUD, with environmental factors contributing the other half 4, 6
• Specific genes have been identified that affect risk, including ADH1B and ALDH2 (involved in alcohol metabolism), as well as GABRA2, CHRM2, KCNJ6, and AUTS2 6
• AUD is often comorbid with other psychiatric disorders, with studies showing that 60.8% of those with a psychiatric diagnosis also had a substance use disorder 1

Treatment Approaches

• Despite being a treatable condition, AUD is significantly undertreated, with less than 15% of individuals with a lifetime diagnosis receiving any treatment 4
• Treatment approaches include:
  • Psychosocial interventions such as cognitive-behavioral therapy and motivational enhancement therapy 4
  • FDA-approved medications including disulfiram, naltrexone, and acamprosate 4
  • Off-label medications with demonstrated efficacy including topiramate and gabapentin 4
• Primary healthcare providers should routinely screen for alcohol use and provide a staggered treatment response, from brief advice to pharmacological treatment 7

Common Pitfalls in Assessment and Treatment

• Focusing exclusively on alcohol consumption without assessing functional impairment and consequences 2
• Failing to recognize AUD as a medical condition requiring treatment rather than a moral failing 1
• Underdiagnosis due to insufficient systematic screening in primary healthcare settings 7
• Underprescribing of effective medications despite their status as first-line treatments in clinical practice guidelines 4
• Not addressing the high stigma associated with AUD, which contributes to undertreatment 4, 7