What is chronic alcoholism?

Definition of Chronic Alcoholism

Chronic alcoholism is now formally termed Alcohol Use Disorder (AUD), defined as a problematic pattern of alcohol use causing clinically significant impairment or distress, with at least 2 of 11 specific criteria occurring within a 12-month period. 1

Modern Diagnostic Framework

The term "chronic alcoholism" has been replaced in modern medical practice by the DSM-5 classification of Alcohol Use Disorder, which provides a more precise, dimensional approach to diagnosis. 2

Core Diagnostic Criteria (DSM-5)

AUD requires meeting ≥2 of the following 11 criteria within a 12-month period: 1

• Loss of control: Alcohol consumed in larger amounts or over longer periods than intended 1
• Failed attempts: Persistent desire or unsuccessful efforts to cut down or control use 1
• Time consumption: Excessive time spent obtaining, using, or recovering from alcohol 1
• Craving: Strong desire or urge to use alcohol 1, 2
• Role impairment: Failure to fulfill major obligations at work, school, or home 1
• Social problems: Continued use despite persistent social or interpersonal problems 1
• Activity reduction: Important activities given up or reduced because of alcohol 1
• Hazardous use: Recurrent use in physically dangerous situations 1
• Physical/psychological harm: Continued use despite knowledge of persistent problems caused by alcohol 1
• Tolerance: Need for markedly increased amounts to achieve intoxication, or markedly diminished effect with continued use 1
• Withdrawal: Characteristic withdrawal syndrome or use of alcohol to relieve/avoid withdrawal 1

Severity Classification

The severity is determined by the number of criteria met: 1, 2

• Mild AUD: 2-3 criteria 1
• Moderate AUD: 4-5 criteria 1
• Severe AUD: ≥6 criteria 1

Key Conceptual Changes from Historical Definitions

The DSM-5 eliminated the previous distinction between "alcohol abuse" and "alcohol dependence," combining them into a single dimensional disorder. 2 This change reflects evidence that all criteria form a single unidimensional continuum rather than two separate disorders. 2

Important caveat: For patients using substances under medical supervision, tolerance and withdrawal alone should not count toward diagnosis if no other criteria are met. 2

Clinical Characteristics

AUD is fundamentally characterized by: 3

• Primary chronic disease with genetic, psychosocial, and environmental factors influencing development 3
• Progressive and potentially fatal course 3
• Impaired control over drinking 3
• Preoccupation with alcohol 3
• Use despite adverse consequences 3
• Distortions in thinking, most notably denial 3
• Continuous or periodic symptoms 3

Practical Screening Tools

For clinical identification, structured questionnaires should be used: 1

• AUDIT (Alcohol Use Disorders Identification Test): Gold standard screening instrument with proven sensitivity and specificity 2
• AUDIT-K: Recommended for Korean populations 1
• AUDIT-C: Shortened version using first 3 questions for time-limited settings 1
• CAGE questionnaire: ≥2 "yes" responses indicate AUD 1

Neurobiological Basis

AUD is a chronic, relapsing biobehavioral disease mediated by: 4

• Brain reward systems 4
• Memory circuits 4
• Prefrontal cortex dysfunction 4, 5
• Altered balance between neuronal excitation and inhibition 6

The disease involves loss of ability to drink in moderation and continued drinking despite negative consequences. 4

Epidemiological Context

AUD prevalence has increased dramatically: 1

• 50% increase in AUD prevalence between 2001-2013 in US adults 1
• Greater increases among women, minorities, and lower socioeconomic status populations 1
• Rising rates of binge drinking and consumption of distilled spirits 1