From the Guidelines
Mild to moderate alcohol use disorder is characterized by the presence of 2-5 symptoms from the diagnostic criteria established for alcohol use disorders, as defined by the American Association for the Study of Liver Diseases in 2020 1. The symptoms include drinking more or longer than intended, unsuccessful attempts to cut down, spending significant time obtaining 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 hazardous situations, continued use despite physical or psychological problems, developing tolerance, or experiencing withdrawal symptoms. The severity classification helps clinicians determine appropriate treatment approaches, with mild cases (2-3 symptoms) potentially benefiting from brief interventions and counseling, and moderate cases (4-5 symptoms) requiring more structured outpatient treatment, including behavioral therapies like cognitive-behavioral therapy or motivational enhancement therapy, as supported by studies on screening and behavioral counseling interventions in primary care 1. Some key points to consider in the diagnosis and treatment of mild to moderate alcohol use disorder include:
- The importance of early intervention to prevent progression to severe disorder
- The use of screening tools, such as the AUDIT or CAGE, to detect alcohol-related problems in primary care settings
- The effectiveness of brief interventions and counseling in reducing alcohol consumption
- The potential benefits of medications, such as naltrexone, acamprosate, or disulfiram, in reducing cravings or creating aversion to alcohol. The most recent and highest quality study, published in 2020, provides the most reliable guidance on the diagnosis and treatment of mild to moderate alcohol use disorder 1.
From the Research
Definition of Mild to Moderate Alcohol Use Disorder
Mild to moderate alcohol use disorder is characterized by a problematic pattern of alcohol use accompanied by clinically significant impairment or distress 2.
Prevalence and Treatment
It is estimated that up to 14% of US adults experience alcohol use disorder during a 1-year period, although only about 8% of affected individuals receive treatment in an alcohol treatment facility 2.
Approved Medications
There are four medications approved by the US Food and Drug Administration to treat alcohol use disorder: disulfiram, naltrexone, and acamprosate 2, 3, 4.
Treatment Approaches
Treatment approaches for alcohol use disorder include counseling, motivational interviewing, peer support or mutual help groups, and individualized therapy 3, 5.
Effectiveness of Interventions
Combined psychosocial and pharmacologic interventions may be associated with a greater reduction in harmful alcohol use compared to psychosocial interventions alone 6.
Limitations of Current Evidence
There is limited evidence regarding the efficacy of pharmacologic interventions, and specific types of psychosocial interventions, for reducing harmful alcohol use, particularly in low- and middle-income countries 6.
Key Findings
- Motivational interviewing can reduce the extent of substance abuse compared to no intervention 5.
- Naltrexone can reduce the likelihood of a return to any drinking by 5% and binge-drinking risk by 10% 2.
- Disulfiram, naltrexone, and acamprosate are underused medications for the treatment of alcohol use disorder 3, 4.