DSM-5 Remission Criteria for Alcohol Use Disorder
According to DSM-5, remission from Alcohol Use Disorder requires not meeting any of the 11 diagnostic criteria (except craving) for a specified time period: early remission is defined as 3 to <12 months without criteria, and sustained remission as ≥12 months without criteria. 1
Remission Categories
Early Remission
- Time frame: At least 3 months but less than 12 months without meeting DSM-5 AUD criteria 1
- The 3-month threshold was selected based on data showing better outcomes for individuals retained in treatment for at least this duration 1
- Craving is explicitly allowed to persist during early remission, as it can continue long after other symptoms resolve 1
Sustained Remission
- Time frame: 12 months or longer without meeting DSM-5 AUD criteria 1
- Craving may still be present without disqualifying sustained remission status 1
- This represents a simplified approach compared to DSM-IV, which had six course specifiers that were complex and rarely used in clinical practice 1
Key Remission Specifications
What Counts as Remission
- No criteria met except craving: The individual must not meet any of the 11 DSM-5 AUD criteria during the remission period, with the sole exception of craving 1
- The 11 criteria include: larger amounts/longer periods than intended, persistent desire to cut down, time spent obtaining/using/recovering, failure to fulfill obligations, continued use despite social problems, activities given up, hazardous use, use despite physical/psychological problems, tolerance, withdrawal, and craving 1, 2
Eliminated DSM-IV Distinctions
- Partial remission was eliminated from DSM-5 to simplify the diagnostic framework 1
- DSM-5 uses only two temporal categories (early and sustained) rather than the four timeframe-based specifiers in DSM-IV 1
Special Circumstances
Controlled Environment Specifier
- The "in a controlled environment" specifier remains unchanged from DSM-IV 1
- This applies when the individual is in a setting where access to alcohol is restricted (e.g., incarceration, residential treatment) 1
Maintenance Therapy Specifier
- DSM-5 updated the "on agonist therapy" category to "on maintenance therapy" with specific examples 1
- Examples include: agonists (methadone, buprenorphine), antagonists (naltrexone), and tobacco cessation medications (bupropion, varenicline) 1
Clinical Considerations
Remission vs. Abstinence
- DSM-5 remission criteria focus on absence of diagnostic criteria, not necessarily complete abstinence from alcohol 1
- This differs from many clinical studies that define remission based on substance use per se 1
- The criteria emphasize substance-related difficulties rather than extent of use, though lack of consensus exists on what level of use constitutes a good outcome 1
Relapse Risk Factors
- Research shows cumulative relapse rates of 5.6% at 5 years, 9.1% at 10 years, and 12.0% at 20 years among those in remission 3
- Medium to high past alcohol intake, 6+ lifetime AUD symptoms, impaired control over use, and current at-risk drinking predict relapse 3
- Current at-risk drinking (≥8 drinks weekly for women, ≥15 for men) coupled with other risk factors substantially increases relapse likelihood 3
Recovery Patterns
- Among individuals with prior AUD, 16.0% achieve abstinent recovery and 17.9% achieve non-abstinent recovery (asymptomatic low-risk drinking) 4
- Approximately 25% of individuals achieve recovery without treatment, though 43.2% of those achieving abstinent recovery reported receiving treatment 4
Common Pitfalls
- Do not require complete abstinence to diagnose remission—the focus is on absence of problematic criteria, not zero alcohol consumption 1
- Do not forget that craving can persist throughout remission without disqualifying the diagnosis 1
- Do not use the old DSM-IV "partial remission" category—this was eliminated in DSM-5 1
- Monitor for at-risk drinking patterns even during remission, as current drinking provides an adequate reference point for relapse prevention 3