DSM-V Criteria For Alcohol Use Disorder From Alcoholism Clinical Presentation

In this post I excerpt from the DSM-5 criteria for alcohol use disorder from Alcoholism Clinical Presentation
Updated: Mar 23, 2020
Author: Warren Thompson, MD, FACP from emedicine.medscape.com.

Here is the excerpt:

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) changed from differentiating Alcohol Abuse and Alcohol Dependence to a single category of Alcohol Use Disorder. DSM-5 criteria are as follows:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of the following, occurring at any time in the same 12-month period:

  • Alcohol is often taken in larger amounts or over a longer period than was intended.

  • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.

  • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

  • Craving, or a strong desire or urge to use alcohol.

  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.

  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

  • Recurrent alcohol use in situations in which it is physically hazardous.

  • Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

  • Tolerance, as defined by either of the following:

    1. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
    2. A markedly diminished effect with continued use of the same amount of alcohol.
  • Withdrawal, as manifested by either of the following:

    1. The characteristic withdrawal syndrome for alcohol
    2. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Specify if the Alcohol Use Disorder is:

  • Mild – Presence of 2–3 symptoms
  • Moderate – Presence of 4–5 symptoms
  • Severe – Presence of 6 or more symptoms

Specify if the Alcohol Use Disorder is:

  • In early remission – The individual who had once met criteria for Alcohol Use Disorder has not met criteria for more than 3 months and less than 12 months (does not count the presence of cravings)
  • In sustained remission – The individual who had once met criteria for Alcohol Use Disorder has not met criteria for more than 12 months (does not count the presence of cravings)

Specify if the patient is in a controlled environment  where access to alcohol is limited. [26]

Additional questions, as follows, may be helpful when screening for alcoholism:

  • Have you ever had a drinking problem?

  • When was your last drink? (Less than 24 h is a red flag)

  • Do you use alcohol to relieve pain, anxiety, or insomnia?

  • Have you ever been arrested for drinking, such as driving under the influence?

  • Have you ever lost friends or girlfriends/boyfriends because of your drinking?

  • Have you ever been to an Alcoholics Anonymous (AA) meeting?

  • For geriatric patients: Did your drinking increase after someone close to you died? Does alcohol make you sleepy so that you often fall asleep in your chair?

  • For adolescents: Do you drink alone? Do you ever miss school to go drinking or because you have a hangover?

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