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Chapter 199: Alcohol Use Disorder

INTRODUCTION

Alcohol use disorder is defined as repeated alcohol-related difficulties in at least 2 of 11 life areas that cluster together in the same 12-month period (Table 199-1). Severity is based on the number of items endorsed: mild is two or three items, moderate is four or five, and severe is six or more.

TABLE 199-1DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION, CLASSIFICATION OF ALCOHOL USE DISORDER (AUD)
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TABLE 199-1DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION, CLASSIFICATION OF ALCOHOL USE DISORDER (AUD)
Criteria

Two or more of the following items occurring in the same 12-month period must be endorsed for the diagnosis of an AUDa:

 Drinking resulting in recurrent failure to fulfill role obligations

 Recurrent drinking in hazardous situations

 Continued drinking despite alcohol-related social or interpersonal problems

 Tolerance

 Withdrawal, or substance use for relief/avoidance of withdrawal

 Drinking in larger amounts or for longer than intended

 Persistent desire/unsuccessful attempts to stop or reduce drinking

 Great deal of time spent obtaining, using, or recovering from alcohol

 Important activities given up/reduced because of drinking

 Continued drinking despite knowledge of physical or psychological problems caused by alcohol

 Alcohol craving

aMild AUD: 2–3 criteria required; moderate AUD: 4–5 items endorsed; severe AUD: 6 or more items endorsed.

CLINICAL FEATURES

Lifetime risk for alcohol use disorder is 10–15% for men and 5–8% for women. Typically, the first major life problem from excessive alcohol use appears in early adulthood, followed by periods of exacerbation and remission. The course is not hopeless; following treatment, between half and two-thirds of pts maintain abstinence for years and often permanently. If the alcoholic continues to drink, life span is shortened by an average of 10 years due to increased risk of death from heart disease, cancer, accidents, or suicide.

Screening for alcoholism is important given its high prevalence. Standardized questionnaires can be helpful in busy clinical practices including the 10-item Alcohol Use Disorders Identification Test (AUDIT) (Table 199-2).

TABLE 199-2THE ALCOHOL USE DISORDERS IDENTIFICATION TEST (AUDIT)a
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TABLE 199-2THE ALCOHOL USE DISORDERS IDENTIFICATION TEST (AUDIT)a
Item 5-Point Scale (Least to Most)
1. How often do you have a drink containing alcohol? Never (0) to 4+ per week (4)
2. How many drinks containing alcohol do you have on a typical day? 1 or 2 (0) to 10+ (4)
3. How often do you have six or more drinks on one occasion? Never (0) to daily or almost daily (4)
4. How often during the last year have you found that you were not able to stop drinking once you had started? Never (0) to daily or almost daily (4)
5. How often during the last year have you failed ...

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