Alcohol-use disorder

Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5-TR)[3]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.​​

Alcohol-use disorder is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following criteria over the same 12-month period:

• Alcohol used in larger amounts or over a longer period of time than intended

• Persistent desire or unsuccessful attempts to cut down or control alcohol use

• Significant time spent obtaining, using, and recovering from the effects of alcohol

• Craving or strong desire to use alcohol

• Recurrent alcohol use leading to failure to fulfil major role obligations at work, school, or home

• Recurrent use of alcohol, despite having persistent or recurring social or interpersonal problems caused or worsened by alcohol

• Continued alcohol use despite having persistent or recurring physical or psychological problems caused or worsened by alcohol

• Giving up or reducing important social, occupational, or recreational activities due to alcohol use

• Recurrent alcohol use in hazardous situations

• Continued alcohol use despite having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol

• Tolerance: markedly increased amounts of alcohol are needed to achieve intoxication or the desired effect, or continued use of the same amount of alcohol achieves a markedly diminished effect

• Withdrawal: there is the characteristic alcohol withdrawal syndrome, or alcohol is taken to relieve or avoid withdrawal symptoms.

Severity is specified based on the number of criteria met: mild alcohol-use disorder when 2-3 criteria are met, moderate alcohol-use disorder when 4-5 criteria are met, and severe alcohol-use disorder when 6 or more criteria are met. Remission is specified when no criteria, other than cravings, are met for at least 3 months (early remission) or 12 months (sustained remission).

International classification of diseases, 11th ed. (ICD-11)[4]World Health Organization. International classification of diseases​ 11th revision (ICD-11). Jan 2022 [internet publication]. https://icd.who.int/en ​​[55]Lingford-Hughes AR, Welch S, Peter L, et al. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction, and comorbidity: recommendations from BAP. J Psychopharmacol. 2012 Jul;26(7):899-952. http://www.ncbi.nlm.nih.gov/pubmed/22628390?tool=bestpractice.com

Harmful pattern of use of alcohol:

• A pattern of alcohol use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others.

• The pattern of alcohol use is evident over a period of at least 12 months if substance use is episodic or at least 1 month if use is continuous.

• Harm to health of the individual occurs due to one or more of the following:

  • Behaviour related to intoxication

  • Direct or secondary toxic effects on body organs and systems

  • A harmful route of administration.

• Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour-related to alcohol intoxication on the part of the person to whom the diagnosis of harmful pattern of use of alcohol applies.

Alcohol dependence:

• Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol.

• The characteristic feature is a strong internal drive to use alcohol, which is manifested by impaired ability to control use, increasing priority given to use over other activities, and persistence of use despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use alcohol.

• Physiological features of dependence may also be present, including tolerance to the effects of alcohol, withdrawal symptoms following cessation or reduction in use of alcohol, or repeated use of alcohol or pharmacologically similar substances to prevent or alleviate withdrawal symptoms.

• The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 3 months.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)​​​[1]National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined [internet publication].​ https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption

Binge drinking: a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08% (0.08 g/dL) or higher. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.

Heavy drinking:

• For men, consuming more than 4 drinks on any day or more than 14 drinks per week

• For women, consuming more than 3 drinks on any day or more than 7 drinks per week.