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Alcohol Use Disorder

Definition

Substance use disorders occur when the on-going use of alcohol and/or drugs causes significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. A diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.  Common substance use disorders include alcohol, tobacco, cannabis (marijuana), stimulants, hallucinogens, and opioids.  Excessive drinking can put you at risk for developing an alcohol use disorder.  88,000 deaths occur each year due to excessive drinking.

Symptoms

In order to be diagnosed with an alcohol use disorder (AUD), a person must exhibit any 2 symptoms from a list of 11 criteria over a 12-month period. The severity of the AUD is defined as:

Mild = 2-3 symptoms present

Moderate = 4-5 symptoms present  

Severe = 6 or more symptoms present

Diagnosis

Criteria for diagnosis of alcohol use disorder:

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

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

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

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

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

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

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

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

9. 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.

10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.

11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol: shaking, nausea, vomiting b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Causes

Alcohol use disorder often seems to run in families.  Research shows that genes are responsible for about half the risk of developing AUD.  Environmental factors account for the remainder of the risk.  Dependency on alcohol develops when you drink so much alcohol it causes chemical changes in the brain.  Risk factors increase when you have more than 15 drinks a week for males and more than 12 drinks a week for females.  There is also greater risk if you binge drink (more than 5 drinks per occasion at least once a week), are a young adult with peer pressure, have low self-esteem, have a high level of stress, live in a family or culture where alcohol use is common and accepted, or have a mental health issue such as depression, anxiety or schizophrenia.

Treatment

Treatment for alcohol abuse disorder may occur in stages and can include the following:

Recovery from alcoholism is difficult. Prognosis will depend on the ability to abstain from alcohol use. Many people who seek treatment for alcoholism will be able to overcome addiction. A strong support system is helpful for making a complete recovery.