What, Exactly, is Alcohol Use Disorder?

April 7, 2021

Approximately 60% of respondents to a national survey report pandemic-related increased alcohol consumption. Could any of your patients be at risk for alcohol use disorder?

April is Alcohol Awareness Month and also the first full month into the second year of the COVID-19 pandemic.

The National Institute on Alcohol Abuse and Alcoholism urges primary care clinicians to be particularly alert for signs of increased alcohol use or deterioration in known problem drinking or alcohol use disorder (AUD) among their patients--and not just this month. The protracted stress of the pandemic and increased availability of alcohol are both factors contributing to increased drinking. In one recent survey, 60% of participants reported consuming more alcohol and consuming alcohol more frequently than pre-pandemic, attributing the behavior change, in part, to both conditions.

What, exactly, is AUD? In this slide show, find the 11 questions from the Diagnostic and Statistical Manual of Mental Disorders V that serve as criteria for a diagnosis--and think about your patients as you read through.

Alcohol use disorder (AUD) is a medical diagnosis and defined as: A chronic relapsing brain disorder characterized alcohol use despite adverse social, occupational, or health consequences.

Definition from the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).

AUD in the United States. AUD affects approximately 15 million people in the US; in 2018, approximately 5.7% of the adult population had AUD--9.2 million men and 5.3 million women. Approximately 400 000 adolescents aged 12-17 yrs had AUD in 2018.

AUD Criteria. The DSM–5 includes 11 criteria on which a diagnosis can be made of mild, moderate, or severe AUD.

In the past year have you: … had times when you ended up drinking more, or longer, than you intended?
… more than once wanted to cut down or stop drinking, or tried to, but couldn’t?
… spent a lot of time drinking? Or being sick or getting over other aftereffects?

In the past year, have you: ... wanted a drink so badly you couldn't think of anything else?
… found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?|
… continued to drink even though it was causing trouble with your family or friends?

In the past year, have you: given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
…more than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

In the past year, have you: continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
… had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

In the past year, have you: … found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

Any 2 of the 11 Criteria can be Diagnostic for AUD. Under DSM–5, anyone who meets any 2 of the 11 criteria during a 12-month period receives a diagnosis of AUD. Severity is based on the number of criteria met: Mild: 2 to 3 symptoms Moderate: 4 to 5 symptoms Severe:≥6 symptoms

Note for Primary Care. Research conducted for the 2019 National Survey on Drug Use and Health found that people with AUD are more likely to seek care from a primary care clinician for an alcohol-related medical problem than specifically for drinking too much alcohol.

A Small Sampling of Many Available Resources for Clinicians

Rethinking Drinking (NIAAA)

Screening Brief Intervention and Referral to Treatment (SBIRT)

Alcohol Use Disorders Identification Test (AUDIT)

NIAAA Treatment Navigator (NIAAA)

Medication for the Treatment of Alcohol use Disorder: A Brief Guide (SAMHSA)

Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide (NIAAA)