Substance-Related and Addictive Disorders: Alcohol Use Disorder – DSM-5

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Alcohol use has never been a topic that lends itself naturally to sober, intellectual discourse. This is hardly surprising, really, given that what’s at stake is nothing less than our lives. Below I am going to mention co-morbidities associated with alcohol use disorder and the criteria of the DSM-5 for the diagnosis of Alcohol Use Disorder (AUD).

AUD is associated with psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, obsessive-compulsive disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders. The onset of these co-morbidities can be during intoxication and/or withdrawal.

It is worth noting that the word “addiction” is not mentioned in the DSM-5, however, it is in common usage in many countries and disciplines to describe severe problems related to compulsive and habitual use of substances.

The following are the diagnostic criteria for AUD:

A problematic patter of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Alcohol is often taken in large 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 role 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 desired effect.
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.
b. Alcohol is taken to relieve or avoid withdrawal symptoms.

Stay sober and watch out for the people you love for any signs of alcohol addiction, and most importantly Never Ever Drink and Drive.

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6 thoughts on “Substance-Related and Addictive Disorders: Alcohol Use Disorder – DSM-5

  1. It is an interesting document, however treating it is much more difficult than it seems. It will need a lot dedication by loved ones and even after the psychotic symptoms are gone, it is very likely that small triggers can reactivate the addiction all over again. Is it possible to convert this addiction into another addiction that might have positive effect on the person or a less negative effect, such as jogging or gaming,or arts?

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    • Thank you for your comment Antabinader,
      I totally agree that treating AUD is a long road and comes with significant challenges, having a supportive environment is definitely a constructive factor. Since, as you said, small triggers can re-activate the craving, abstinence with psychotherapy and medications when needed are key points in getting rid of the addiction. Patients who are on cognitive behavioral therapy for AUD, are not allowed to even drink a sip of alcohol for a very long period of time. It is quite difficult and challenging.
      Concerning your question of using another addiction as a substitute for alcohol, I think the word “addiction” comes with a bad connotation, so i would use the word distraction instead, for example having a habit of jogging everyday would diverge your thoughts away from alcohol craving. Gaming also can be fun as long as its absence doesn’t cause distress in functioning and there is no feeling of craving for it.

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      • i agree, but is there something wrong with addiction? addiction is part of our daily life. take for example facebook, or eating. A lot of what we do in life are based on addictions rather than needs. Maybe if we teach the patients to accept that their behaviors are normal, they will heal faster and be happier with themselves, and find a better life. If we keep hiding to the patients that addictive is bad, they will know that they are being manipulated. Its easier to make them believe that its normal. No?

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      • You are right, a lot of things we do in our daily lives are on the addiction spectrum and as a matter of fact internet addiction and binge eating are very dysfunctional.
        You cannot tell the patient that being addicted to alcohol, internet, tobacco, or even caffeine is normal, otherwise there is not need to come to a clinic. Specialists in treating substance use disorders want to help the patient have a better life, there is no room for manipulation or hidden agendas.

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