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For many people, alcohol plays a significant role in their social life and leisure time. Whether it’s going to happy hour with colleagues, cocktails for date night or a glass or two of wine in the evening to unwind, many people associate alcohol with fun and relaxation. While an occasional drink isn’t likely to cause harm, it can be difficult to identify the line between casual drinking and unhealthy use, including alcohol use disorder.
What Is Alcohol Use Disorder?
Definition and Overview
Alcohol use disorder is a chronic disease characterized by the inability to stop of control alcohol use despite undesired consequences. Those living with this medical condition experience lasting changes to the brain that makes it difficult for them to reduce their intake and make them vulnerable to relapse.
Individuals who drink casually are able to monitor their alcohol intake and modify their behavior in response to adverse social, occupational and health consequences. By contrast, those living with an AUD diagnosis are unable to change their drinking habits, even if they want to.
Prevalence and Impact
According to the National Institute on Alcohol Abuse and Alcoholism, nearly 29 million people met the clinical definition of AUD in 2023. Overall, this disease is slightly more prevalent in males, who account for a little less than 60 percent of cases. However, among adolescents aged 12-17, 3.8 percent of girls met the criteria for AUD compared to two percent of boys. Among those aged 18 and over, almost 11 percent met the criteria for AUD, including 13.2 percent of males and 8.7 percent of females.
AUD has significant social, physical and economic impacts. These range from relationship problems and societal stigma to health issues such as cancer, liver disease and brain damage. It also takes a financial toll on the individuals living with this disease, resulting in increased medical bills, job instability and in some cases, legal problems.
Criteria for Diagnosis within the DSM Framework
Overview of the DSM-5 Framework
The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is a classification system that provides standardized criteria for diagnosing mental health conditions. It contains all recognized mental health disorders and organizes them into categories such as anxiety disorders, psychotic disorders and mood disorders. It also lists the symptoms of each condition.
The most recent edition, the DSM-5-TR, features the latest developments in research on mental illnesses. This important tool gives health care providers a way to compare conditions with similar symptoms, and it provides an objective standard for making diagnoses.
Key Diagnostic Criteria for AUD
The DSM-5 lists 11 symptoms of AUD, and it indicates a diagnosis if someone exhibits at least two of these criteria in a 12-month period. These symptoms include:
- The individual regularly drinks more alcohol than they intend to, or they drink over a longer period than they intend to
- The person wants to drink less alcohol, but they’re unsuccessful in curbing consumption
- They spend a significant amount of time obtaining alcohol, drinking it and recovering from the effects of drinking
- They have a strong craving or desire for alcohol
- Their alcohol use affects their performance at work or school, and it keeps them from fulfilling their responsibilities at home
- They continue to use alcohol despite its negative impact on their social or relationships
- They give up or reduce time spent on social or recreational activities to drink instead
- They use alcohol in situations where drinking can be dangerous, such as driving
- The individual continues to drink even if they experience serious health or psychiatric problems
- They have an increasingly high tolerance for alcohol, meaning they need to drink more to get the desired effect
- They experience uncomfortable or dangerous withdrawal symptoms, or they drink to avoid these symptoms
Understanding the Severity Levels of AUD
Classification of Severity
Mental health professionals classify the severity levels of AUD as mild, moderate and severe depending on how many symptoms an individual exhibits. For example, if someone has two or three symptoms, their mental health care practitioner classifies their condition as mild. Four to five symptoms point to moderate severity, while six or more symptoms indicate the person has severe AUD.
Progression of AUD
If an individual with AUD doesn’t get professional treatment, their condition can evolve and become increasingly dangerous and disruptive. Some negative outcomes they may experience include:
- Deterioration of their physical health, including liver damage, cardiovascular disease or pancreatitis
- Mental health issues such as depression or anxiety
- Social and occupational problems, such as job loss, strained relationships and social isolation
- Higher likelihood of accidents and injuries due to impaired judgment and coordination
- Legal problems related to public intoxication and DUIs
- Physical dependency on alcohol and withdrawal symptoms when not drinking
Neglecting professional treatment can also cause the disorder to become more severe, resulting in the individual experiencing more disruptive and dangerous symptoms.
The Role of Triggers and Risk Factors
Genetic and Biological Factors
Genetics plays a significant role in the likelihood of someone developing AUD, with one study indicating that this factor contributes to about 50 percent of the risk of having this disease. While someone can’t be born with AUD, being in an environment or having a family history of alcohol misuse increases their likelihood of developing this condition. Scientists have pinpointed specific genes, such as ADH1B, ADH1C and ALDH2, that affect how a person’s body processes alcohol. This can impact their susceptibility to AUD.
There are also biological factors that contribute to AUD. Alcohol affects neurotransmitters such as dopamine, leading some to experience cravings and dependence. Additionally, many people living with this disorder have a more intense stress response, which can also cause them to experience more cravings and have a harder time recovering from AUD.
Environmental and Social Triggers
For someone who is genetically predisposed to AUD, certain environmental and social triggers can increase their odds of developing the disorder. For example, growing up in a home where alcohol use is common can normalize drinking, making them more likely to develop AUD. Along with this, social circles and peer groups where heavy use is the norm can directly impact the individual’s exposure and consumption. In some cases, socioeconomic status and experiencing discrimination due to being part of a racial or ethnic minority group can contribute to AUD.
Psychological Contributors
Psychological triggers for AUD often involve mental health issues and that can lead to or worsen alcohol misuse. For example, high levels of stress from work, school or interpersonal relationships can result in individuals using alcohol as a coping mechanism. Those with low self-esteem or who have conditions such as social anxiety may use alcohol to feel more confident in social settings.
Untreated mental illnesses can also make someone more likely to develop AUD, as alcohol often provides a coping mechanism for dealing with difficult emotions. Post-traumatic stress disorder, anxiety and depression can all trigger alcohol misuse and contribute to AUD for those who use alcohol to self-medicate.
Treatment Options Based on DSM Guidelines
The treatment options for AUD include a mix of behavioral health treatments, certain medications and support groups.
Behavioral Therapies
Traditional talk therapy is the standard for addressing AUD. While different mental health care specialists use different approaches, the most common therapies include cognitive behavioral therapy, dialectical behavioral therapy and motivational interviewing. These therapies can uncover the factors that contribute to AUD and help individuals learn new habits and coping skills for managing stressors, cravings and conflicts.
Medication-Assisted Treatment
Medication-assisted treatment incorporates FDA-approved medications to manage alcohol cravings. Currently, three medications are approved for the treatment of AUD, including disulfiram, acamprosate and naltrexone. These medications support recovery efforts by reducing cravings and withdrawal symptoms.
Support Groups and Peer Support
Peer support is a vital component of AUD recovery. Organizations such as Alcoholics Anonymous offer emotional support for members, reducing feelings of stigma and isolation and giving individuals opportunities to give and receive empathy and understanding. Members share coping strategies and practical advice for managing situations where alcohol is present, and they can work together to find solutions for problems such as relationship conflicts.
AUD is a complex disease with a variety of genetic, environmental and mental health considerations. If you or a loved one is living with this disorder, FHE Health is here to help. We take a holistic approach to addiction treatment and offer tailored plans to support lifelong health and recovery. Contact us today to learn more about our detox program and residential and outpatient care.
