Diagnosis of Alcohol Problems: Comparing DSM-IV and DSM-5

Caduceus Medical SymbolIn the offices of psychologists, psychiatrists, psychiatric researchers, insurance companies, drug regulators, lawyers, and lawmakers around the country is a book known informally as the bible of American psychiatry and officially as the Diagnostic and Statistical Manual of Mental Disorders.

Since 1952 the DSM has provided a common criteria for classifying mental disorders. Recently, a task force of experts in several fields updated the information from DSM-IVto DSM-5 (the numbering system was changed to allow for incremental updates, 5.1, 5.2 etc.)

Following is a comparison of the major changes that relate to alcohol use:

  • DSM-5 combines the distinct disorders of Alcohol Abuse and Alcohol Dependence described in DSM-IV into one, Alcohol Use Disorder. Alcohol Use Disorder (AUD) is sub-divided into Mild, Moderate, and Severe classifications.
  • DSM-IV included legal problems as a criterion for a diagnosis of Alcohol Abuse and Alcohol Dependence; DSM-5 removes that criterion.
  • DSM-5 adds a new criterion, craving, that was not included in DSM-IV.
  • The DSM-5 task force updated the descriptions of some criteria.

The most extensive changes are to the thresholds that determine the severity of the alcohol use disorder.

In DSM-IV:

A diagnosis of Alcohol Abuse was made if the client met any one of four criteria:

  • Recurring alcohol use that interferes with work, school, or at home
  • Recurring alcohol use when it poses a safety risk, as when driving a car, operating a machine, or caring for a dependent
  • Recurring legal problems related to alcohol, such as arrests for disorderly conduct
  • Continuing to use alcohol even when it causes personal or social problems like physical fights or arguments with relatives or friends

A diagnosis of Alcohol Dependence was made if the client met any three of the following criteria:

  • Tolerance – having to drink significantly more to become intoxicated or becoming less intoxicated after drinking the same amount of alcohol
  • Withdrawal – suffering classical symptoms of alcohol withdrawal or using alcohol to avoid such symptoms
  • Using more alcohol or drinking for longer than intended
  • Having a persistent desire to consume less alcohol, or being unsuccessful when attempting to control drinking
  • Putting great time and effort into getting alcohol, using alcohol, or recovering from drinking
  • Reducing social, work, or recreational activities because of alcohol use
  • Continuing drinking even when the client knows the alcohol is contributing to a chronic physical or psychological problem

In DSM-5

A diagnosis of Alcohol Use Disorder (AUD) is made if the client has two of the following symptoms. The AUD is diagnosed as mild if the client has two or three of the symptoms, moderate with four or five symptoms and severe with six symptoms or more:

  • Alcohol is often consumed more often or in larger amounts than intended
  • Having a persistent desire to consume less alcohol, or being unsuccessful when attempting to control drinking
  • Putting great time and effort into getting alcohol, using alcohol, or recovering from drinking
  • Craving, or a strong desire, to consume alcohol
  • Recurring alcohol use that interferes with work, school, or at home
  • Continuing to use alcohol even when it causes personal or social problems like physical fights or arguments with relatives or friends
  • Reducing social, work, or recreational activities because of alcohol use
  • Recurring alcohol use when it poses a safety risk, as when driving a car, operating a machine, or caring for a dependent
  • Continuing drinking even when the client knows the alcohol is contributing to a chronic physical or psychological problem
  • Tolerance – having to drink significantly more to become intoxicated or becoming less intoxicated after drinking the same amount of alcohol
  • Withdrawal – suffering classical symptoms of alcohol withdrawal or using alcohol to avoid such symptoms

What about “alcoholism?”

You may be wondering where the label of alcoholism fits into this diagnostic system. Believe it or not, alcoholism isn’t really a formal clinical diagnosis. It’s a folk term, popularized over the years, and a very imprecise one at that. Nonetheless, you can still see the term used in the professional literature, though less so as time goes on.

In DSM-IV, Alcohol Dependence was considered the equivalent of alcoholism. Maybe now, with the advent of DSM-5, which places Alcohol Use Disorders on a continuum, we’ll see and hear less of this shame-inducing label, which, in my opinion, has over-stayed its welcome!

Speak Your Mind

*