Alcohol Use Disorder

According to The U.S. National Survey on Drug Use and Health in 2015, approximately 15.1 million adults, or 6.2% of the population meet the criteria for Alcohol Use Disorder.1 A further 623,000 adolescents, boys and girls between 12 and 17, live with a person who has AUD. The survey makes use of the term Alcohol Use Disorder, which might cause confusion to a reader has no medical background. This is particularly true because previous surveys used the terms alcoholism, alcoholic, and alcohol abuse. To add to the confusion, popular support groups like Alcoholics Anonymous continue to use the term alcoholism in meetings, books, and manuals.

Alcohol Use Disorder (AUD) is the most recent term used in official diagnoses from doctors and other healthcare professionals who use the DSM-5, a diagnostic manual prevalent in North America. In the past, various other terms have been used, including alcohol misuse, alcoholism, alcohol addiction, alcohol dependency, and so forth. The terms are often used interchangeably by clinicians and non-clinicians alike, but there are in fact subtle differences between them. It is important to understand what these differences are so that patients, family members, and the general public can better understand alcohol use disorders which affect themselves and their friends, family, and colleagues.

A Pattern of Alcohol Use

Alcohol use disorder is a pattern of alcohol use that involves various symptoms including, but not limited to: the inability to control alcohol consumption, being preoccupied with alcohol, the need to drink more to get the same desired effect, or going through a withdrawal when alcohol consumption is decreased or stopped.

Alcohol use disorder includes different levels of unhealthy alcohol use which is defined as any type of consumption that puts an individual's health and safety at risk, or may cause other problems. If a person's drinking results in repeated emotional or physical distress, it is likely that he or she has an alcohol use disorder. A clinician can diagnose an AUD based upon eleven criteria in the DSM-5. Furthermore, an AUD can range from being mild,to moderate, to severe.

The latest terminology was developed to help clinicians make a more informed, and accurate, decision on their diagnosis. Furthermore, it allows the diagnosis to individualized to the patient rather than diagnosing him or her with a broader term like alcohol abuse or alcohol dependency - which were the two terms previously used in the DSM-IV. It's worth noting that in a sample study of primary care patients who were considered to be heavy drinkers, the DSM-5's symptoms help clinicians to diagnose 13% more patients with AUD than the previous version of the manual.2

People who have been diagnosed with an AUD may or may not require inpatient treatment. In general, those who have a moderate to severe AUD will need, or benefit from, medical assistance. In the later severity, there is a probable risk of serious withdrawal symptoms which will need to be monitored by clinicians.

Alcohol Dependency

Alcohol dependency is a term previously used by clinicians who followed earlier versions of the DSM (DSM-IV, DSM-III, etc.). The term is still used by the World Health Organization, and clinicians who refer to the ICD-10. This manual, popular in the UK and Europe, diagnoses patients with either alcohol dependence or harmful alcohol use.

Alcohol dependence is defined by the WHO and ICD-10 as:

a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.3

Earlier classification systems has called this state alcoholism, but this term is generally no longer used by medical professionals.

Categorical terms for diagnosing the severity of alcohol dependence are not present in the ICD-10; however, they do in reality exist. Clinicians are encouraged to subdivide alcohol dependence into categories of mild, moderate, or severe - as noted in the DSM-5. In general people who have mild alcohol dependency will not need an assisted medical withdrawal. Whereas those who are considered to have a severe alcohol dependency disorder will need help with a withdrawal, typically through an inpatient treatment program.

Non clinicians may also refer to alcohol dependency (or alcohol dependent) over other terms because it is thought that the term itself is less harsh than others like alcoholic. Patients themselves may too prefer the former terminology; thereby, preventing a reduction in self worth or self esteem.

Harmful Alcohol Use

Harmful alcohol use, replaces non dependent use, and is considered to be a predecessor of alcohol dependency and defined as a pattern of psychoactive substance use that is causing damage to health. Damage includes physical health problems or mental health problems. It should be noted that harmful use could have social consequences, but these in and of themselves are not sufficient enough to justify a clinical diagnosis of harmful use. The closest term to harmful alcohol use is alcohol abuse.

When a person exhibits the symptoms of harmful alcohol use, they may have already experienced some of the preeminent symptoms of mild alcohol dependency, or mild AUD. At this point, very few people will actually take note of the issue and reduce their drinking or seek out help. Family members or close friends might believe a problem exists. Depending on the circumstances of their relationship, they may or may not choose to talk with the individual who is engaging in this type of behavior.

Alcohol Misuse

The term alcohol misuse is widely used in the UK, Ireland, and parts of Europe. In general, alcohol misuse is not a familiar term in the US or Canada. It is considered to be less harsh than alcohol abuse and used by clinicians to inform their patients of a potential problem.4 Alcohol misuse refers to excessive drinking, or in which the individual is drinking more than the suggested limits which include not consuming more than 14 units of alcohol per week. When alcohol misuse is suggested, there is an increased risk for alcohol induced harm.

Alcohol Abuse

The current accepted definition of alcohol abuse is similar to alcohol dependency in that both cause harm to the individual and those closest to them. The most notable difference is that in the case of alcohol abuse, the drinker can typically put limitations on their drinking. They are not physically addicted to alcohol and will not experience a withdrawal. A tolerance could be prevalent.

Binge drinkers are considered to be a type of alcohol abuser. People who are anti-social, experience frequent anxiety, or have pleasure seeking tendencies are also common abusers of alcohol. In general, these people are unable to control their drinking once they start. The key to understanding this term is not how much alcohol is consumed, but how it affects the drinker. Alcohol abuse often exhibits signs of an AUD or alcohol dependency, but to a lesser degree. Unfortunately, most people who abuse alcohol will not admit that there could be underlying problems which causes them to drink. There is also a very low chance of getting help from a clinician or treatment center.

Alcoholism and Alcoholic

Alcoholism, or alcoholic, is a common term used worldwide. It describes an impaired ability to limit the consumption of alcohol regardless of any consequences of use. Alcoholism meets the current definition of addiction which is a complex condition (sometimes also referred to as a disease) that is manifested by compulsive substance use despite any negative or harmful consequences. 5

The term is not used by the American Psychiatric Association nor is it used by clinicians in the UK or Europe. It is a clinical term used by certain medical organizations such as The American Public Health Association, and in this case refers to alcoholism being a disease.

Just as addiction can range from mild to severe so too can alcoholism.It typically refers to a severe or extreme severity; however, related problems are likely to have occurred long before this state. Many people believe that if they are not an alcoholic they don't need help. Furthermore, the term can be harsh to some men and women, leading them to feel upset, or ashamed about their drinking. This is one reason many clinicians elect to not use the term.

Drunk and Drunkard

A drunk, or drunkard, is a term used by non-clinicians and could even be considered slang for an alcohol abuser or alcohol dependent person, but this is not always true. A drunk may be so intoxicated with alcohol that they have lost control over their physical and cognitive functioning. Another way the term is used is when a person is considered to be drunk. In this case it is the physiological state that has been induced by alcohol. Whether or not they have a problem with alcohol is entirely circumstantial.

What is Alcoholism to the Non-Medical Community

Alcoholism is a generalized, typically broad term that may be used to describe a person who is severely dependent on alcohol. Someone who does not have a medical background may use the term to refer to a person who drinks too much, but alcoholism is much more than just that. When a person is considered to have alcoholism they will exhibit many symptoms as listed in the DSM-5.

The term alcoholic is mostly used in text published by Alcoholics Anonymous. Their book, The Big Book of AA states:

If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.

Alcoholics Anonymous and their members will not diagnose a member as being an alcoholic; rather, he or she is asked to make that decision on their own. AA meetings tend to not use the term Alcohol Use Disorder, but alcoholics with different types of severity will attend the groups.