Recognizing Problematic Alcohol Use and Alcohol Use Disorder

Alcohol use disorder (AUD) is a medical condition in which it is difficult to control or stop drinking despite alcohol causing adverse health, occupational, or social consequences.¹ If you think you may be struggling with an AUD and are researching alcohol rehabilitation, you may be wondering how the disorder is diagnosed.

To assess whether a person has an AUD, healthcare professionals use a set of 11 criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5).¹ There are also assessment instruments and screening tests used by primary care physicians and other healthcare providers, which intend to help them to understand their patients drinking as well as screen for unhealthy alcohol use. They can then provide brief alcohol counseling where they raise awareness with patients on what constitutes unhealthy alcohol use and refer patients for further assessment and treatment as needed.

A diagnosis of AUD may indicate that specialized treatment is needed.² Unfortunately, unhealthy alcohol use often goes unrecognized, and AUD can go undiagnosed for many reasons. In some cases, primary care physicians simply do not discuss alcohol or drug use with patients. This can be due to a lack of training or awareness on how to recognize or talk with their patients about their alcohol or drug use.

In other cases, fear of stigmatization may result in people withholding information that would be helpful for their doctor or general healthcare provider to know.³ Withholding information or avoiding discussions about alcohol or drug use can prevent a person from receiving the education and care they need.³

There have been increased efforts on the part of the general medical community for physicians to help patients better understand their relationship with alcohol and help them to take the necessary measures to cut back.^{4, 5}

If you are struggling with alcohol use, talking to your doctor or healthcare provider is important. This article discusses the criteria used to diagnose AUD and other ways healthcare professionals assess a patient’s relationship with alcohol.

Problematic Alcohol Use, Misuse, and Alcohol Use Disorder

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines alcohol misuse as alcohol consumption in any amount, frequency, manner, or situation that could harm a person or the people around them.⁶ This includes binge drinking, heavy drinking, and high-intensity drinking:⁶

• Binge drinking is defined by the NIAAA as a pattern of drinking that raises a person’s blood alcohol concentration (BAC) to the legal limit of 0.08% or higher. This typically occurs after consuming 4 or more drinks (women) or 5 or more drinks (men) in a 2-hour period.
• Heavy drinking is defined by the NIAAA as consuming more than 3 drinks on any day or more than 7 drinks per week (women) and more than 4 drinks on any day or more than 14 drinks per week (men).
• High-intensity drinking refers to consuming 2 or more times the gender-specific threshold for binge drinking. This includes 8 or more drinks for women and 10 or more drinks for men.

Problematic patterns of alcohol use and alcohol misuse not only increase a person’s risk of developing an AUD but may also increase a person’s risk of experiencing other alcohol-related illnesses.¹

How Are Patients Evaluated for Problematic Drinking?

If you or someone you care about are concerned about patterns of alcohol use or are considering treatment, talking to your doctor can be an important first step as they can:⁷

• Evaluate a person’s drinking patterns.
• Evaluate a person’s overall health.
• Help create a treatment plan or a plan to reduce alcohol use.

In some cases, they may refer you to a mental health practitioner or substance use specialist who can perform a more thorough assessment and discuss other treatment strategies.²

DSM-5 Alcohol Use Disorder Criteria

Psychiatrists and mental health specialists diagnose an alcohol use disorder based on a patient displaying 2 or more criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) within a 12-month period. These criteria include:⁸

• Drinking for longer periods or in larger quantities than intended.
• Making efforts to cut down or stop drinking but being unsuccessful.
• Spending a significant amount of time finding alcohol, drinking alcohol, or recovering from the effects of alcohol.
• Experiencing a strong desire or craving to drink alcohol.
• Continuing to drink even though you are experiencing alcohol-related relationship problems.
• Difficulty keeping up with responsibilities at home, school, or work.
• Giving up social, recreational, or other activities because of alcohol use.
• Continuing to use alcohol despite having psychological or physical problems caused by or worsened from alcohol.
• Consuming alcohol in physically hazardous situations, such as driving a vehicle.
• Tolerance, or needing more alcohol to feel the same effects at the previously lower dose or feeling diminished effects when using the same amount of alcohol.
• Experiencing alcohol withdrawal symptoms after stopping drinking or drinking alcohol to avoid experiencing withdrawal symptoms.

The severity of AUD is determined by the number of criteria met within the 12-month period:⁸

• 2–3 criteria present indicates mild AUD.
• 4–5 criteria present indicates moderate AUD.
• 6 or more criteria present indicates severe AUD.

Other Tools Used to Assess Problematic Drinking

Other tools can be used to identify patients in whom problematic alcohol use or alcohol misuse may be adversely impacting their health and wellbeing. This can alert clinicians and patients to the potential need to initiate some form of treatment intervention. The U.S. Preventive Services Task Force (USPSTF) recommends 2 brief screening tools for adults:⁹

• The Alcohol Use Disorders Identification Test–Consumption (AUDIT-C): This 3-question screening test assesses a patient’s drinking frequency and quantity. The higher a patient’s score, the more likely they are to be experiencing negative health and safety consequences due to alcohol consumption.
• The NIAAA Single Alcohol Screening Question (SASQ): This single-item screening test asks, “How many times in the past year have you had (4 for women, or 5 for men) or more drinks in a day?” Following a positive screen, a healthcare provider may ask additional questions to get a more accurate picture of a patient’s drinking patterns.

While these screening tools may be used for many adults, healthcare providers may use additional screening tools and resources to assess problematic alcohol use or alcohol misuse in adolescents, culturally diverse populations, and pregnant women.⁹

Getting Help

If you think you or someone you care about are struggling with alcohol use, speaking openly and honestly with your doctor can be an important first step.

You and your doctor may determine that you need additional assistance to stop drinking. If that is the case, there are several treatment options available. Treatment for alcohol addiction not only addresses a person’s problematic drinking patterns but also several other individual factors; there’s no one size fits all treatment approach. Treatment can be inpatient or outpatient, can vary in the time commitment required and duration, and may include any number of evidence-based interventions, including behavioral therapies, psychotherapy, counseling, medications for AUD, family therapy, and peer support groups.⁷

If you aren’t sure where to start, American Addiction Centers (AAC) is here to help. You can call to speak with an admissions navigator who can answer questions you have about treatment, help you find treatment near you, and verify your insurance.