Alcohol Use Disorder (AUD) is when people who have consistent issues with alcohol continue to drink to excess. A person with AUD has a strong desire for alcohol, a difficult time controlling its use, and continues using it even though it causes him significant distress and impairment. Even with serious consequences, the person places a higher priority on alcohol than the events and commitments in his life. With continued use, his tolerance to alcohol builds up.

AUD is a constant, reoccurring disease that leaves a person in a bad/pessimistic condition when he’s not using alcohol.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 16 million people in the nation have the disorder. An estimated 9.8 million men and 5.3 million women, who were 18 years and older, as well as 623,000 adolescents ages 12 to 17, were diagnosed with AUD in the U.S in 2015. The NIAAA reports that about 88,000 people die every year from alcohol-related causes. (https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics)

According to the Diagnostic Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which is published by the American Psychiatric Association, people with AUD fall into three degrees–mild, moderate or severe.

DSM-5 Criteria for AUD Diagnosis*

  • Consumed more alcohol or spent more time drinking than intended.
  • Want to limit or halt alcohol use, but haven’t succeeded.
  • Spends an inordinate duration drinking, being ill and undergoing the aftereffects of alcohol use.
  • Strong cravings for alcohol.
  • Consuming alcohol or becoming ill because of it has kept the person from properly attending to household duties and children, or resulted in difficulties performing on the job or at school.
  • Continued drinking in spite of it causing problems with family and loved ones.
  • Discontinue or are only sporadically involved with things that were once enjoyable or important to be able to drink.
  • Have repeatedly been in situations during the consumption of alcohol that have increased the chance of being injured (using machinery, driving).
  • Even though a person feels sad or distressed, or it affects an already existing health problem, the person continues to drink. Or, after episodes of forgetting or going blank about the events during drinking, the individual continues to use alcohol.
  • Have to increase drinking to get the results he wants. (The usual amount of alcohol provides little results.)
  • When alcohol wears off, causing symptoms like such as insomnia, difficulty staying asleep, aggravation, nervousness, sadness, stomach upset and nausea and/or perspiring. Or, the person felt items were there, but they are actually not.

*The DSM–5 eliminated legal problems and added craving as a criterion for an AUD diagnosis. It was not included in DSM–IV.

The following is a breakdown of what is considered mild, moderate and severe AUD, according to the DSM-5 criteria.

DSM-5 (305.00 F10.10) Mild AUD Diagnosis
The presence of two symptoms in the criteria signify mild AUD. (Mild AUD is sometimes referred to as “problem drinking.”)

DSM-5 (303.90 F10.20) Moderate AUD Diagnosis
When an individual has four to five criteria, the AUD diagnosis is considered moderate. (Moderate AUD is sometimes referred to as “problem drinking.”)

DSM-5 (303.90 F10.20) Severe AUD Diagnosis
Individuals who have six or more of the criteria are diagnosed with severe AUD.

What Causes AUD?

Health experts believe that AUD is caused by a combination of genes, the environment and psychological symptoms (low self-esteem, impulsiveness).

Alcohol dependency develops when a person drinks so much that it causes chemical changes in the brain, which increase the feelings of pleasure they have when using alcohol—making him want to drink more frequently even if it’s harmful. When the pleasurable feelings from alcohol go away, the person with AUD will drink in order to prevent withdrawal symptoms.

In severe AUD, the underlying change in brain circuits may even persist beyond detoxification. The behavioral effects of the brain changes may be shown in the repeated relapses and strong cravings when people with severe AUD are exposed to stimuli relating to alcohol.

What Are the Risk Factors for Alcoholism?

  • Men who have more than 15 alcoholic drinks a week or frequently have five or more drinks at one time. (One drink is 12 ounces of beer with five percent alcohol; five ounces of wine with 12 percent alcohol; or 1.5 ounces of liquor with 40 percent alcohol.)
  • Women who have eight or more drinks a week or have four or more drinks at one time.
  • Young adults dealing with peer pressure.
  • People with depression, bipolar disorder, anxiety disorders or schizophrenia.
  • Alcohol is easy to get.
  • Have low self-esteem.
  • Have difficulties with relationships.
  • A stressful lifestyle.

What are the Effects of Alcohol?

Some of the short-term effects of alcohol use/abuse are:

  • Increased emotional responses, such as outrage and hostility.
  • Decreased ability for body to function normally (can’t walk straight or barely).
  • Poor equilibrium.
  • Speech is slurred.
  • Sick in the stomach and regurgitating.
  • Dizziness.
  • Sleep is interrupted.
  • Alcohol alters the body in phases, resulting in restfulness, exhilaration, enthusiasm, disoriented and stupor.
  • Serious use of alcohol can cause loss of memory or blackouts, entire lack of functioning (walking) and alcohol overdose that may result in death.

The effects of alcohol can do damage to the tissues in the body, including:

  • Increase stomach acid secretion, which causes vomiting.
  • Increase of blood flow to the epidermis, resulting in sweatiness and flushing.
  • Reduction of blood flowing to the tendons causes aches, which is most apparent when the alcohol is gone from the body (hangover).

The long-term effects of alcohol abuse are:

  • Reliance on alcohol.
  • The body is affected and shows signs when abruptly stopping or greatly reducing alcohol use.
  • Withdrawal symptoms.

What is DSM-5 (291.0 F10.231) Alcohol Withdrawal Delirium?

Alcohol Withdrawal Delirium (AWD) is the gravest type, causing sudden and serious neurological problems. It is estimated that 50 percent of individuals with alcohol addiction will experience AWD if they suddenly stop using alcohol. Between three to five percent of the individuals will experience signs of tonic-clonic seizures, as well as serious confusion.

The causes of AWD, which affects individuals who have a history of heavy alcohol use, are if they stop drinking abruptly; lessen the amount too abruptly; fail to consume nourishing foods and/or don’t consume an adequate amount of food when they reduce their alcohol use; have damage to the skull; and are ill or are diagnosed with some type of infection.

When the body relies on alcohol during the span of a long period, the brain is not able to adapt to a lack of alcohol. Alcohol suppresses certain neurotransmitters in the brain—the information-carriers–and makes a person feel relaxed. However, when the information-carriers are not being suppressed any longer—and have to labor more to fight the suppression—they change to being in a frenzied condition. That is why abruptly stopping drinking or greatly reducing the alcohol use can cause AWD.

What are the Treatments for AUD?

Depending on the need, AUD treatment may include individual or group counseling, an outpatient program or a residential, inpatient stay. Treatments may include the following.

  • Treatment may start with detoxification, which is withdrawal that is managed by medical professionals. It usually takes from two to seven days and may include taking medications to prevent withdrawal symptoms. The “detox” is usually at an inpatient treatment center or at a hospital.
  • Therapy for groups and individuals helps to educate a person about alcohol dependency and the support he needs during recovery. Couples or family therapy may be beneficial, especially because family members can be integral in the process of recovery.
  • Support groups for recovering from AUD help the person to manage relapses and learn to cope with changes in his lifestyle.
  • Severe AUD may require staying at a residential treatment center, which may include individual and group therapy, support groups, informational sessions, activity therapy and participation by family members.

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