An AUD, or alcohol use disorder, is a term defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to describe a person struggling with alcohol addiction. Aside from AUD, you may have heard many terms to describe an unhealthy relationship with alcohol: alcoholism, alcohol abuse, or alcohol dependence, among others. But what is the relation between these terms?
What is Alcohol Use Disorder?
Prior editions of the DSM categorized substance addictions–including alcohol addiction–under two terms: dependence and abuse.
Substance dependence, according to the DSM-IV, was diagnosed in individuals who “continu(e) use of the substance despite significant substance-related problems” (p. 176). Substance abuse, however, was classified by “recurrent and significant adverse consequences related to the repeated use of substances” (p. 182).
However, in the DSM-5, both of these conditions were grouped together under one label: alcohol use disorder.
Research from the National Institute on Alcohol Use and Alcoholism in 2015 shows that 15.1 million adults (6.2% of adults) have AUD. Another 2.5% of adolescents age 12-17 have AUD. About 88,000 people die every year from alcohol-related causes.
AUD vs. Alcoholism
Alcoholism is just a colloquial term for alcohol use disorder.
If you are attending a meeting of Alcoholics Anonymous, a large support network for those struggling with their relationship with alcohol, you will hear the term “alcoholism” far more commonly. Alcoholic is also a common term in our everyday vocabulary.
However, if you are speaking with a therapist or clinician about your alcohol use, they will likely use the term alcohol use disorder over alcoholism.
How is Alcohol Use Disorder Classified?
According to the DSM-5, drugs (including alcohol) activate a reward system in the brain, causing a pleasurable feeling which leads to the neglect of “normal” behaviors. Alcohol use disorder is therefore classified as one of many substance abuse disorders, which include gambling.
There are 11 criteria that the DSM-5 cites as determining factors in alcohol use disorder. Presenting 2-3 symptoms within a 12-month period indicates mild AUD; 4-5 symptoms indicate moderate AUD, and 6 or more symptoms indicate severe AUD.
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499-500)
b. Alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms.DSM-5, p. 490-91
The DSM-5 further discusses the environmental factors that may lead to an alcohol use disorder (notably our culture’s encouragement of drinking in social situations), as well as the high genetic influence toward an individual’s risk for developing an AUD. AUD also tends to co-occur with other mental illnesses including bipolar disorder, schizophrenia, antisocial personality disorder, anxiety, and depression.
Getting Help For An AUD
While the National Institute on Alcohol Abuse and Alcoholism estimates that about 15.1 million adult Americans have AUD, only about 6.2% of these individuals receive treatment.
If the above list of criteria has you worried about your relationship with alcohol, or that of a loved one, know that you are not alone and help is available to you.
However, no single method of treatment for AUD can help everyone. It may take some time before you find a method that works best for you. Because of this, it can be especially important for individuals with AUD to have a support system willing to stick with them while they try several different types of recovery.
One of the most prevalent resources for AUD recovery is Alcoholics Anonymous. You can find local AA meetings here.
Some people that do not believe in God or a “higher power” may be wary of attending Alcoholics Anonymous. While AA can be perfectly secular with some modification to the 12 steps, there are other secular programs that atheists or agnostics might find more beneficial.
There are also some medications that have been proven to help treat AUD in extreme cases, and many options for inpatient rehab.
And last but not least, a substance abuse counselor can be an invaluable tool for your AUD. They can help dive into the reasons you turn to alcohol, the triggers you need to avoid, and how to be sure you stay on the path of recovery.