What Are the Eleven Symptoms of Alcohol Use Disorder?

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New research has found that alcohol use disorder (AUD) is an often untreated epidemic in the United States. This post highlights the 11 symptoms of alcohol use disorder based on new criteria for assessing alcohol abuse and dependence.

Globally, alcohol use disorder is one of the most prevalent mental-health disorders and leading causes of sickness and death. In the United States, alcohol use disorders and binge drinking have increased in recent years. Unfortunately, only 19.8 percent of adults with lifetime alcohol use disorder ever seek treatment or ask for help.

A study published in April 2015 reported that binge drinking in the United States is escalating. On average, heavy drinking among Americans rose 17.2 percent between 2005 and 2012.

The skyrocketing increase of alcohol consumption by American women is considered to be the driving force behind the nationwide escalation in the binge drinking rate. Across the nation, binge drinking among women increased more than seven times the rate among men.

The June 2015 study, “Epidemiology of DSM-5 Alcohol Use Disorder,” was published in JAMA Psychiatry. The study was led by Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (NIH).

The revised data is based on new guidelines published in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) for diagnosing alcohol use disorder. The study found a lifetime AUD prevalence of 29.1 percent and a 12-month prevalence of 13.9 percent. This represents approximately 68.5 million and 32.6 million adults, respectively.

The findings of the June 2015 study were based on a sample size of 36,309 adults. Researchers compared previous statistics based on diagnostic criteria (DSM-IV) to examine changes in prevalence of AUD under the new DSM-5 criteria.

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Across the board, there were differences in the corresponding rates of AUD when compared to the previous diagnostic criteria of DSM-IV. The authors emphasize that more research is needed to identify the reason for the increase and to explain discrepancies in the rates of AUD from previous years.

The changes in diagnostic criteria from the DSM-IV to the DSM-5 included the elimination of separate categories for alcohol abuse and dependence diagnoses. The DSM-5 also eliminated legal problems as a symptom, but added cravings to the 11 symptoms of AUD.

The new fact sheet, “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5,” includes a useful chart for comparing the old definitions of alcohol abuse and dependence with the new streamlined criteria for alcohol use disorder. The DSM-5 criteria have been combined into a single diagnosis of “alcohol use disorder” based on 11 symptoms.

The 11 Symptoms of Alcohol Use Disorder

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); b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

The presence of at least two of these symptoms indicates an alcohol use disorder (AUD). The severity of an AUD is graded mild, moderate, or severe:

• Mild: The presence of 2 to 3 symptoms.
• Moderate: The presence of 4 to 5 symptoms.
• Severe: The presence of 6 or more symptoms.

Alcohol abuse has the potential to destroy people's lives. Hopefully, raising awareness of the symptoms for diagnosing alcohol use disorders will lead more individuals to seek help if they have two or more of the 11 symptoms listed above.

In summing up the findings of their study, Bridget Grant and colleagues concluded, "Most importantly, this study highlighted the urgency of educating the public and policymakers about AUD [alcohol use disorder] and its treatments, destigmatizing the disorder and encouraging among those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment.”

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