Alcohol Use Disorder

by

Shulamith Lala Ashenberg Straussner, Sarina Beth Straussner, Stanley (Shlomo) Einstein

• LAST REVIEWED: 22 February 2018
• LAST MODIFIED: 22 February 2018
• DOI: 10.1093/obo/9780195389678-0025

Introduction

Millions of individuals use alcohol every day; however, not everyone experiences a problem due to such use. It is therefore helpful to conceptualize alcohol use as ranging on a continuum from nonproblematic social use (e.g., a glass of wine with dinner); to alcohol misuse (e.g., a one-time incident of binge drinking); to excessive use or abuse (e.g., frequent use of alcohol that results in a negative impact on the life of the individual and those around him or her, such as recurrent driving under the influence of alcohol); and finally, to physical dependence or addiction to alcohol (e.g., a chronic disorder that may require medical detoxification and/or formal treatment). While not used professionally, the commonly used term alcoholism has been used synonymously with alcohol addiction and refers to the compulsive use of alcoholic beverages. Both terms imply a progressive deterioration of the individual’s social, physical, and mental status combined with the inability to stop using alcohol even when wishing to do so. Although the professional literature on alcohol use problems is extensive and can be found in almost every country in the world, the inconsistent use of terminology is often confusing. There are tremendous overlaps among literature on topics such as alcohol-related problems, risky drinking, hazardous drinking, alcohol abuse and dependence, substance abuse, and alcohol addiction. The confusion has been compounded by the changes in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5; Washington, DC: American Psychiatric Association, 2013), which eliminated the previous diagnostic classifications of “alcohol abuse” and “alcohol dependence” and replace them with the overall category of “Alcohol Use Disorders” (AUD), which itself is part of the broader new DSM-5 category of “Substance-Related and Addictive Disorders.” A fuller discussion of the DSM changes can be seen in S. Lala A. Straussner’s 2013 article “The DSM–5 diagnostic criteria: What’s new?” Journal of Social Work Practice in the Addictions. Research studies in the United States indicate a general decrease in the proportions of individuals with “pure” alcohol use diagnosis and an increase among those using multiple substances. Consequently, the topic of alcohol-use disorders needs to be considered within the context of the literature on problematic use of a variety of other chemical substances as well as other addictions, such as gambling and smoking. It also needs to take into account co-occurring mental disorders; age, gender, and sexual identity of users; socioeconomic and psychological issues; family dynamics; and ethnocultural factors. Finally, research and treatment focusing on AUD must be viewed within the context of governmental policies, which vary over time and in different locations.

General Overview

The literature in this section provides general background information on the nature of AUD and its prevalence in both the United States and other countries. The first reference is to the US government publication Alcohol Research: Current Reviews (ARCR), which is available on the National Institute of Alcohol Abuse and Alcoholism website and provides free, state-of-the-art on-line publications on a variety of topics related to alcohol use disorders. World Health Organization’s (WHO) 2014 Global Status Report on Alcohol and Health, The National Institute for Health and Clinical Excellence 2011; Grant, et al. 2015; and Substance Abuse and Mental Health Services Administration (SAMHSA) 2015 are good sources for recent prevalence rates of alcohol problems in different parts of the world, the United Kingdom and the United States, respectively. Straussner 2014 offers an overview of the issues involved in understanding alcohol problems and the process for assessing and helping individuals impacted by such problems, while Willenbring 2010 summarizes the progress made in this field through well-known research studies over the past four decades. Vaillant 2003, a classic longitudinal study, documents the effects on alcoholic men over a sixty-year time span.

• Alcohol Research: Current Reviews (ACRC). 1976–.

  A bi-annual, peer-reviewed scientific journal (formerly known as Alcohol Research & Health), offers a wealth of rigorously researched studies focusing on alcohol and related topics. Issues of this journal are indexed in PubMed. In addition, a topic index of journal articles from 2008 to date is available on website.

• Grant, Bridget F., Risë B. Goldstein, Tulshi D. Saha, et al. 2015. Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry 72.8: 757–766.

  DOI: 10.1001/jamapsychiatry.2015.0584

  This publication provides twelve-month and lifetime prevalence rates of DSM-5 AUD and correlates, including psychiatric comorbidity, associated disabilities, and treatment according to severity level (mild, moderate, or severe). The authors conclude that AUD as defined by DSM-5 criteria is a highly prevalent, highly comorbid, disabling disorder, that is often untreated in the United States, with only 19.8% of respondents with lifetime AUD ever treated for it.

• National Institute for Health and Clinical Excellence. 2011. Alcohol-use disorders: The NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical practice guidelines 115. Leicester, UK: British Psychological Society.

  About 4 percent of the United Kingdom population is alcohol dependent. This guideline reviews the evidence for the assessment and diagnosis of alcohol use disorders, organization and delivery of care, assisted alcohol withdrawal, and psychological and pharmacological interventions.

• Straussner, S. Lala A. 2013. The DSM–5 diagnostic criteria: What’s new? Journal of Social Work Practice in the Addictions 13.4: 448–453.

  DOI: 10.1080/1533256X.2013.840199

  This article provides background information on the overall changes in the DSM over the years, and an in-depth discussion of the revisions from DSM-IV to DSM-5 as they relate specifically to the new category of “Substance-Related and Addictive Disorders.” The article focuses on the elimination of the diagnostic classifications of “alcohol abuse” and “alcohol dependence” and their replacements with the term of “Alcohol Use Disorders” (AUD), which is then stratified by severity based on how many symptoms are met: mild disorder (two or three symptoms), moderate disorder (four or five symptoms), or severe disorder (six or more symptoms). The higher end of severity is equivalent to the DSM–IV “substance dependence” diagnosis.

• Straussner, Shulamith L. A. 2014. Assessment and treatment of clients with alcohol and other drug abuse problems: An overview. In Clinical work with substance-abusing clients. 3d ed. Edited by Shulamith L. A. Straussner, 3–36. New York: Guilford.

  This chapter provides an overview of the issues related to the scope, diagnosis, assessment, and treatment of alcohol problems (and other drugs) as they relate to social work clinicians.

• Substance Abuse and Mental Health Services Administration (SAMHSA). 2015. Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Washington, DC: Substance Abuse and Mental Health Services Administration (SAMHSA).

  This collection of tables presents national estimates based on data from the U.S. National Survey on Drug Use and Health (NSDUH). The tables include information on both youths aged twelve to seventeen and adults eighteen or older focusing on alcohol, tobacco and illicit drug use, substance use disorder prevalence, treatment, health topics, and alcohol consumption.

• Vaillant, George E. 2003. A 60-year follow-up of alcoholic men. Addiction 98.8 (August): 1043–1051.

  DOI: 10.1046/j.1360-0443.2003.00422.x

  Describes the course of problems for male alcoholics from age twenty to age eighty of two community cohorts: Harvard students and inner-city adolescents. By age seventy, chronic alcohol dependence in each group was rare due either to death or stable abstinence. Alcoholics Anonymous attendance predicted sustained abstinence. Available online for purchase or by subscription.

• Willenbring, Mark L. 2010. The past and future of research on treatment of alcohol dependence. Alcohol Research & Health 33.1–2: 55–63.

  Over the past forty years, alcoholism treatment research has moved from anecdotal findings to well-designed studies. The National Institute on Alcohol Abuse and Alcoholism’s Project MATCH and Project COMBINE, as well as data from the National Epidemiologic Survey on Alcohol and Related Conditions, provided the foundation for problem definitions and new treatment approaches.

• World Health Organization (WHO). 2014. Global Status Report on Alcohol and Health. Geneva, Switzerland: WHO Publications.

  This report was developed within the framework of WHO activities on global monitoring of alcohol consumption, alcohol-related harm and policy responses. It provides detail information about alcohol use and problems in different regions of the world.