Alcohol use disorder is a mental health diagnosis established in 2013 by the American Psychiatric…
More People Being Diagnosed With Alcohol Abuse
In May 2013, the American Psychiatric Association (the primary source for mental illness definitions in the U.S.) replaced separate criteria for the diagnosis of alcohol abuse and alcoholism with a single set of criteria for a condition called alcohol use disorder. This disorder encompasses all cases of damaging, dysfunctional alcohol consumption. In a study review published in September 2014 in the journal Addictive Behaviors, researchers from Italy and the United Kingdom looked at the impact that the shift to alcohol use disorder has had on the number of people who qualify for a diagnosis of problematic alcohol use.
Alcohol Abuse and Alcoholism
Alcohol abuse is the common term for a damaging pattern of alcohol intake that occurs in a person not affected by a physical dependence on alcohol. Conversely, the chief characteristic of alcoholism (i.e., alcohol dependence) is a physically established need to keep drinking. Before May 2013, the American Psychiatric Association (APA) used a total of four potential symptoms to identify cases of alcohol abuse; a minimally affected person had to have at least one of these four symptoms within any given 365-day time period. Before 2013, the APA used a total of seven potential symptoms to identify cases of physically dependent alcoholism; a minimally affected person had to have at least three of these symptoms within any given 365-day time period. The APA guidelines required doctors to treat alcohol abuse and alcoholism as separate issues. This standard meant that the symptoms of one condition could not be used to support a diagnosis of the other condition.
Alcohol Use Disorder
Doctors diagnosing patients with alcohol abuse and alcoholism have long known that physically dependent alcohol consumers sometimes develop symptoms associated with non-dependent abuse. They have also long known that non-dependent alcohol consumers can develop symptoms that are essentially indistinguishable from some of the symptoms used to diagnose alcoholism. In addition, for well over a decade researchers in the field have accumulated evidence that shows that alcohol abuse and alcoholism are better understood as opposite ends of an overlapping spectrum of problems rather than as separate entities. When the APA released the latest edition of its main guidebook — the Diagnostic and Statistical Manual of Mental Disorders or DSM — in 2013, it validated doctors’ observations and the growing research consensus by removing separately diagnosable alcohol abuse and alcoholism and replacing them with alcohol use disorder. Diagnosis of this disorder requires the presence of at least two (out of a total of 11) symptoms that point toward the presence of alcohol abuse and/or alcoholism.
Impact on the Number Affected
In the study review published in Addictive Behaviors, researchers used an analysis of information previously gathered by other researchers to determine if the new alcohol use disorder definition has increased the number of people affected by diagnosable alcohol problems. Such an increase is possible largely because the number of symptoms required to diagnose alcohol use disorder is lower than the number of symptoms previously required to diagnose alcoholism or alcohol dependence.
All told, the researchers included 12 studies conducted throughout the world in their review. Each of these studies compared some aspect of the prevalence of separately defined alcohol abuse and alcoholism to the prevalence of alcohol use disorder. The researchers concluded that seven of the studies indicated an increase in the number of people diagnosed with alcohol problems after the introduction of the new criteria for alcohol use disorder. Two of the studies pointed toward no meaningful difference in the number of people diagnosed, while the three remaining studies indicated a decrease in the number of people diagnosed with alcohol problems after the introduction of alcohol use disorder.
All things considered, the study’s authors concluded that the replacement of separately diagnosable alcohol abuse and alcohol dependence with alcohol use disorder has been accompanied by a notable increase in the percentage of the world’s population affected by alcohol problems. While this increase may reflect a wider trend in alcohol consumption, it probably primarily reflects a rise in the number of people with pre-existing, non-diagnosable dependence-related problems who now qualify for an alcohol use disorder diagnosis. The authors urge future researchers to investigate the possibility of similar changes in the percentage of people affected by other substance problems, since the switch to alcohol use disorder reflects a larger American Psychiatric Association move to group issues of abuse and addiction together under a single heading (e.g., opioid use disorder, stimulant use disorder, cannabis use disorder, etc.).