Alcohol abuse

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the use of alcoholic beverages despite negative consequences. It is differentiated from alcohol dependence by the lack of symptoms such as tolerance and withdrawal. Alcohol abuse is sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse.

Epidemiology and Demographics

Prevalence

The 12 month prevalence of alcohol use disorder is:

• 4,600 per 100,000 (4.6%) in ages 12-17 years
• 8,500 per 100,000 (8.5%) in age group of 18
• 12,400 per 100,000 (12.4%) in adult men
• 4,900 per 100,000 (4.9%) in adult women

About 18% of American adults have had an alcohol abuse problem at some time in their life, in addition to about 12% who have also had an alcohol dependence problem. Significant correlations exist between alcohol abuse and other substance abuse disorders.

Diagnostic Criteria

DSM-V Diagnostic Criteria for Alcohol Use Disorder

“

A.A problematic pattern of alcohol use leading to clinically significant impairment or distress,as manifested by at least two of the following, occurring within a 12-month period: 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. b.Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Specify if: In early remission: After full criteria for alcohol use disorder were previously met,none of the criteria for alcohol use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use alcohol,” may be met). In sustained remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use alcohol,” may be met). Specify if: In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Specify current severity: Mild: Presence of 2-3 symptoms. Moderate: Presence of 4-5 symptoms. Severe: Presence of 6 or more symptoms.

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