According to the ICD 10, a definite diagnosis is made when three or more of the key features of dependence have been present at the same time during the previous year:
- a strong desire or sense of compulsion to drink alcohol
- difficulties in controlling drinking behaviour in terms of its onset, termination, or levels of consumption
- a physiological withdrawal state when drinking has stopped or been reduced, as evidenced by the characteristic alcohol withdrawal syndrome (tremor, sweating, anxiety, nausea and vomiting, agitation, insomnia) or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms—for example, benzodiazepines
- evidence of tolerance, such that increased quantities of alcohol are required to achieve the effects originally produced by lesser amounts
- progressive neglect of alternative pleasures or interests because of alcohol consumption, increased amount of time necessary to obtain or drink alcohol or to recover from its effects (1)
According to the DSM-V criteria for alcohol use disorder (AUD), problematic pattern of alcohol use causing significant impairment is diagnosed by experiencing at least two of 11 specific symptoms within a 12-month period, categorized into impaired control, social impairment, risky use, and physical dependence (tolerance/withdrawal). Severity is determined by the number of criteria met: mild (2-3), moderate (4-5), or severe (6 or more) and the following criteria with respect to alcohol use must be manifest during a 12 month period:
Impaired Control
- Drinking more or for longer than intended.
- Persistent desire or unsuccessful attempts to cut down/control use.
- Spending a lot of time obtaining, using, or recovering from alcohol.
- Craving or a strong desire/urge to drink.
Social Impairment
- Failure to fulfil major role obligations (work, school, home).
- Continued use despite persistent or recurrent social/interpersonal problems.
- Giving up or reducing important activities because of drinking.
Risky Use
- Recurrent use in physically hazardous situations (e.g., driving).
- Continued use despite knowledge of a physical or psychological problem caused by alcohol.
Physical Dependence
Tolerance: Needing significantly more alcohol for the desired effect, or a diminished effect with continued use.
Withdrawal: Experiencing characteristic withdrawal symptoms (e.g., shakiness, nausea, sweating) or drinking to relieve/avoid them.
Reference:
- Day E, Copello A, Hull M. Assessment and management of alcohol use disorders. BMJ. 2015;350:h715
- NICE. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. Clinical guideline CG115. Published February 2011, last updated October 2014