What is Alcohol Use Disorder or AUD? Is it just a new name for alcoholism? Or is it something else? Here are the facts.

DSM: Alcohol Use Disorder

Doctors and mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM). They use it because it defines mental disorders and illnesses. The fifth edition is DSM-5. It appeared in 2013. It’s also very important because it’s used for insurance billing purposes.

DSM-5 categorizes people who have two or more of the following in a 12-month period as having AUD.

• • Becoming sick for an extended period of time from drinking.
  • Continuing to drink despite problems caused by family or friends.
  • Continuing to drink despite adding to another health problem. Feeling depressed, or anxious, or blacking out. (Click to find out how blacking out is different from losing consciousness.)
  • Decreased activities which were once important.
  • Drinking more or for a longer time than intended.
  • Drinking more to get the same effect. That is, alcohol tolerance.
  • Feeling unable to cut back on how much you consume.
  • Finding yourself in harmful or dangerous situations because of drinking.
  • Having withdrawal symptoms. Such things as such as trouble sleeping, shakiness, restlessness, or nausea. Or sweating, a racing heart, a seizure, or seeing or hearing things that aren’t there? 
  • Inability to concentrate because of alcohol cravings.
  • Inability to keep a job, care for a family, or perform in school.

Alcohol Use Disorders

DSM-5 categorizes people as follows.

• • Two to three: Mild AUD.
  • Four to five: Moderate AUD.
  • Six or more: Severe AUD.

The previous edition (DSM-4) appeared in 1994. It identified two categories. One was alcohol abuse. The other was alcohol dependence. But many people thought dependence means addiction. It doesn’t. Instead, it refers to alcohol tolerance and inability to stop drinking without having withdrawn symptoms.

Criticisms of Alcohol Use Disorders

Some point out that the new definition greatly increases the number of those with AUD. For example, young people who sometimes binge drink and crave a cold beer on a hot day. and find it hard to study. Yet they would have AUD! Thus, they would mislabeled as alcoholics. Doing that could follow them throughout life on their medical records. 

The director of the National Institute of Mental Health (NIMH) says it lacks validity. That it classifies too many people with AUD. As a result, the NIMH is developing objective criteria. The NIMH wouldn’t rely on self-reports as does DSM-5.

A.A.

A.A. would strongly disagree with the new definition. First, it prefers the terms “alcoholic” and “alcoholism.” Second, A.A. believes that there is no continuum.

A.A. states that “Once problem drinkers cross over the line into alcoholism, however, they cannot turn back.” Or as members usually say more simply, “Once a pickle, never a cucumber.”

Moreover, A.A. teaches that alcoholics

• • Suffer from an incurable disease.
  • Must submit their will to that of God or a Higher Power.
  • Are powerless over their alcoholism.
  • Will never be able to drink any alcohol for the rest of their lives.
  • Must be constantly be on guard against “slips.”

NIAAA

But NIAAA research shows that alcoholism is curable. In fact, it found “Many people with AUD do recover, but setbacks are common.” And most recover on their own with no outside help.

Alcoholism

Alcoholism was a medical term used in early editions of the DSM. But it is no longer used as such. But doctors and other health professionals use the term informally. As do most people. 

Resources: Alcohol Use Disorder

Web Pages

• • Alcoholics Can Recover.
  • Is Alcoholism a Disease?
  • The Road to Recovery.
  • Is Alcoholism an Allergy? 
  • Does A.A. Work?
  • Alcoholic Loss of Control.
  • Understanding Alcoholism.
  • This is A.A.
  • Many Doctors Reject Alcoholism as a Disease.

Readings

• • A.A. Alcoholics Anonymous. NY: A.A., 2008.A.P.A. DSM. Wash: A.P.A., 1952. (1st ed.)
  • _____. DSM-2. Wash: APA, 1968. 
  • _____. DSM-3. Wash: APA, 1980.
  • Cooper, R. Diagnosing the DSM. London: Routledge, 2019.
  • ____. Classifying Madness. Dordrecht: Springer, 2005. 
  • Haynes, S. and Hofmann, S. (Eds.) Beyond the DSM. Oakland, CA: Context, 2020.
  • Johnson, B. The Rehab Myth. DaCap, 2010.
  • Thatcher, R. Fighting Firewater Fictions. Toronto: U Toronto, 2018.

Historical Note

Learn about Dr. Leslie Keeley’s “gold cure.” He had over over 200 clinics or Keeley Institutes. And they were in several countries. See more at “Alcoholism is a Disease and I Can Cure It.”