Alcohol Use Disorder – Overview
According to the U.S. National Survey on Drug Use and Health in 2015, approximately 15.1 million adults, or 6.2% of the population, met the criteria for Alcohol Use Disorder. A further 623,000 adolescents, boys and girls between 12 and 17, live with a person who has AUD. The survey uses the term Alcohol Use Disorder, which may cause confusion for readers without a medical background. This is particularly true because previous surveys used the terms alcoholism, alcoholic, and alcohol abuse. Adding to this, popular support groups such as Alcoholics Anonymous continue to use the term alcoholism in meetings, books, and manuals.
Alcohol Use Disorder (AUD) is the most recent term used in official diagnoses by doctors and other healthcare professionals who follow the DSM-5, a diagnostic manual widely used in North America. In the past, other terms have been used, including alcohol misuse, alcoholism, alcohol addiction, and alcohol dependency. These terms are often used interchangeably by clinicians and non-clinicians, but there are subtle differences between them. Understanding these distinctions helps patients, family members, and the general public better interpret alcohol-related conditions affecting themselves, friends, family, and colleagues.
A Pattern of Alcohol Use
Alcohol use disorder is a pattern of alcohol use that involves various symptoms, including, but not limited to, the inability to control alcohol consumption, being preoccupied with alcohol, needing to drink more to achieve the same effect, or experiencing withdrawal when alcohol use is reduced or stopped.
Alcohol use disorder includes different levels of unhealthy alcohol use, defined as any consumption that puts an individual’s health and safety at risk or may cause other problems. If a person’s drinking results in repeated emotional or physical distress, it is likely that he or she has an alcohol use disorder. A clinician can diagnose AUD based on eleven criteria in the DSM-5. An AUD can range from mild to moderate to severe.
The updated terminology was developed to help clinicians make more informed and accurate diagnoses. It also allows the diagnosis to be individualized rather than applying broader terms such as alcohol abuse or alcohol dependency, which were used in the DSM-IV. In a sample study of primary care patients considered to be heavy drinkers, the DSM-5 criteria enabled clinicians to diagnose approximately 13% more patients with alcohol use disorder than the previous version.
People diagnosed with an AUD may or may not require inpatient treatment. In general, those with moderate to severe alcohol use disorder may need or benefit from medical assistance. At higher levels of severity, there is a risk of serious withdrawal symptoms that require clinical monitoring. For those seeking professional help, consider exploring our alcohol rehab in Thailand.
Alcohol Dependency
Alcohol dependency is a term previously used by clinicians who followed earlier versions of the DSM (DSM-IV, DSM-III, and earlier). The term is still used by the World Health Organization and by clinicians who reference the ICD-10. This manual, widely used in the UK and Europe, diagnoses patients with either alcohol dependence or harmful alcohol use.
Alcohol dependence is defined by the WHO and ICD-10 as:
a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.
Earlier classification systems referred to this state as alcoholism, but this term is generally no longer used by medical professionals.
Although the ICD-10 does not formally categorize the severity of alcohol dependence, these distinctions exist in practice. Clinicians may subdivide alcohol dependence into mild, moderate, or severe categories, consistent with DSM-5 guidance. Individuals with mild alcohol dependency may not require medically assisted withdrawal, whereas those with severe alcohol dependency typically require withdrawal support, often through an inpatient treatment program.
Non-clinicians may prefer the term alcohol dependency (or alcohol dependent) because it is perceived as less harsh than terms such as alcoholic. Some patients also prefer this terminology, as it may reduce negative self-perception or stigma.
Harmful Alcohol Use
Harmful alcohol use replaces the term non-dependent use and is considered a precursor to alcohol dependency. It is defined as a pattern of psychoactive substance use that is causing damage to health. Damage may include physical or mental health problems. Harmful use may also have social consequences, but these alone are not sufficient for a clinical diagnosis. The closest related term is alcohol abuse.
When a person exhibits symptoms of harmful alcohol use, some early features of mild alcohol dependency or mild alcohol use disorder may already be present. At this stage, many individuals do not reduce their drinking or seek help. Family members or close friends may recognize a potential issue, although whether it is addressed often depends on the nature of the relationship.
Alcohol Misuse
The term alcohol misuse is widely used in the UK, Ireland, and parts of Europe, but it is less commonly used in the US or Canada. It is generally considered less severe than alcohol abuse and is used by clinicians to alert patients to potential risk. Alcohol misuse refers to excessive drinking, including consumption above recommended limits, such as more than 14 units of alcohol per week. When alcohol misuse is identified, there is an increased risk of alcohol-related harm.
Alcohol Abuse
The accepted definition of alcohol abuse is similar to alcohol dependency in that both may cause harm to the individual and others. A key distinction is that individuals who abuse alcohol can often impose some limits on their drinking. They are not typically physically dependent on alcohol and do not experience withdrawal, although tolerance may be present.
Binge drinkers are commonly classified as a form of alcohol abuse. Individuals who experience frequent anxiety, exhibit antisocial behavior, or have strong pleasure-seeking tendencies may also fall into this category. In many cases, these individuals struggle to control their drinking once it begins. The defining factor is not the amount consumed, but how alcohol affects the person. Alcohol abuse may share some features with alcohol use disorder or alcohol dependency, but to a lesser degree. Many individuals who abuse alcohol do not recognize underlying issues or seek professional help.
Alcoholism and Alcoholic
Alcoholism, or alcoholic, is a commonly used term worldwide. It describes an impaired ability to limit alcohol consumption despite negative consequences. Alcoholism aligns with the broader definition of addiction, a complex condition characterized by compulsive substance use despite harmful outcomes.
The term is not used by the American Psychiatric Association and is generally not used by clinicians in the UK or Europe. Some medical organizations, such as the American Public Health Association, use the term in reference to alcoholism as a disease.
As with addiction, severity can range from mild to severe, although the term alcoholism often implies more advanced severity. Related problems typically develop well before this stage. Some individuals believe that if they are not an alcoholic, they do not need help. The term may also feel stigmatizing to some people, which is one reason many clinicians avoid using it.
Drunk and Drunkard
Drunk, or drunkard, is a non-clinical term and may be considered slang for an individual who abuses alcohol or is alcohol dependent, although this is not always accurate. A person described as drunk may be acutely intoxicated and temporarily impaired in physical or cognitive functioning. In other contexts, the term simply refers to the physiological state caused by alcohol. Whether a person has an underlying alcohol-related condition depends on individual circumstances.
What is Alcoholism to the Non-Medical Community
Alcoholism is often used as a broad, non-medical term to describe someone perceived to be severely dependent on alcohol. Individuals without medical training may use the term to describe heavy drinking, although alcoholism encompasses more than consumption alone. When a person meets criteria associated with alcoholism, multiple symptoms described in the DSM-5 are typically present.
The term alcoholic is commonly used in Alcoholics Anonymous materials. Their book, The Big Book of AA, states:
If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.
Alcoholics Anonymous does not diagnose members as alcoholic. Individuals are encouraged to make that determination themselves. AA meetings generally do not use the term Alcohol Use Disorder, although people with varying levels of alcohol-related severity may attend.
