Diagnostic Criteria

NIAAA Guideline for Low-Risk Alcohol Use

The National Institute on Alcoholism and Alcohol Abuse (NIAAA) has provided a definition of low-risk drinking. If your alcohol use is within these limits, you are likely not at risk for AUD or its associated health complications. For women, low-risk drinking is defined as no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA research shows that only about 2 in 100 people who drink within these limits have AUD.

 

Clinical Diagnosis of AUD

DSM-5 Criteria:  Alcohol Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosis, and provides a common language for clinicians to communicate about their patients. It also establishes consistent and reliable diagnoses that can be used in the research of mental disorders.

The presence of at least 2 of these symptoms occurring within a 12-month period indicates an alcohol use disorder (AUD):

  • Alcohol is often taken in larger amounts or over a longer period of time than intended.
  • There is a persistent desire or unsuccessful effort to cut down or control alcohol use.
  • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  • Craving, or a strong desire or urge to use alcohol.
  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  • Recurrent alcohol use in situations where it is physically dangerous.
  • 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.
  • 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.
  • 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.

The severity of the AUD is defined as:

  • Mild: 2-3 symptoms.
  • Moderate: 4-5 symptoms.
  • Severe: 6 or more symptoms.

NIAAA Fact Sheet on DSM criteria>

ASAM Criteria

The American Society of Addiction Medicine (ASAM) has developed a set of criteria for assessing the severity of addiction and providing appropriate placement along a continuum of care. The assessment takes into account a patient’s past and current substance use, health history, emotional and behavioral health, readiness to change, experience with relapse, and living environment. Placement is made along a continuum of clinical treatment ranging from 0.5 (early intervention) to 4.0 (medically managed intensive inpatient care):

Level 0.5: Early Intervention

Level I: Outpatient Treatment

Level II: Intensive Outpatient/Partial Hospitalization

Level III: Residential/Inpatient Treatment

Level IV: Medically-Managed Intensive Inpatient Treatment

The ASAM criteria have become the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions. ASAM’s criteria are required to be used by addiction healthcare professionals in over 30 states.

ASAM Criteria>