What are the diagnostic criteria for alcohol-related mental health disorders?

The reference guide used by clinicians to diagnose mental health disorders is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The most recent version of the manual, the DSM-5, was released in May 2013. Prior to this, the DSM-IV-TR was used by clinicians and researchers from 2000 to 2013.

The diagnostic criteria for alcohol-related mental health disorders differ significantly between the DSM-IV-TR and the new DSM-5. These differences are explained in more detail below. For the purposes of the NADK, all reported data on alcohol-related mental health disorders utilise the DSM-IV-TR diagnostic criteria. This is because at the time of data collection, the newer version of the DSM had not been released.

DSM - IV Diagnostic Criteria

According to the Diagnostic and Statistical Manual of Mental Disorders – 4th Edition, Text Revision (DSM-IV-TR), there are two main alcohol-related mental health disorders: alcohol dependence and alcohol abuse. The diagnostic criteria for each are presented below.

Alcohol Dependence

Alcohol dependence is defined by the DSM-IV-TR as:

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:

1.  Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

b. Markedly diminished effect with continued use of the same amount of alcohol.

2.  Withdrawal, as defined by either of the following:

a. The characteristic withdrawal syndrome for alcohol (refer to DSM-IV-TR for further details).

b. Alcohol is taken to relieve or avoid withdrawal symptoms.

3.  Alcohol is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.
5.  A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
6.  Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
7.  The individual continues to use alcohol despite knowing that they suffer from a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by drinking alcohol.

Alcohol Abuse

Alcohol abuse is defined by the DSM-IV-TR as:

A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

  1. Recurrent alcohol use resulting in failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
  2. Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).
  3. Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
  4. Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).

DSM-5 Diagnostic Criteria

According to the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5), there is one main alcohol-related mental health disorder: an alcohol use disorder.

Alcohol Use Disorder

Alcohol use disorder is defined by the DSM-5 as:  

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 fulfil 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 (refer to DSM-5 for further details).
b.  Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

A mild alcohol use disorder is defined as the presence of 2-3 of the above symptoms.

A moderate alcohol use disorder is defined as the presence of 4-5 of the above symptoms.

A severe alcohol use disorder is defined as the presence of 6 or more of the above symptoms.

Sources: American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.); American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders: fourth edition, text revision. In use from 2000-2013.

DSM-5: Diagnostic and Statistical Manual of Mental Disorders: fifth edition. Released May 2013.