DSM-V Diagnostic Criteria of Alcohol Use Disorder Term Paper

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Substance use disorders including alcohol use disorder are defined in the most recent edition of the Diagnostic and Statistical Manual (DSM-V) by the presence of several time-dependent subjective and behavioral criteria. Diagnostic criteria vary depending on the substance being used or abused. Alcohol abuse disorder is among the most significant of the diagnoses given the legality of alcohol and the prevalence of alcohol use in the general population.

According to the National Institutes of Health, the vast majority (upwards of 86%) of all people in the United States drink at least sometimes, with more than half drinking monthly (National Institute on Alcohol Abuse and Alcoholism, 2015). It is estimated that about seven percent of the adult population in the United States have an alcohol use disorder: more than 16 million people. Of those, only 1.3 million people receive formal treatment in a specialized facility (National Institute on Alcohol Abuse and Alcoholism, 2015). Alcohol use can be considered a serious and costly burden to society because of the high mortality rates associated with alcohol use including impaired driving.

The DSM-V has changed the operational definitions of alcohol use disorder to simplify the criteria for diagnosis and to help professionals provide more timely and effective interventions including counseling, cognitive-behavioral therapy, and pharmacological interventions. Among the most important updates to the DSM-V from previous editions include the amalgamation of alcohol abuse and alcohol dependence into the single designator, alcohol use disorder. Instead of classifying abuse and dependence separately, the DSM-V offers the potential to classify the alcohol abuse disorder as being mild, moderate, and severe based on the expression of specific criteria.

The criteria for alcohol use disorder include those related to subjective responses such as desire and craving, as well as more measurable indicators like behavior, to biological or physiological responses to withdrawal. Several of the criteria for diagnosing alcohol use disorder relate directly to the effects of alcohol on friendships and other social affairs, work, or physical safety. For example, a person might perform poorly or be absent from work directly due to alcohol use. Behavioral criteria also include time spent in alcohol-related activities and ingesting larger quantities of alcohol over a longer period of time than what was either desired or intended. Loss of friendships and other social problems may also be behavioral signs that the person has alcohol use disorder. One of the diagnostic criteria of alcohol use disorder is the cessation of participation in activities that once benefitted the individual or brought pleasure: such as sports or social events.

A cornerstone to the diagnosis is frequency of the behavioral patterns; alcohol use disorder is qualified by recurrence and persistence, and not by single isolated events or behaviors. Overall, there are eleven different criteria defining alcohol use disorder. According to the DSM-V, a person who expresses two or more of these criteria may be classified as having mild alcohol use disorder. A person expressing four or five symptoms would be classified with moderate alcohol use disorder, and persons exhibiting six or more symptoms would be classified as having severe alcohol use disorder.

As with other substance use disorders, alcohol use disorder is also qualified by the presence of tolerance, or increased resistance to the effect of the drug leading to increased intake in order to achieve desired effects. Another criteria of alcohol use disorder is interference in obligations or getting into legal trouble, although the latter is not an official feature of the DSM-V criteria. On the other hand, severe withdrawal symptoms may be present and are associated with alcohol use disorder at its most severe stages. Withdrawal can be characterized by nausea, sweating, tremors, and even hallucinations (American Psychological Association, 2015). Loss of appetite or loss of interest in food, uncharacteristically violent or aggressive behavior, neglect of personal hygiene, defensiveness when discussing the issue of alcoholism, and hiding alcohol are other behavioral markers that may indicate that alcohol abuse disorder is present (Burke, 2012).

Quantity of alcohol consumed is not part of the official criteria for diagnosis according to the DSM-V. However, substance abuse organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA, 2015) claims that moderate, binge, and heavy drinking can be classified according to the quantities of alcohol consumed. These quantities can be distinguished from the DSM-V diagnostic criteria for alcohol use disorder, and are simply guidelines that therapists may use when assessing or interviewing clients. SAMHA (2015) defines moderate drinking as one to two drinks per day; binge drinking as five or more drinks at the same occasion on at least one day over the past thirty days. Heavy drinking is defined as five or more drinks on the same occasion for five or more days in the past three months (SAMHA, 2015).

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Some people experience blackouts, or lapses in memory, after binge or heavy drinking (Burke, 2012).

There is no single known cause of alcohol use disorder although genetic, biological, psychological, and sociological factors may all be involved (American Psychological Association, 2015). Some individuals may be more prone to alcohol use disorder due to genetics, personality characteristics, and environmental variables ("Causes," n.d.). Environmental or situational variables range from poverty and social oppression to the experience of trauma and abuse. Moreover, the different causal variables impact each person differently. Some people are more affected by peer pressure than others, for example (American Psychological Association, 2015). There is no genetic test for alcohol abuse disorder, although genetics are most likely involved in the etiology.

No cure for alcohol use disorder exists, but there are many methods by which a person can reduce alcohol intake or stop drinking altogether. What works for one person may not work for another, and it is important to recognize individual differences when providing treatment interventions. The Twelve Step program Alcoholics Anonymous is a commonly used and widely recommended program of treatment involving a particular type of group therapy. Classified as a self-help type of intervention, Alcoholics Anonymous has a spiritual component that might not work for some. Professional counseling might also be an option for people suffering from alcohol use disorder. Cognitive-behavioral therapies have been particularly effective at helping people with alcohol use disorder (American Psychological Association, 2015). When alcohol use occurs in conjunction with other psychological or social issues ranging from personality or mood disorders to the experience with domestic abuse or poverty, then ancillary assistance in the form of professional counseling may be required. Because alcohol use disorder frequently affects the individual's family and social life, family therapy may be helpful. Family members often benefit from counseling to help them cope with the behavioral issues linked with both the use of alcohol and also the recovery from alcohol use disorder.

Research into the biological and genetic etiology of alcohol abuse disorder has revealed several trends that might help offer medication treatments to some populations. For example, the drug Naltrexone (sometimes sold as ReVia or Vivitrol) blocks the receptors in the brain that cause one to feel positive effects from alcohol (Burke, 2012). This drug might help reduce cravings in people with alcohol use disorder. To prevent persons with alcohol use disorder from drinking, a drug called Disulfiram (also sold as Antabuse) not only reduces the positive effects of alcohol intoxication but actually causes negative effects like nausea, headaches, and vomiting. Other medications that have been developed to treat alcohol use disorder include Acamprosate (also known as Campral), which helps restore brain functioning in certain individuals (Burke, 2012). Persons with a family history of alcohol use disorder and who have had trouble managing their alcohol intake may have difficulty recovering from the disorder and may require long-term and multifaceted interventions.

Excessive alcohol use can cause a number of physical as well as psychological complications including liver disease and cardiovascular issues like hypertension. Furthermore, alcohol use disorder can cause risky behaviors ranging from driving while intoxicated to violent outbursts. One of the criteria of alcohol use disorder is the continued use of alcohol in relatively large or frequent doses in spite of either health problems or risky behaviors causing potential or actual harm to self and others. There is a risk of suicide in persons with alcohol use disorder, particularly when alcohol use disorder is comorbid with mood disorders like clinical depression (National Institute on Alcohol Abuse and Alcoholism, 2008). Some persons with alcohol use disorder may also use other drugs, as recent research does show that persons who are dependent on alcohol are more likely to use drugs and vice versa (National Institute on Alcohol Abuse and Alcoholism, 2008). When drug and alcohol dependence occur together, the person is also more likely to meet more diagnostic criteria for each disorder and therefore be labeled as having a more severe or chronic issue (National Institute on Alcohol Abuse and Alcoholism, 2008).

Alcohol use disorder has recently been reclassified to combine the diagnostic criteria of alcohol dependence and alcohol abuse. Alcohol use disorder shares much in common with other substance use disorders, including those for tobacco, narcotics, stimulants, or cannabis.….....

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