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Problem Drinkers Are Not Necessarily Alcoholics

Why Is Alcoholism
Called a 'Disorder?'

By BuddyT

It seems absurd to make the statement that there is no such thing as alcoholism. After all, we all probably have known someone in our lives who was beyond a doubt a full-fledged alcoholic.

But, medically speaking there is no official diagnosis of alcoholism. Today, the condition that generations have called alcoholism is known as alcohol use disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), published in May 2013, alcohol use disorders range from mild to moderate to severe.

Therefore, an alcoholic would be someone suffering from a severe alcohol use disorder.

The DSM-5 lists 11 criteria, or symptoms, that qualify someone as having a disorder. If you exhibit as few as two of the symptoms, you can be diagnosed with a mild alcohol use disorder. If you meet four or five of the criteria, your disorder is considered moderate.

If you display six or more of the symptoms, you would be given a severe alcohol use disorder diagnosis.

The 11 Symptoms of Alcohol Use Disorder

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 fulfill 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, or 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 b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Mild Disorders Are Still Disorders

As you can see, it doesn't take much to be diagnosed with an alcohol use disorder under this criteria. Anyone who gets drunk once a week and has a hangover, could potentially fall under this diagnosis.

In fact, that was one of the criticisms when the DSM-5 changed to this method of diagnosis from the DSM-IV's alcohol abuse and alcohol dependence categories: every college student who drinks to the point of intoxication, and has ever missed a class because of it, could conceivable be labeled as having a drinking problem.

It turns out, that was the point. Anyone who binge drinks is consuming alcohol at a high-risk level, and anyone who misses work or school because of their drinking does have a problem with alcohol, even if it is only a budding problem.

The Previous System Had Some Drawbacks

For decades, the only time someone received treatment for alcohol problems was after they had progressed to the severe stage and had become an alcoholic and their drinking had reached the level that it had profoundly affected their quality of life.

When their drinking finally reached the point that they could no longer function in society, then and only then, would their insurance cover expensive 28-day trips to residential treatment facilities.

When the Surgeon General's report, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health," was published in 2016, one of its main recommendations was that healthcare providers, including primary care physicians, not wait until a disorder becomes severe before intervening in the process.

A Costly and Sometimes Deadly Mistake

The report said that waiting until substance abuse problems reach the crisis level to begin intervention and treatment has been a costly and sometimes fatal mistake.

Treating substance abuse orders outside the mainstream healthcare system in a specialized, separate, and isolated system has also been a mistake and has contributed in part to the growing substance abuse problem in the United States, the Surgeon General reported.

By waiting until alcohol use became a serious, debilitating problem, the system help perpetuate a stigma associated with getting treatment and the myth that you had to "hit bottom" before you could receive any help for your problem.

Screening and Brief Intervention

The Surgeon General cited dozens of studies that showed that severe substance abuse disorders could be prevented if primary care physicians routinely screened for substance misuse in all of their patients and implemented brief intervention efforts when even a mild disorder was detected.

A family doctor merely mentioning to a patient that their drinking could become a problem then giving them information about the risks and dangers of excess alcohol use consumption would in many cases stop the progression of the disorder.

With the DSM-5's diagnosis of mild, moderate, and severe alcohol use disorders in their tool kit, physicians can provide treatment and brief intervention efforts in their offices and the patient's insurance would cover the costs.

Don't Wait Until It's Too Late

That is the reason that an alcoholism diagnosis does not exist anymore and we have alcohol use disorders that range from a teenager drinking four or more drinks in one session to a housewife drinking a bottle of wine every day.

If we wait until it gets to be "alcoholism" it could be too late. It could be fatal.

Sources:

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, Executive Summary." Washington, DC: HHS, November 2016.

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health." Washington, DC: HHS, November 2016.

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