Alcohol use disorder

Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5-TR)[4]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.​​

Alcohol use disorder is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following 11 criteria over the same 12-month period:

• Alcohol used in larger amounts or over a longer period of time than intended

• Persistent desire or unsuccessful attempts to cut down or control alcohol use

• Significant time spent obtaining, using, or recovering from the effects of alcohol

• Craving or strong desire to use alcohol

• Recurrent alcohol use leading to failure to fulfil major role obligations at work, school, or home

• Recurrent use of alcohol, despite having persistent or recurring social or interpersonal problems caused or worsened by alcohol

• Giving up or reducing important social, occupational, or recreational activities due to alcohol use

• Recurrent alcohol use in physically hazardous situations

• Continued alcohol use despite having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol

• Tolerance: markedly increased amounts of alcohol are needed to achieve intoxication or the desired effect, or continued use of the same amount of alcohol achieves a markedly diminished effect

• Withdrawal: there is the characteristic alcohol withdrawal syndrome, or alcohol is taken to relieve or avoid withdrawal symptoms.

Severity is specified based on the number of criteria met: mild alcohol use disorder when 2-3 criteria are met, moderate alcohol use disorder when 4-5 criteria are met, and severe alcohol use disorder when 6 or more criteria are met. Remission is specified when no criteria, other than cravings, are met for at least 3 months (early remission) or 12 months (sustained remission).

International classification of diseases, 11th ed. (ICD-11)[5]World Health Organization. International classification of diseases​, 11th revision (ICD-11). Feb 2025 [internet publication]. https://icd.who.int/en ​​[72]World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR). Mar 2024 [internet publication]. https://www.who.int/publications/i/item/9789240077263 ​​

Harmful pattern of use of alcohol, essential features:

• A pattern of continuous, recurrent, or sporadic use of alcohol that has caused clinically significant damage to a person’s physical or mental health, or has resulted in behaviour leading to harm to the health of others.

• Harm to health of the individual occurs due to one or more of the following:

  • Behaviour related to intoxication

  • Direct or secondary toxic effects on body organs and systems

  • A harmful route of administration.

• Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour-related to alcohol intoxication on the part of the person to whom the diagnosis of harmful pattern of use of alcohol applies.

• The pattern of alcohol use is evident over a period of at least 12 months if substance use is episodic or at least 1 month if use is continuous.

• Harm to health is not better accounted for by another medical condition or another mental disorder, including another disorder due to dubstance use.

Harmful pattern of use of alcohol is further defined by specifiers describing the pattern of use (e.g., episodic, continuous, unspecified).

Alcohol dependence (the term used in ICD-11), essential features:

• A pattern of recurrent episodic or continuous use of alcohol with evidence of impaired regulation of alcohol use that is manifested by two or more of the following:

  • Impaired control over alcohol use (i.e., onset, frequency, intensity, duration, termination, context).

  • Increasing precedence of alcohol use over other aspects of life, including maintenance of health, and daily activities and responsibilities, such that alcohol use continues or escalates despite the occurrence of harm or negative consequences (e.g., repeated relationship disruption, occupational or scholastic consequences, negative impact on health).

  • Physiological features indicative of neuroadaptation to the substance, including: 1) tolerance to the effects of alcohol or a need to use increasing amounts of alcohol to achieve the same effect; 2) withdrawal symptoms following cessation or reduction in use of alcohol; or 3) repeated use of alcohol or pharmacologically similar substances to prevent or alleviate withdrawal symptoms.

  • The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 3 months.

Alcohol dependence is further defined by specifiers describing the pattern of current alcohol use (e.g., episodic, continuous) or remission (e.g., early full, sustained partial, or full remission).

National Institute on Alcohol Abuse and Alcoholism (NIAAA)​​​[1]National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. Feb 2025 [internet publication].​ https://www.niaaa.nih.gov/alcohols-effects-health

Binge drinking: a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08% (0.08 g/dL) or higher. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.

Heavy drinking:

• For men, consuming more than 4 drinks on any day, or more than 14 drinks per week

• For women, consuming more than 3 drinks on any day, or more than 7 drinks per week.