Substance-Related and Addictive Disorders
Alcohol Use Disorder
ICD-10-CM: F10.20
1. Criteria
DSM Criteria
Criterion A
- Alcohol is often taken in larger amounts or over a longer period than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time is spent obtaining alcohol, using alcohol, or recovering from its effects.
- Craving, or a strong desire or urge to use alcohol, is present.
- Recurrent alcohol use results in failure to fulfill major role obligations at work, school, or home.
- Alcohol use continues despite persistent or recurrent social or interpersonal problems caused or worsened by alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use occurs in situations in which it is physically hazardous.
- Alcohol use continues despite knowledge of a persistent or recurrent physical or psychological problem likely caused or worsened by alcohol.
- Tolerance is present, defined by needing markedly increased amounts for intoxication or diminished effect with continued use of the same amount.
- Withdrawal is present, defined by the characteristic withdrawal syndrome or using alcohol to relieve or avoid withdrawal symptoms.
DSM Criteria
Criterion B
- At least 2 of the criterion A symptoms occur within the same 12-month period.
DSM Criteria
Severity Specifier
- Severity is mild with 2 to 3 symptoms, moderate with 4 to 5 symptoms, and severe with 6 or more symptoms.
2. Context
- Alcohol use disorder is the pattern that emerges when drinking stops being just a habit and starts causing loss of control, relationship strain, role failure, risky behavior, craving, tolerance, or withdrawal. The diagnosis becomes more convincing when use keeps going despite obvious consequences.
- Severity count: Severity is count-based in DSM, so it helps to explicitly ask through the full checklist rather than relying on a general impression.
- Withdrawal matters: A safe assessment has to include withdrawal risk, medical complications, and whether the person may need a higher level of care.
- Medication role: Medication is usually about reducing craving, helping maintain abstinence, or making relapse less likely, not treating intoxication itself.
- Clinical focus: Common screening and severity tool for unhealthy alcohol use.
3. Validated scales
AUDIT
Common screening and severity tool for unhealthy alcohol use.
CIWA-Ar
Used when monitoring alcohol withdrawal severity.
Timeline Follow-Back
Helps quantify drinking patterns over time.
4. FDA approved treatments
FDA-indicated medications for alcohol use disorder
Diagnosis-specific FDA-approved pharmacotherapies for alcohol-use disorder focus on relapse prevention or deterrence.
Common off-label medications
Interventional psychiatry modalities
- Ketamine-assisted psychotherapy is being explored in addiction treatment research.
- TMS is under study for craving reduction and relapse prevention.
- ECT is not a standard treatment for alcohol use disorder itself.
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5. Top management articles
- Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis JAMA, 2014
- Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study JAMA, 2006
- Management of alcohol use disorder in adults Guideline literature