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Substance-Related and Addictive Disorders

Alcohol Use Disorder

ICD-10-CM: F10.20

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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.

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

  1. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis JAMA, 2014
  2. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study JAMA, 2006
  3. Management of alcohol use disorder in adults Guideline literature