Alcohol Use Disorder DSM-5 312.9 (F91.9)
DSM-5 Category: Substance-Related and Addictive Disorders
Alcohol use disorder is actually a combination of alcohol-related medical conditions characterized by alcohol dependence or alcohol abuse (American Psychiatric Association, 2013). It is more commonly referred to as alcoholism. Experts estimate that approximately 18 million Americans suffer from this condition. The intake of alcohol is common in the United States. Many people enjoy a glass of wine for dinner or have a beer at the ballpark. This is not an indication of alcohol abuse. Rather, alcohol use disorder is likely present when the patient’s drinking causes harm or distress.
Symptoms Alcohol Use Disorder
According to the DSM-5, the symptoms of alcohol use disorder include a combination of craving, physical dependence, an increasing tolerance for alcohol and loss of control. Considered individually; craving refers to the driving need for alcohol intake; and those who suffer from alcohol use disorder will have withdrawal symptoms without it. The individual who is alcoholic may be anxious, exhibit tremors or shaking, sweat effusively and be nauseous when they do not have alcohol. As well, the more the person with alcohol use disorder drinks; the greater amounts of alcohol they need in order to have the same effect (Farren, Hill, & Weiss, 2012). The alcohol abuser also lacks self-control and is unable to curb or restrain their drinking. The alcoholic individual will also spend as much time as possible in the act of drinking. This includes associated activities such as ensuring they have alcohol available; suffering the throes of being drunk or recovering from its side effects. Alcohol use disorder is linked to high rates of medical and psychiatric comorbidity; and early mortality (Kendler, & Myers, 2012). It is a chronic condition that is treatable but not curable.
Alcohol use disorder can have devastating effects on both the sufferer and/or their loved ones. Alcoholics and alcohol abusers tend to be negligent in areas of their life such as their job and home or family. Additionally, they tend to make poor choices when under the influence of alcohol such as drinking and driving; and may also have legal and social problems.
The important first step is to seek treatment for the disorder. Staged interventions may help to push the alcohol abuser into therapy. Families should be very supportive of the alcoholic while they are undergoing treatment and embarking on an alcohol-free life. The home must be alcohol free; the sufferer cannot be exposed to alcohol outside the home either. For example, going to a bar after work is a poor choice. All activities should occur in an area where alcohol is not available. It is difficult to say ‘no’ time and again; so family and friends should respect this and avoid placing the alcohol abuser in a situation that compromises their sobriety.
Treatment for Alcohol Abuse Disorder
The DSM-5 does not offer a plan of treatment for Alcohol Abuse Disorder but provides an excellent framework for diagnosing the illness. As with many psychological afflictions; there is no known cure for alcohol use disorder. There are a variety of psychotherapeutic and pharmacological treatment plans that have been employed to combat this illness (Kiselica, Cohn, & Hagman,2013). In fact, as alcoholism began to be viewed as a disease and not a social problem; the techniques and tools used to address it have increased and improved in the past three decades.
The ultimate goal in alcohol abuse disorder is to bring the patient to a state of complete abstinence. After that, the chances for recovery are better. Even so, 30% to 40% of those who have participated in a treatment plan return to alcohol abuse within a year. Important factors in sober living include a strong support system – family and friends, motivation and a reasonable lack of comorbidity issues. The presence of additional psychiatric disorders may spur the patient towards relapse; and despite the length of abstinence the individual must face each day anew with the realization that they have a problem and risk sobriety with a single drink.
There are three steps to recovery. The first is detoxification that should be overseen by medical personnel if the disorder is severe. Next the individual must go through rehabilitation that is a combination of counseling and medication; and, finally, maintenance of sobriety. The last step requires self-motivation and self-determination.
A plan of treatment could include the prescription of one or more medications. Commonly, benzodiazepines are used to treat withdrawal symptoms. These may present as anxiety, sleep problems, delirium or seizures. There are also several medications that are designed to support the alcohol abuser who is the maintenance stage of recovery. Disulfiram has been found to have some success in preventing a return to alcohol abuse. If an individual who takes this medication then tries to drink alcohol; he or she will become nauseous and exhibit other unpleasant side effects. Again, it does not interfere with the motivation to drink – it is up to each and every individual to draw upon the personal strength to avoid alcohol. Also, all medication should be closely monitored by a medical professional because of their addictive nature. In situations of comorbidity other pharmaceuticals may be used to address the additional ailments – such as depression.
The standard forms of psychotherapy used in the treatment of alcohol use disorder include cognitive-behavioral therapy, combined behavioral intervention and interactional group psychotherapy (modeled after the Alcoholics Anonymous 12 step program).Cognitive-behavioral therapy (CBT) employs a structured teaching approach most appropriate for those with severe alcoholism. CBT is a psychotherapeutic method that has been successful in treating patients with dysfunctional and maladaptive behaviors and cognitive processes; through the use of systematic, goal-oriented procedures. For example, a patient may receive assignments that must be completed outside the therapy session such as keeping a written list of cues or situations that trigger the desire to drink. The therapist will also work with the patient to help them find healthy alternatives to drinking such as sports or another hobby.
A more recent treatment is Combined Behavioral Intervention (CBI). This regimen applies specific counseling techniques intended to motivate the individual to change their destructive behavior. CBI is a combination of all multiple therapies including cognitive behavioral therapy, 12 step programs and additional enhancement and/or motivational therapy (Hepner, 2012) Coping mechanisms are introduced and patients are taught strategies for refusing alcohol in order to remain sober. Studies have found this therapy to be highly effective. Studies have been conducted that report these approaches may be equally effective; specific people may do better with one program than another.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Farren, C.; Hill, K.; & Weiss, R. (2012) Bipolar Disorder and Alcohol Use Disorder: A Review.
Current Psychiatry Reports, Vol. 14, Iss, 6, pp. 659 – 666.
Hepner, K. (2012). Developing quality measures for alcohol misuse and alcohol use disorders. Journal of Substance Abuse Treatment, Vol. 43, Iss. 3, pp. e22 - e23.
Kendler, K. & Myers, J. (2012). Clinical Indices of Familial Alcohol Use Disorder. Alcoholism: Clinical and Experimental Research, Vol. 36, Iss. 12, pp. 2126 – 2131.
Kiselica, A.; Cohn, A.; & Hagman, B. (2013). Alcohol Use Disorders: Translational Utility of DSM-IV Liabilities to the DSM-5 System. Addictive Disorders & Their Treatment, p. 1.
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