DSM-5 Alcohol Use Disorder

The DSM-5 defines alcohol use disorder as a pattern of drinking that causes significant distress or impairment. Meeting 2 or more of 11 specific criteria in a 12-month period qualifies for diagnosis, with severity based on how many criteria apply.

What You'll Discover:

• What the DSM-5 is and why it matters for alcohol diagnosis.

• The 11 criteria used to diagnose alcohol use disorder.

• How severity levels are determined.

• How to assess your own drinking against the criteria.

• What an alcohol use disorder diagnosis means for treatment.

• How medication-assisted treatment addresses alcohol use disorder.

If you've wondered whether your drinking qualifies as a disorder, the DSM-5 provides the clinical criteria that healthcare providers use for diagnosis. Understanding these criteria helps you assess your own situation and have informed conversations with providers.

What Is the DSM-5?

The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It's the standard reference guide that mental health professionals use to diagnose psychiatric conditions.

Published by the American Psychiatric Association, the DSM-5 provides standardized criteria for diagnosing everything from depression and anxiety to substance use disorders. When a healthcare provider diagnoses alcohol use disorder, they're using the criteria defined in this manual.

The DSM-5 was released in 2013, replacing the previous DSM-IV. The update made significant changes to how alcohol problems are classified and diagnosed.

Understanding the DSM-5 criteria matters because diagnosis determines access to treatment, insurance coverage, and which evidence-based interventions are appropriate for your situation.

How DSM-5 Defines Alcohol Use Disorder

According to the National Institute on Alcohol Abuse and Alcoholism, the DSM-5 defines alcohol use disorder (AUD) as "a problematic pattern of alcohol use leading to clinically significant impairment or distress."

The key phrase is "clinically significant impairment or distress." This isn't primarily about how much you drink or how often. It's about whether drinking is causing problems in your life or making you feel distressed about your drinking.

A diagnosis requires meeting at least 2 of 11 specific criteria within a 12-month period. The more criteria you meet, the more severe the disorder.

This approach recognizes alcohol problems as a spectrum rather than an all-or-nothing condition. You can have mild, moderate, or severe alcohol use disorder, with different treatment implications for each level.

The 11 Diagnostic Criteria

The DSM-5 uses 11 criteria organized into four categories: impaired control, physical dependence, social problems, and risky use.

Impaired Control

1. Drinking more or longer than intended - You frequently drink more than you planned to, or drinking sessions extend longer than you intended. You might set out to have two drinks and end up having six, or plan to leave by 10 PM but stay until closing.

This criterion captures the experience of lost control over consumption once drinking begins.

2. Wanting to cut down but being unable to - You've tried to reduce your drinking or set limits, but you haven't been able to sustain those changes. The desire to drink less exists, but something keeps pulling you back to previous patterns.

This doesn't mean you've never successfully moderated. It means persistent efforts haven't produced lasting change.

3. Spending significant time obtaining, using, or recovering from alcohol - Drinking takes up substantial time in your life. This includes time spent getting alcohol, drinking, and dealing with hangovers or other after-effects. Time spent thinking about and planning around drinking also counts.

4. Experiencing cravings - You feel strong urges or desires to drink. These cravings might be triggered by specific situations, emotions, or times of day. The urge to drink intrudes on your thoughts even when you're trying not to think about it.

Social Problems

5. Failing to fulfill major obligations - Drinking interferes with your responsibilities at work, school, or home. You might miss work due to hangovers, neglect household duties, or underperform at your job because of drinking-related impairment or preoccupation.

6. Continued use despite relationship problems - You keep drinking even though it's causing or worsening problems with family, friends, or romantic partners. Arguments about drinking, damaged trust, or social isolation from drinking haven't stopped you.

7. Giving up activities because of drinking - You've reduced or stopped participating in activities you used to enjoy because of drinking. This might mean missing events, dropping hobbies, or limiting social activities to those that involve alcohol.

Risky Use

8. Using alcohol in physically hazardous situations - You drink in situations where it creates danger. This includes drinking and driving, drinking while operating machinery, drinking while responsible for children, or combining alcohol with medications that interact dangerously.

9. Continued use despite physical or psychological problems - You keep drinking even though you know it's causing or worsening a health problem. This might be a physical condition like liver problems or high blood pressure, or a mental health issue like depression or anxiety.

Physical Dependence

10. Tolerance - You need more alcohol to get the same effect you used to get with less. What once gave you a pleasant buzz now barely affects you. Alternatively, the same amount of alcohol produces much less effect than it used to.

11. Withdrawal - You experience withdrawal symptoms when you stop drinking or significantly reduce consumption. Symptoms might include anxiety, shakiness, sweating, nausea, insomnia, or in severe cases, seizures. Taking a drink to relieve or avoid these symptoms also counts.

Severity Levels

The DSM-5 classifies alcohol use disorder severity based on how many criteria you meet.

Mild AUD: 2-3 criteria - You meet 2 or 3 of the 11 criteria. This is the least severe form but still represents a diagnosable condition that typically benefits from intervention. Many people with mild AUD don't recognize they have a diagnosable condition because they don't match stereotypes of alcoholism.

Moderate AUD: 4-5 criteria - You meet 4 or 5 criteria. At this level, drinking is causing more significant problems and the condition is more likely to progress without intervention.

Severe AUD: 6 or more criteria - You meet 6 or more criteria. This represents serious alcohol use disorder with substantial impairment and high risk of medical and social consequences.

Research from NIAAA shows that approximately 1 in 7 men and 1 in 11 women in the United States meet criteria for alcohol use disorder. Many of these cases are mild or moderate and go undiagnosed.

Changes from DSM-IV

The DSM-5 changed how alcohol problems are diagnosed in important ways.

Combined two previous diagnoses - The DSM-IV had separate diagnoses for "alcohol abuse" and "alcohol dependence." The DSM-5 combined these into a single "alcohol use disorder" with severity levels. This better reflects the reality that alcohol problems exist on a spectrum.

Added craving as a criterion - The strong urge to drink is now recognized as a diagnostic criterion. This acknowledges the psychological component of alcohol problems beyond just behavior and physical symptoms.

Removed legal problems - The DSM-IV included legal problems related to alcohol as a criterion. The DSM-5 removed this because legal consequences depend heavily on circumstances and enforcement rather than the severity of the disorder itself. Someone could have severe AUD without legal problems, or legal problems without severe AUD.

Changed the diagnostic threshold - Under DSM-IV, you needed to meet 1 criterion for abuse or 3 for dependence. Under DSM-5, you need to meet 2 of 11 criteria for any diagnosis. This means some people who wouldn't have qualified under DSM-IV now receive a diagnosis, and vice versa.

These changes reflect better understanding of alcohol problems and make diagnosis more consistent across providers.

Assessing Your Own Drinking

You can review the 11 criteria and assess how many apply to your drinking in the past 12 months. This isn't a formal diagnosis, but it provides useful information.

For each criterion, consider whether it has been true for you during the past year:

If you meet 2 or more criteria, you may have alcohol use disorder. This doesn't mean you're an "alcoholic" in the stereotypical sense. It means your drinking has crossed into territory where it's causing problems and would likely benefit from intervention.

Be honest with yourself when reviewing these criteria. The goal isn't to minimize or maximize your situation. It's to get accurate information about where you stand.

What a Diagnosis Means

An alcohol use disorder diagnosis is medical information, not a moral judgment.

It means that your drinking pattern has reached a level where it's causing significant problems in your life. It doesn't mean you're weak, broken, or fundamentally flawed. It means you have a condition that responds to treatment.

The diagnosis also qualifies you for evidence-based treatment. Insurance typically covers treatment for diagnosed conditions. Healthcare providers can prescribe medications specifically approved for alcohol use disorder.

Many people resist diagnosis because of stigma associated with terms like "alcoholic." The DSM-5's approach helps address this by treating alcohol problems as a spectrum condition, like high blood pressure or diabetes, rather than an all-or-nothing label.

You can have mild alcohol use disorder and address it with relatively modest interventions. You don't have to hit rock bottom to deserve treatment. In fact, intervening earlier typically produces better outcomes than waiting until the disorder is severe.

Why People Avoid Diagnosis

Despite meeting criteria, many people avoid seeking formal diagnosis.

Stigma - The label "alcoholic" carries social stigma. People fear how others would view them if they had this diagnosis.

Identity threat - Accepting that you have alcohol use disorder can feel like an identity change. It conflicts with how you see yourself.

Fear of required abstinence - Many people assume diagnosis means being told they can never drink again. This isn't necessarily true.

Minimization - Comparing yourself to stereotypes of severe alcoholism makes your own situation seem less serious. "I'm not that bad."

Denial - The brain chemistry driving continued drinking also supports denying there's a problem.

These barriers are understandable, but they prevent people from accessing effective treatment. Understanding that AUD is a spectrum condition that doesn't require permanent abstinence for everyone can help overcome these barriers.

Treatment Options for Alcohol Use Disorder

Alcohol use disorder is treatable at all severity levels.

Behavioral approaches - Cognitive behavioral therapy, motivational interviewing, and other talk therapies help address the psychological patterns driving drinking. These approaches work for many people, particularly with mild AUD.

Support groups - Alcoholics Anonymous and other peer support groups provide community and accountability. They work well for some people, though they're not the only option.

Medication-assisted treatment - FDA-approved medications like naltrexone can significantly improve outcomes. Naltrexone blocks opioid receptors involved in alcohol's rewarding effects, reducing the reinforcement that drives continued drinking.

The medication doesn't make you sick if you drink. It simply reduces the pleasurable effects of alcohol, weakening the brain's learned association between drinking and reward.

Over time, this changes the neurological basis of the disorder. Drinking becomes less compelling because it's no longer as rewarding.

The Sinclair Method involves taking naltrexone before drinking. This allows gradual reduction without requiring immediate abstinence. For many people with mild to moderate AUD, this approach produces lasting change.

Combining approaches often works best. Medication addresses the brain chemistry while behavioral approaches address habits and triggers.

Getting Help

If you recognize your drinking in the DSM-5 criteria, several options exist for getting help.

Medical providers can formally assess your drinking and discuss treatment options. Many primary care doctors can prescribe naltrexone and other medications for alcohol use disorder.

Telehealth services make it easier to access treatment without disrupting your schedule or revealing your situation to others. You can receive medical evaluation and prescriptions from home.

The first step is acknowledging that your drinking meets criteria for a disorder and that treatment could help. Many people spend years knowing their drinking is problematic without taking action because they're not sure how to start.

Conclusion

The DSM-5 defines alcohol use disorder using 11 specific criteria. Meeting 2 or more criteria in a 12-month period qualifies for diagnosis, with severity based on how many criteria apply.

This approach treats alcohol problems as a spectrum condition. You can have mild, moderate, or severe AUD. All levels are treatable, and earlier intervention typically produces better outcomes.

If you meet DSM-5 criteria for alcohol use disorder, you're not alone. Approximately 29 million Americans have AUD. Effective treatments exist, including FDA-approved medications that change how alcohol affects your brain.

Understanding the criteria is the first step. The next step is taking action.

Take the online Alcohol Use Assessment to see if medication-assisted treatment could help you address alcohol use disorder.