Alcoholism & Addiction

Understanding Alcohol-Related Disorders

Alcohol-related disorders is the collective name for a group of mental health conditions that revolve around the dysfunctional consumption of alcoholic beverages. These conditions appear in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in a chapter dedicated to all kinds of substance-related disorders.

DSM 5, the new fifth edition of the Diagnostic and Statistical Manual released in May 2013, changes the working definitions of alcohol-related disorders in several ways. Some of these changes are essentially cosmetic, while others involve a fundamental restructuring of the concepts associated with alcohol misuse.

Alcohol-Related Disorders Basics

The five diagnosable alcohol-related disorders listed in DSM 5 are alcohol use disorder, alcohol intoxication, alcohol withdrawal, “other” alcohol-induced disorders and “unspecified” alcohol-related disorder. Alcohol use disorder is a newly defined condition that incorporates the basic concepts of both alcohol abuse and alcohol dependence (i.e., alcoholism). Alcohol intoxication and alcohol withdrawal retain the same definitions they had in DSM IV, the Diagnostic and Statistical Manual’s long-used fourth edition. “Other” alcohol-induced disorders incorporates the definitions of eight different alcohol-related conditions formerly listed in DSM IV. “Unspecified” alcohol-related disorder replaces a similarly conceived diagnosis in DSM IV called alcohol-related disorder not otherwise specified.

Alcohol Use Disorder

Alcohol abuse and alcohol dependence are well-known concepts among both medical professionals and the general public. However, in many ways, the definitions for these terms used by mental health practitioners differ from the definitions used by the average layperson. According to the official guidelines set forth in DSM IV, people affected by alcohol abuse don’t have an alcohol addiction; however, they participate in a habitual pattern of alcohol use that produces at least one clearly dysfunctional alcohol-related symptom or behavior. In contrast, the DSM IV guidelines state that people affected by alcohol dependence are addicted to alcohol use, and participate in a pattern of alcohol use that produces at least three clearly dysfunctional alcohol-related symptoms or behaviors.

Over the last 10 years or so, doctors and researchers have increasingly noted the fact that real-world cases of substance abuse and substance dependence often don’t follow the guidelines established in DSM IV. Instead, issues of abuse and dependence commonly intertwine in complex ways that the DSM IV guidelines don’t and can’t cover. Because of the complex interconnection between abuse and dependence, the newly published DSM 5 no longer asks doctors to attempt to separate these issues when treating their patients. Instead, it asks doctors to diagnose conditions called substance use disorders, which include symptoms and behaviors associated with both abuse and dependence. Alcohol use disorder is the substance use disorder diagnosable in people with alcohol-related abuse/dependence problems.

Alcohol Intoxication

Alcohol intoxication merits concern as a mental health issue when it produces mental or behavioral changes that significantly decrease a person’s ability to functionally interact with his or her surrounding environment. Symptoms that indicate an impairing level of intoxication include loss of normal body balance, slurring of words, an inability to walk in a coordinated manner, memory deficits, attention deficits, an involuntary eye movement called nystagmus, and the unresponsive mental/physical states known as stupor and coma. Affected individuals must not have other problems that account for the presence of one or more of these symptoms.

Alcohol Withdrawal

Alcohol withdrawal occurs in habitual consumers of large amounts of alcohol who either quickly stop drinking entirely or stop drinking nearly as much as they normally do. In a period of time ranging anywhere from hours to several days after these changes in alcohol use occur, affected individuals must have at least two symptoms that indicate the onset of the withdrawal process. Potential symptoms include nausea, vomiting, trembling hands, unusual anxiousness, sleeplessness, a heart rate in excess of 100 bpm, seizures called grand mal seizures, and hallucinatory or illusory changes in normal sensory perception that involve sight, sound or touch. In order to merit attention as a mental health concern, the symptoms of withdrawal must substantially disturb a person’s sense of mental well-being, or damage his or her ability to function normally during the course of the day.

“Other” and “Unspecified” Disorders

The symptoms of several different mental health disorders can arise in people affected by drinking problems. DSM IV contained a listing for each of the most prominent of these conditions, including mood disorders (depression or bipolar disorder), anxiety disorders, sleep disorders, persisting (ongoing) dementia, persisting amnestic disorder (ongoing amnesia), sexual dysfunction, hallucination-based psychotic disorder, and delusion-based psychotic disorder. DSM 5 replaces these individual listings with a catchall listing called “other” alcohol-induced disorders, which doctors can use to diagnose the symptoms of any mental disorder they encounter in people with alcohol use problems. The “unspecified” alcohol-related disorder listing is designed to help doctors account for any alcohol-related mental health issues that don’t fully meet the criteria used to diagnose any of the specifically named alcohol-related disorders.

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