Alcohol Use Disorder (AUD) | Is Your Drinking Pattern a Cause for Concern?

Alcohol Use Disorder (AUD) is a chronic brain disorder, not a moral failing or a lack of willpower. It is medically defined by a cluster of behavioral and physical symptoms, including a compulsion to drink, a loss of control over alcohol intake despite negative consequences, and the emergence of a negative emotional state when not drinking. It is crucial to understand that AUD exists on a continuum, ranging from mild to severe. This spectrum is determined by the number of diagnostic criteria an individual meets. A mild disorder may involve only a couple of symptoms, such as consistently drinking more than intended or spending significant time recovering from alcohol's effects. As the number of symptoms increases, the severity escalates to moderate and then severe. This model avoids a simple 'alcoholic' versus 'non-alcoholic' binary, recognizing instead that the relationship with alcohol can be problematic to varying degrees. This nuanced view is essential for both clinical diagnosis and personal understanding, as it allows for earlier and more tailored interventions.

The diagnosis of AUD is formally guided by the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5), which outlines 11 specific criteria. A clinician assesses these criteria based on an individual's experiences over the past 12 months. The presence of 2-3 symptoms indicates mild AUD, 4-5 suggests moderate AUD, and 6 or more signifies severe AUD. These criteria include: drinking in larger amounts or for longer than intended; a persistent desire or unsuccessful efforts to cut down; spending a great deal of time obtaining, using, or recovering from alcohol; intense cravings; failure to fulfill major role obligations at work, school, or home; continued use despite social or interpersonal problems; giving up important activities; recurrent use in physically hazardous situations; continued use despite knowledge of having a physical or psychological problem caused by alcohol; tolerance (needing more to get the same effect); and withdrawal (experiencing physical and psychological symptoms when alcohol use is stopped).

A professional diagnosis of AUD is made by a qualified healthcare provider, such as a psychiatrist, psychologist, or a primary care physician with expertise in addiction. The assessment does not rely on a single test but is a comprehensive evaluation. It involves a detailed interview where the clinician asks specific questions about drinking patterns, the consequences of drinking, and the 11 diagnostic criteria from the DSM-5. Questionnaires and screening tools may also be used. The goal is to understand the extent to which alcohol is impacting the individual's life and health and to determine the severity of the disorder, which is critical for creating an effective treatment plan.

There is no single blood test or brain scan that can definitively diagnose Alcohol Use Disorder. The diagnosis is clinical, based on behavior and patient history. However, physicians often use laboratory tests to assess the physical health consequences of chronic and excessive alcohol consumption. These tests can include liver function tests (AST, ALT), which can indicate liver damage, and a complete blood count (CBC) to check for anemia. These biomarkers can provide objective evidence of heavy drinking and its physiological impact, thereby supporting a clinical diagnosis and helping to motivate the individual to accept treatment.

Chronic alcohol exposure fundamentally alters the brain's intricate circuitry, particularly the reward system. This system, which involves structures like the ventral tegmental area (VTA) and the nucleus accumbens, is designed to release the neurotransmitter dopamine in response to pleasurable and life-sustaining activities like eating or social interaction. Alcohol hijacks this system, causing a surge of dopamine that reinforces drinking behavior. Over time, the brain adapts to this overstimulation by reducing its natural dopamine sensitivity. This leads to two critical changes: tolerance, where more alcohol is needed to achieve the same feeling of pleasure, and anhedonia, a diminished ability to experience pleasure from everyday activities. This neurological adaptation creates a powerful cycle where the individual feels compelled to drink not just to feel good, but to simply feel normal, driving the compulsive behavior central to AUD.