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Diagnosing the Severity of Alcohol Use

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

A person needs to meet at least 2 of the above 11 criteria to be diagnosed with an alcohol use disorder. The severity of addiction is determined by the number of criteria met. The DSM-5 uses a dimensional scale to estimate the severity of addiction. This scale based upon the total number of symptoms matching the diagnostic criteria. The scale ranges from mild-to moderate-to severe. Clinicians include this severity code as part of the diagnosis. In general, two to three symptoms indicate a mild alcohol use disorder. Four to five symptoms would ordinarily be called a moderate alcohol use disorder. If six or more symptoms are present, this would be classified as a severe alcohol use disorder.

Alcohol Withdrawal

Alcohol withdrawal begins 4-12 hours after stopping or reducing heavy use. Symptoms of alcohol withdrawal are often extremely unpleasant. Symptoms may include sweating; tremor; insomnia; nausea/vomiting; hallucinations; agitation; anxiety; and even seizures. In severe cases, alcohol withdrawal may result in death. Consult with a physician prior to discontinuing heavy alcohol use.

Effects of Alcohol: Alcohol Intoxication

Alcohol intoxication is indicated by behavioral and psychological symptoms. This includes poor judgment and difficulty getting along with other people. Alcohol affects the brain's cerebral cortex. This makes it difficult to inhibit impulsive urges. Impulsivity can lead to aggression and risky sexual behavior. Alcohol intoxication causes observable symptoms. These symptoms include slurred speech; unsteady gait; a lack of coordination; impaired memory/attention; involuntary rapid eye movements (nystagmus); and even coma. Heavy alcohol use can cause many health problems. These problems often involve the gastrointestinal, cardiovascular, and nervous systems. In addition, the interaction between alcohol and other drugs can be fatal. This is especially true with other drugs that depress the central nervous system such as sedatives, hypnotics, and anxiolytics.