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New DSM-5 Criteria Offers Hope For Earlier Intervention and Treatment

A recent report in the Journal of the American Medical Association (JAMA) confirms what addiction professionals have long known: problem drinking, which is now known as Alcohol Use Disorder (AUD), is among the most prevalent behavioral health disorders worldwide. Just as important, it’s a treatable disorder that often goes undetected because of a cultural acceptance of alcohol. The lack of awareness about how much alcohol is safe to consume or what constitutes problem drinking is also a significant issue. It doesn’t help that there is still a stigma about asking for help and often, there are also barriers to treatment.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5), the standard classification of behavioral health disorders used by mental health professionals, includes several changes to the section involving alcohol use. The authors have combined abuse and dependence diagnoses, now calling them Alcohol Use Disorder. They have added “craving” as one criterion for AUD diagnosis and eliminated “legal problems.” In version 5, only two criteria from an agreed-upon list are needed for an AUD diagnosis and severity of AUD has been added based upon criteria count.

In the June issue of JAMA Psychiatry, researchers from several renowned institutes surveyed 36,309 Americans age 18 and over to determine how prevalent AUDs were within a year and over a lifetime. They also wanted to identify patterns of AUDs for each time period. The researchers found that besides being so widespread, AUDs can be disabling physically, socially, and emotionallyand are often accompanied by another disorder.

Specific findings included the following:

  • There were significant correlations between 12-month and lifetime AUDs and other co-occurring issues including: other substance use disorders, major depressive and bipolar disorders, and antisocial and borderline personality disorders across all levels of AUD (mild, moderate and severe).
  • Lifetime AUD was frequently associated with persistent depression, panic disorder, specific phobia, and generalized anxiety disorder.
  • Only 19.8% of respondents with lifetime AUD received treatment. Yet, researchers noted that a large body of literature supports the effectiveness of treatment and indicates that participation in 12-step groups increases the likelihood of recovery.

As the report states, “alcohol use disorders impair productivity and interpersonal functioning and place psychological and financial burdens on those who misuse alcohol, on their families, friends, and coworkers, and, through motor vehicle crashes, violence, and property crime, on society as a whole.”

The authors strongly suggest, and we agree, that we need to continue to work to remove the stigma surrounding the disorder and encourage early intervention. We are also adamant that too much focus is placed on harm reduction with regard to alcohol; in these cases, the goal is often to help the user consume less. However, for many people, this simply isn’t possible and can waste precious time and resources that could have been invested in abstinence-based and holistic treatment.

From brief screenings and intervention in primary care settings for those with mild AUD, to evidence-based treatment programs facilitated by 12-step programs, to motivational interviewing, cognitive-behavioral therapy and other methods, there are several ways to help people with an AUD.

As problem drinking progresses, a person may become addicted to alcohol. The older adult population at Caron reflects the nature of this issue. Older adults may drink to excess and may also end up taking benzodiazepines and opiates for a number of reasons, such as anxiety, difficulty sleeping, and pain. The interactions between these medications, alcohol, and the deteriorating brain can be devastating. For example, older adults may have mild AUD for many years, which evolves into severe AUD due to a variety of factors, such as significant life changes, isolation, and changes in body chemistry. Taking addictive prescription drugs can add to the problem.

Our philosophy at Caron Treatment Centers is that through a holistic and individualized treatment and recovery plan, individuals can recover from addiction and lead productive and healthy lives. Since addiction affects the entire family, we begin working with the patient and adapt tools for individuals and families as part of a comprehensive plan that includes the family. Recovery is an ongoing process, so Caron has a personalized aftercare program for both patients and their families. Some patients need a shot of Vivitrol and a halfway house, others need to stay for extended care, and some might go home and attend out-patient counseling/treatment.

As the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reminds people: However severe the problem may seem, most people with an alcohol use disorder can benefit from treatment. Ultimately, receiving treatment can improve an individual’s chances of success in overcoming an AUD.

David Rotenberg
Featured Expert
David Rotenberg

Mr. Rotenberg is the Chief Clinical Officer for Caron Pennsylvania. He is recognized throughout the industry as an expert in treating co-occurring mental health disorders, relapse and family issues, and innovative approaches to the intervention and treatment of adolescents and young adults.

During his 20 year tenure at Caron, Mr. Rotenberg has pioneered treatment approaches and developed...

Mr. Rotenberg is the Chief Clinical Officer for Caron Pennsylvania. He is recognized throughout the industry as an expert in treating co-occurring mental health disorders, relapse and family issues, and innovative approaches to the intervention and treatment of adolescents and young adults.

During his 20 year tenure at Caron, Mr. Rotenberg has pioneered treatment approaches and developed...