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Understanding the New Drinking Spectrum

The Diagnostic and Statistical Manual (DSM) is known as the “psychiatrist’s bible.” Psychiatrists rely on the DSM to diagnose mental disorders and recommend treatments. The DSM is the authoritative text to help professionals decide what is – and what is not – a mental disorder. The latest edition offers a new way of categorizing alcohol use disorder. The DSM views drinking issues on a spectrum. Viewing alcoholism this way ensures that people with alcoholism receive alcohol abuse counseling early on.

How to Diagnose Alcohol Use Disorder

Alcohol use disorder has certain diagnostic criteria. In the DSM-5 (the fifth and latest edition), there is no longer a distinction between alcohol abuse and alcohol dependence. The DSM-5 criteria states that alcohol use disorder involves a maladaptive pattern of alcohol use, which means that the behavior is more harmful than helpful. It must also cause significant impairment and distress. Doctors must detect at least two of the following patterns within a 12-month period. A person must:

  • Consume alcohol in larger amounts than intended or over longer periods of time
  • Have a desire to cut down on alcohol use or has unsuccessfully attempted to control use
  • Spend a large amount of time obtaining alcohol, drinking or recovering from drinking
  • Crave alcohol
  • Fail to carry out duties at work, school or the home due to alcohol use
  • Use alcohol in spite of persistent personal or social problems that relate to alcohol
  • Have given up or reduced time on social, occupational or leisurely activities due to alcohol use
  • Use alcohol in dangerous situations
  • Use alcohol despite knowing that it will lead to – or worsen – a physical or psychological problem
  • Have developed a tolerance
  • Experience withdrawal, which can manifest in the following ways: characteristic alcohol withdrawal symptoms or using alcohol or a benzodiazepine in order to relieve withdrawal symptoms

Traditional Alcoholism Diagnosis

According to past editions of the DSM, drinking problems could either be defined as alcoholism or alcohol abuse, as opposed to today’s sliding scale. Doctors divided drinkers into those who had a real problem and those who didn’t. Many critics argued that this was risky. It allowed those with a serious drinking problem to avoid getting the help they needed. For example, under the old DSM, you could be at risk of full-scale alcoholism but not receive treatment because you didn’t meet the right criteria. It was also possible for problem drinkers to deny they had an alcohol addiction. After all, it was easier to deny their drinking problem if their behavior didn’t fit the criteria.

The Drinking Spectrum

It is now clear that alcohol use can cause physical and mental problems without meeting the criteria in the previous DSM. The new DSM-5 removes the old division between alcoholism and normal drinking. Instead, experts underscore that there is a drinking spectrum, with normal drinking at one end and disordered drinking at the other. Normal drinking is defined as alcohol use that meets the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. The NIAAA makes certain recommendations if you want to drink at a level that involves a low risk of developing alcohol use disorder. The guidelines state that low-risk drinking for women is no more than three drinks on a single day and no more than seven in a week. For men, the number of recommended drinks is no more than four on a single day and no more than 14 a week. The opposite side of the spectrum includes people struggling with alcohol abuse or alcoholism. This level of drinking has a serious impact on your physical and mental health, social life, relationships, work or education. The space between normal drinking and alcoholism is often grey. This area applies to people who drink more than the NIAAA recommendations but don’t meet the criteria for alcohol abuse or alcoholism. Some people in this category don’t need treatment. Others, however, may be dangerously close to abusing alcohol. The latter group may benefit from alcohol intervention programs.

Changing Attitudes About the Drinking Spectrum

The DSM-5 views drinking problems in degrees. Alcohol use disorder can have mild, moderate and severe sub-classifications. Getting treatment when you’re in the grey zone of the drinking spectrum can be hugely beneficial. Let’s explore some of the treatments available.

Early Intervention for Alcohol Use Disorder

In order to prevent alcohol use disorder from becoming a severe issue, it’s crucial for some alcohol users to receive early intervention. Alcohol intervention programs may include:

  • Counseling and therapy: Talking to a mental health professional can help to shed light on your alcohol use. For a lot of people, mental health issues can lead to increased or heavy drinking or be worsened by it.
  • Education: Learning about the physical, psychological and social effects of alcohol can offer an incentive to control drinking habits.

At The Ranch PA, we are determined to offer you the best course of treatment, wherever you sit on the drinking spectrum. We believe that it’s important to recognize the signs of problematic drinking and intervene as early as possible. While your current drinking could turn more serious, it doesn’t have to. With the right information, tools and resources, you can seek help as soon as necessary. In cases of alcohol abuse or alcoholism, we have a range of treatments to help you achieve long-term sobriety.

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