Alcohol Use Disorders (117) Q5 How can we define and measure alcohol use disorders?

3 March, 2024

Dear HIFA colleagues,

As we move into week 5 of our deep-dive on Alcohol Use Disorders, I invite you to consider Q5:

How can we define and measure alcohol use disorders?

I have had a look at the question of definition and it appears to be not very straightforward.

One of the challenges is that there are at least two official sources: the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).

'The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association'

According to Wikipedia, DSM is used primarily in the US, while ICD is used elsewhere. It would be interesting to know which other countries use DSM. It seems likely there are different organisations within the same country that use one or the other source.

Searching for the DSM, I was signposted to the Internet Archive. I then had to register but was still unable to access to the full text. I note that the landing page contains only 2 reviews by users, and each of these is only a few words. One would expect hundreds of reviews for an important reference of this type. Perhaps HIFA members can point us to a better way of accessing this.

ICD is published by WHO and it is straightforward to access and search. The text includes: 'Disorders due to use of alcohol are characterised by the pattern and consequences of alcohol use. Alcohol — more specifically termed ethyl alcohol or ethanol — is an intoxicating compound produced by fermentation of sugars usually in agricultural products such as fruits, cereals, and vegetables with or without subsequent distillation. There are a wide variety of alcoholic drinks, with alcohol concentrations typically ranging from 1.5% to 60%. Alcohol is predominantly a central nervous system depressant. In addition to ability to produce Alcohol Intoxication, alcohol has dependence-producing properties, resulting in Alcohol Dependence in some people and Alcohol Withdrawal when alcohol use is reduced or discontinued. Unlike most other substances, elimination of alcohol from the body occurs at a constant rate, such that its clearance follows a linear rather than a logarithmic course. Alcohol is implicated in a wide range of harms affecting most organs and systems of the body (e.g., cirrhosis of the liver, gastrointestinal cancers, pancreatitis). Harm to others resulting from behaviour during Alcohol Intoxication is well recognized and is included in the definitions of harmful use of alcohol (i.e., Episode of Harmful Use of Alcohol and Harmful Pattern of Use of Alcohol). Several alcohol-induced mental disorders (e.g., Alcohol-Induced Psychotic Disorder) and alcohol-related forms of neurocognitive impairment (e.g., Dementia Due to Use of Alcohol) are recognized.'

ICD also provides 'a list of specific diagnostic categories of that apply to alcohol:

6C40.0 Episode of Harmful Use of Alcohol

6C40.1 Harmful Pattern of Use of Alcohol

6C40.2 Alcohol Dependence

6C40.3 Alcohol Intoxication

6C40.4 Alcohol Withdrawal

6C40.5 Alcohol-Induced Delirium

6C40.6 Alcohol-Induced Psychotic Disorder

6C40.70 Alcohol-Induced Mood Disorder

6C40.71 Alcohol-Induced Anxiety Disorder

6C40.Y Other Specified Disorder Due to Use of Alcohol

6C40.Z Disorder Due to Use of Alcohol, Unspecified'

The list and the paragraph above are just one of many pieces of content on alcohol in the ICD.

My first impression is that neither the DSM nor the ICD are ideal for the primary care health worker, the former because I can't access it, and the latter because there is a lot of confusing detail.

In neither case was I able to find a consensus definition of Alcohol Use Disorders.

Can anyone help?

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: