Alcohol consumption volume as a criterion for AUD | 3.19.2019

Alcohol consumption volume as a criterion for AUD

 

I have emphasized to students and colleagues that one of the better services of DSM III, IV, and 5 has been to release the diagnosis of alcoholism - as alcohol dependence and, subsequently, alcohol use disorder - from being in thrall to the quantity or frequency of alcohol consumption.  The diagnostic core is more rightly the consequences of consumption. 

Included below is the link to a 13 March 2019 JAMA Psychiatry editorial by Dr. David Nutt and associates.  I believe I understand the reasoning within it, but I am concerned about the unintended consequences of its conclusions. Past ASAM President Stuart Gitlow, MD, DFASAM provided a guest editorial here recently, on the matter of criteria.  His reaction to the editorial follows:

“The editorial in this week’s JAMA Psychiatry again confuses the issue of Quantity of Alcohol Consumed with Severity of Addictive Disease, essentially suggesting these can be considered comparable. After many years of practice, I have reached the conclusion based on nothing other than observation of my patients that many of my older alcoholic patients drink less than the average non-alcoholic college student. I also have had numerous severe alcoholics who had been imbibing less in any given month than most social drinkers. My worry is that if consumption rate is even considered, it would inevitably be the only question most clinicians would ask, and we would end up with a huge number of false positives, where patients without addiction would be admitted for treatment, and perhaps an equal number of false negatives, where those with addiction are overlooked because they happen to use only a small amount of the substance (but each time afterward, become suicidal, or miss work, or end up in jail, but those will all be missed because the patient answered with too low a number when asked how much he or she used).“ 

- W. Haning, MD