Who Can Diagnose Alcoholism?

Alcoholism affects nearly 15 million people in the United States.1 Many licensed medical and behavioral health professionals can diagnose alcoholism.2 Often, patients are screened in non-specialized settings and then referred to a specialist like a licensed substance use counselor for treatment.2

What Is Alcoholism?

“Alcoholism” is a term used to broadly encompass a variety of problematic alcohol consumption behaviors or symptoms. However, it is not a clinical diagnosis.

Alcohol use disorder is a medical diagnosis defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress.2

To receive this diagnosis, you must display at least two out of 11 criteria in 12 months. These criteria are defined in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), which behavioral health professionals use to evaluate and diagnose mental health conditions.

DSM-5 criteria for alcohol use disorder include:2

  • Using alcohol in more significant amounts or an extended period than was intended
  • A persistent desire or unsuccessful efforts to cut down or control use
  • Alcohol use when it is physically hazardous to your safety
  • Continuing to consume alcohol despite social or interpersonal problems related to use
  • Tolerance to alcohol
  • Withdrawal symptoms
  • Cravings

Alcohol use disorder can range in severity from mild, to moderate, to severe.2 A mild diagnosis is consistent with the presence of 2-3 symptoms, 4-5 for moderate, and 6 or more for severe.2

A screening can diagnose alcoholism.

Any combination of the 11 symptoms of alcoholism can result in a diagnosis, and no particular symptom or symptoms need to be displayed to meet the criteria. For this reason, alcohol use disorder can look very different from person to person.2

For example, someone with mild alcohol use disorder may:

  • Intend to have one drink but unintentionally drinks several about once per month
  • Have driven while intoxicated on more than one occasion

In other words, this hypothetical person experiences 2 of the 11 criteria—using more alcohol than intended and using alcohol when it is dangerous to do so.

Another person with severe alcohol use disorder may:

  • Consume alcohol heavily daily
  • Have been unsuccessful at abstaining from alcohol use
  • Have interpersonal problems due to their alcohol use
  • Have a high tolerance for alcohol
  • Experience withdrawal symptoms if they avoid alcohol
  • Experience strong cravings to use alcohol

This hypothetical person meets 6 of the 11 criteria.

While both individuals meet the criteria for alcohol use disorder diagnosis, their alcoholism presents very differently.

It’s also important to note that only a professional can diagnose alcohol use disorder based on these criteria. For example, not all people who binge drink like the hypothetical person with mild alcohol use disorder actually have alcoholism, even if they have also driven while intoxicated.

Who Can Screen for Alcoholism?

Many people with or at risk for developing alcohol use disorder are first seen in outside of addiction treatment settings, such as their primary care doctor’s office.

For this reason, many public health and medical settings have adopted a screening system for alcohol and other substance use disorders. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a system of identifying at-risk individuals to intervene before symptoms worsen or severe consequences occur.3

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The first step of this model is screening. You may be screened for alcohol use disorder if: 4

  • You self-disclose
  • Alcohol use disorder runs in your family
  • Alcohol is identified in your blood or urine
  • You are being seen due to an alcohol-related incident, such as alcohol poisoning or an injury that occurred while under the influence of alcohol

Several brief screening tools may be used, including: 4

  • Alcohol Use Disorders Identification Test (AUDIT)—AUDIT asks individuals to self-report how much they drink, how many times in the last year they have tried to stop, and how alcohol use has affected their daily life. The questionnaire is 10 questions long, with a score of 8 or more generally indicating harmful or hazardous drinking.
  • Cut Down, Annoyed, Guilty, Eye Opener (CAGE)—CAGE asks if the person has ever felt they should Cut down on how much they drink; if criticism of their drinking has ever Annoyed them; if they have felt Guilt about their drinking; or if they have had an Eye opener drink (i.e., used alcohol first thing in the morning).
  • Tolerance, Annoyed, Cut Down, Eye Opener (T-ACE)—T-ACE measures most of the same metrics as CAGE, but replaces Guilt with Tolerance, with the screening professional specifically asking how many drinks it takes for an individual to feel intoxicated.

These screening tools are brief, self-report questionnaires that do not have to be administered by a physician or licensed professional.5 Screening tools are meant to identify a possible substance use disorder and need for treatment or intervention, not to make a clinical diagnosis.

If the results of your screening identify possible alcohol use disorder, a brief intervention is administered immediately. This usually consists of education about the symptoms of alcohol use disorder and the consequences of disordered alcohol consumption. Brief interventions also include motivational techniques meant to increase insight and encourage behavioral change.3

The final step is a referral to appropriate treatment. Based on the severity of alcohol use identified by the screenings, you may be referred to several levels of treatment and/or to a case manager or care coordinator who can assist with starting treatment as well as logistics such as transportation and payment.

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How Is Alcoholism Diagnosed?

Once possible alcohol use disorder has been identified, a formal diagnosis is usually given by a licensed mental health or substance use professional such as a:2

  • Psychiatrist (MD)
  • Psychologist (Ph.D. or PsyD)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Clinical Addictions Specialist (LCAS)
  • Licensed Mental Health Counselor (LMHC)

These titles can vary by state and also include: 9

  • Credentialed Alcoholism and Substance Abuse Counselor (CASAC)
  • Licensed Professional Counselor (LPC),
  • Licensed Clinical Mental Health Counselor (LCMHC)

These are professional counselors and therapists typically found in settings that specialize in treating substance use and mental health disorders.9

A full psychosocial assessment includes identifying strengths, needs, abilities, and preferences in several life areas, including mental health, substance use, interpersonal relationships, employment, housing, and culture.

Based on potential problem areas identified in this assessment, a licensed professional will make a formal diagnosis using criteria from the Diagnostic and Statistical Manual for Mental Disorders. This is typically done in an interview format, with the licensed professional asking questions to identify certain symptoms and criteria.

A combination of DSM-5 symptoms that leads to significant distress or impairment in one’s functioning will lead to a diagnosis of alcohol use disorder.

What Are Alcoholism Treatment Options?

Based on your assessment results and the severity of your diagnosis, your provider will recommend an appropriate level of care. You and your provider will discuss any factors that may affect their recommendation, such as: 6

  • Your treatment options based on your diagnosis
  • The severity of your symptoms
  • Any co-occurring conditions
  • Your mental and emotional wellbeing
  • Your readiness to change
  • The potential for relapse or continued use
  • How conducive your living environment is to recovery

The effects of alcoholism can be challenging for individuals and families, but treatment is available, and recovery is possible. For more information on how to begin alcoholism treatment, call 800-839-1686Who Answers? to speak with a treatment specialist about the choices available to you.

Resources

  1. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  3. Substance Abuse and Mental Health Services Administration. (2021, June 10). Screening, Brief Intervention, and Referral to Treatment (SBIRT).
  4. National Institute on Alcohol Abuse and Alcoholism. (2021). Screening Tests.
  5. Office of Addiction Services and Support. (2021). Screening, Brief Intervention, and Referral to Treatment (SBIRT): A clinicians’ tool for identifying risky behaviors and providing appropriate intervention.
  6. American Society of Addiction Medicine. (2015). An Introduction to the ASAM Criteria for Patients and Families.

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