Alcoholism and Drug Abuse

Diagnosing alcoholism is difficult because alcoholics often underreport their drinking habits. Many times, it takes family members or loved ones to recognize the problem and talk to the person about seeking help. There are several surveys available to health professionals to help diagnose mental health disorders, the most common of which being the CAGE test. The cage test asks four questions:

• C– has the patient felt the need to Cut down on alcohol?
• A– has the patient felt Annoyed when others discussed their drinking habit?
• G– has the patient experienced feelings of Guilt about their drinking?
• E– has the patient used alcohol as an “Eye-opener” to cure a hangover in the morning?

There are also a number of medical tests that can help confirm suspicions of alcoholism. These include blood tests to check for high levels of CDT (carbohydrate-deficient transferring) and GGT (gamma-glutamyltransferase) which are found in high levels in the blood of alcoholics. Other blood tests may be done to determine the extent of damage done to the liver by checking for the presence of certain proteins.

The DSM-V, the latest diagnostic manual for mental health disorders lists the diagnostic criteria for alcohol use disorder (AUD) as follows. The term alcohol use disorder encompasses alcohol abuse and alcoholism. The presence of 2-3 symptoms indicates mild AUD (mild alcohol abuse), 4-5 indicates moderate AUD (moderate alcohol abuse/borderline alcoholism), and 6 or more indicates severe AUD (alcohol dependency/addiction)

•  Alcohol is often taken in larger amounts or over a longer period than was intended
• There is a persistent desire or unsuccessful effort to cut down or control alcohol use
• A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
• Craving, or a strong desire or urge to use alcohol
• Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
• Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
• Recurrent alcohol use in situations in which it is physically hazardous
• Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
• Tolerance, as defined by either of the following:
  • A need for markedly increased amounts of alcohol to achieve intoxication or desired effect
  • A markedly diminished effect with continued use of the same amount of alcohol

• Withdrawal, as manifested by either of the following:
  • The characteristic withdrawal syndrome for alcohol
  • Alcohol (or a closely related substance,, such as benzodiazepine) is taken to relieve or avoid withdrawal.

As with alcoholism, drug abuse can be difficult to diagnose due to the patient’s reluctance to report drug use. The DSM offers the following criteria for substance use disorder, a term combining both drug abuse and drug addiction.  The presence of 2-3 symptoms indicates mild AUD (mild drug abuse), 4-5 indicates moderate AUD (moderate drug abuse/borderline addiction), and 6 or more indicates severe AUD (drug dependency/addiction):

•  Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
• Recurrent substance use in situations in which it is physically hazardous
• Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance
• The substance is often taken in larger amounts or over a longer period than was intended
• There is a persistent desire or unsuccessful efforts to cut down or control substance us
• A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
• Important social, occupational, or recreational activities are given up or reduced because of substance abuse
• The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
• Craving or a strong desire or urge to use a specific substance
• Tolerance, as defined by either of the following:
  • A need for markedly increased amounts of the substance to achieve intoxication or desired effect
  • Markedly diminished effect with continues use of the same amount of the substance
• Withdrawal, as manifested by either of the following:
  • The characteristic withdrawal syndrome for the substance
  • The same (or closely related) substance is taken to relive or avoid withdrawal symptoms