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Appendix 3 - Diagnostic Criteria for Alcohol Dependence (ICD-11) and Alcohol Use Disorder (DSM-5)

DSM is the Diagnostic and Statistical Manual by the American Psychiatric Association (APA), while ICD is the International Statistical Classification of Diseases by the World Health Organisation (WHO).

DSM-5 Alcohol Use Disorder

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. Craving, or a strong desire or urge to use alcohol.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. Alcohol is often taken in larger amounts or over a longer period than was intended.
  4. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  6. 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.
  7. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  8. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  9. 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.
  1. Withdrawal, as manifested by either of the following:
    • The characteristic withdrawal syndrome for alcohol.
    • Alcohol (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
  2. Recurrent alcohol use in situations in which it is physically hazardous.

ICD-11 Alcohol Dependence

A disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. The diagnosis requires two or more of the three central features to be evident over a period of at least 12 months, but the diagnosis may be made if alcohol use is continuous for at least three months:

  1. Impaired control over alcohol use—in terms of the onset, level, circumstances or termination of use, often but not necessarily accompanied by a subjective sensation of urge or craving to use alcohol.
  2. Alcohol use becomes an increasing priority in life such that its use takes precedence over other interests or enjoyments, daily activities, responsibilities, or health or personal care. Alcohol use takes an increasingly central role in the person’s life and relegates other areas of life to the periphery, and it often continues despite the occurrence of problems.
  3. Physiological features (indicative of neuroadaptation to alcohol) as manifested by:
    1. tolerance,
    2. withdrawal symptoms following cessation or reduction in use of alcohol, or
    3. repeated use of alcohol (or a pharmacologically similar substance) to prevent or alleviate withdrawal symptoms. Withdrawal symptoms must be characteristic for the withdrawal syndrome for alcohol and must not simply reflect a hangover effect.