Alcohol Use Disorders (122) How can we define and measure alcohol use disorders? (3)

5 March, 2024

Dear HIFA colleagues,

Here are the top seven hits from a google search on 'definition of alcohol use disorders' and a comment from me below:

US Medline Plus: 'This means that their drinking causes distress and harm.'

UK NHS: 'Alcohol misuse is when you drink in a way that's harmful, or when you're dependent on alcohol'

American Psychological Association: 'People with alcohol use disorders drink to excess, endangering both themselves and others.'

UK NICE: 'Harmful drinking (high-risk drinking) is defined as a pattern of alcohol consumption causing health problems directly related to alcohol'

WebMD: 'Alcohol use disorder (AUD) is a chronic illness in which you can’t stop or control your drinking even though it’s hurting your social life, your job, or your health.'

Lancet paper 2019: 'Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake.'

WHO: 'Adults (15+ years) who suffer from disorders attributable to the consumption of alcohol (according to ICD-10: F10.1 Harmful use of alcohol; F10.2 Alcohol dependence) during a given calendar year. Numerator: Number of adults (15+ years) with a diagnosis of F10.1, F10.2 during a calendar year.'

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders says someone has alcohol use disorder if they meet two or more of 11 criteria in one 12-month period. AUD may be mild, moderate, or severe, based on how many of the criteria are true. The criteria are:

Alcohol use in larger amounts or for a longer time than intended

A lasting desire or unsuccessful effort to cut down or control alcohol use

A lot of time spent getting alcohol, drinking it, or recovering from its effects

A craving for alcohol

Alcohol use that causes a failure to meet obligations at work, school, or home

Alcohol use that continues even though it leads to lasting or repeated personal problems

Giving up or cutting back on important activities because of alcohol

Repeatedly using alcohol in dangerous situations

Using alcohol even though you know it causes physical or psychological problems, or makes them worse

Alcohol tolerance, when you need more to have the same effect

Alcohol withdrawal

WHO: ICD-11 it [Hazardous Alcohol Use] is defined as: A pattern of alcohol use that appreciably increases the risk of harmful physical or mental health consequences to the user or to others to an extent that warrants attention and advice from health professionals.

COMMENT (NPW): The above are to some extent consistent, but have differing emphasis on specific features such as harm and control. Three of the definitions describe alcohol use disorders (plural). For the latter there are different ways of describing the individual disorders. Does this variation matter? Should we be paying more attention to one or more definitions? And, most importantly, what criteria should frontline health professionals use when assessing a patient's alcohol consumption?

The overall terminology is quite confusing. Is it feasible to reach a point where everything is clear? From my perspective, this seems unlikely. Perhaps, for the individual health worker, there is a case for abandoning terminology that is not useful and instead focus on the number of units of alcohol consumed per week, togetherby a narrative description of the harms attributable to alcohol consumption in each case?

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: