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How Is Alcohol Use Disorder (AUD) Diagnosed?

June 20, 2022

Table of Contents

Alcohol use disorder is a clinical diagnosis, meaning there is no blood test or brain scan that can diagnose an alcohol use disorder (AUD). There are some lab tests that can help determine physical damage as a result of alcohol use, such as liver function tests, but there is no “test” that can tell whether you have an “addiction” to alcohol. Instead, doctors use a list of certain criteria to diagnose AUD. 

Let's walk through the tools and assessments your doctor might use to diagnose an alcohol use disorder. 

Screening for Alcohol Use Disorder

Imagine you've arrived at your doctor's office for a routine physical. The receptionist gives you paperwork, including questions about your health habits over the last year, which will often include questions about alcohol. Doctors are trained to talk with their patients about alcohol every year. They will often do a “screening test” for alcohol use to help identify patients that may be using alcohol in a dangerous or unsafe way: [1-3]

The CAGE is one such common screening test.[2] The CAGE test consists of 4 questions:

  1. Have you ever felt you should cut back on alcohol?
  2. Have people annoyed you by discussing your drinking?
  3. Do you feel bad or guilty about alcohol?
  4. Do you need an eye-opener drink to steady nerves?

If you answer "yes" to two or more of these questions, your doctor might follow up with more questions. Or you might start talking about how treatment works and how it might help. 

Diagnostic Criteria for Alcohol Use Disorder

The CAGE questionnaire is a common way to screen for AUD, but it does not mean you have a diagnosis of AUD. The definitive diagnosis of AUD is made by using the Diagnostic and Statistical Manual of the Mental Disorders (DSM–5) to diagnose mental illnesses. Alcoholism appears in the DSM-5

To qualify for a diagnosis of alcohol use disorder (AUD), you must answer "yes" to at least two of these questions. They all begin with the words, "In the past year, have you":[4]

  1. Drank more or longer than you intended?
  2. Wanted to cut back or stop drinking more than once and couldn't do it?
  3. Spent a lot of time drinking or recovering from drinking?
  4. Wanted a drink so much that you couldn't think of anything else?
  5. Found drinking interfered with your family, home life, job, or schoolwork?
  6. Continued to drink despite the problems it caused?
  7. Given up or spent less time on things you once enjoyed so you could drink?
  8. Put yourself in unsafe positions because of drinking?
  9. Kept drinking even though it harmed your mental health?
  10. Needed to drink more to feel the same effects?
  11. Had withdrawal symptoms when not drinking?

Getting a formal AUD diagnosis can be upsetting and intimidating. Patients can feel accused or judged by their doctors. However, bear in mind that doctors ask these questions ultimately to try to protect your health. If you are able, try to talk openly and honestly to your doctor about how much and in what ways you drink. If you have any questions or concerns about your alcohol consumption, making a diagnosis of AUD can be a helpful first step in identifying the problem and talking with a doctor about treatment options. 

Alcohol Use Disorder Diagnosis FAQs

What are the 11 diagnostic criteria for AUD?

Doctors use the fifth edition of the Diagnostic and Statistical Manual of the Mental Disorders (DSM–5) to diagnose mental illnesses. The DSM-5 includes 11 questions about alcoholism. Answering "yes" to at least two qualifies people for a diagnosis of AUD.

Questions focus on how much someone drinks, where and why they drink, the effects of their alcohol use, and how they feel when they aren’t drinking.

How does a doctor diagnose AUD?

Your doctor will often use a combination of screening questions and lab tests to understand your drinking habits. If certain conditions are present, you might receive a formal diagnosis of alcohol use disorder. If you meet criteria for a formal diagnosis of AUD, your doctor will probably recommend treatment - either medications or therapy or both - to help. 

How is alcohol use disorder defined?

Alcohol use disorder is characterized by out-of-control drinking that harms a person's health, job, or social connections.[5] The formal diagnosis of AUD is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

Can blood tests show alcohol use disorder?

Not strictly, no. Blood tests can show liver damage and other markers that can help identify excessive alcohol use, but this is not the same as having an alcohol use disorder. AUD is a clinical diagnosis that is made when a person meets a set of criteria defined by the DSM.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Recognition of Alcohol and Substance Abuse. American Family Physician. https://www.aafp.org/afp/2003/0401/p1529.html. April 2003. Accessed May 2022.
  2. Screening Tests. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htm. Accessed May 2022.
  3. A Brief Guide to the Assessment and Treatment of Alcohol Dependence. Government of Western Australia. https://www.mhc.wa.gov.au/media/1171/dependence-brochure-2014v8web.pdf. 2015. Accessed May 2022.
  4. Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/sites/default/files/DSMfact.pdf. February 2020. Accessed May 2022.
  5. Understanding Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder. April 2021. Accessed May 2022.

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