New diagnostic criteria for alcohol use disorders and novel treatment approaches - 2014 update.

State of the art paper New diagnostic criteria for alcohol use disorders and novel treatment approaches – 2014 update Ernest M. Tyburski1, Andrzej Sokolowski2, Jerzy Samochowiec3, Agnieszka Samochowiec1,3 Department of Clinical Psychology, Institute of Psychology, Szczecin University, Poland 2 Institute of Psychology, Adam Mickiewicz University, Poznan, Poland 3 Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland 1 Submitted: 7 April 2014 Accepted: 30 May 2014 Arch Med Sci 2014; 10, 6: 1191–1197 DOI: 10.5114/aoms.2014.47829 Copyright © 2014 Termedia & Banach Abstract The study is aimed at presenting new diagnostic and therapeutic proposals for patients with alcohol use disorders. The revised ICD-11 which is currently being updated is coming closer to American standards in disease classification. The latest update of the American DSM-5 has been a notable step forward as it integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder. Recent developments in research into diagnostic tools have brought changes in the approach to therapy. According to most international guidelines, the form of treatment should be customised to the individual patient, with consideration given to his/her mental and physical condition, personality and natural setting. A significant change is the recommendation of a harm reduction strategy as a useful alternative to total abstinence in alcohol dependence treatment for some patients. Key words: alcohol use disorder, DSM-5, ICD-11, harm reduction, genetic risk. Introduction Moderate alcohol consumption is the acceptable norm across most cultures. However, its abuse leads to alcohol dependence and poses a serious problem both to individuals concerned and to the society at large. The estimated financial burden associated with harmful alcohol drinking in developed countries, mainly in the Northern Hemisphere, amounts to more than 1% of the gross national product (GNP) [1]. The total costs linked to alcohol abuse are indicated to be underestimated owing to unregistered alcohol consumption which can account for even 25% of global alcohol consumption. An upward trend in alcohol consumption per capita has recently been observed, with an estimated 12.5 l in European countries and 8.44 l in the US [2, 3]. According to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), more than 17 million American citizens have a drinking problem, and 3.8% in the US general population qualify for alcohol dependence (5.4% among males and 2.3% among females) [4–6]. Poland’s State Agency for the Prevention of Alcohol-Related Problems (PARPA) reports that 2% of Poles are affected by alcohol dependence while 5–7% are at risk of developing the addiction [7]. Corresponding author: Agnieszka Samochowiec Department of Clinical Psychology Institute of Psychology Szczecin University 69 Krakowska St 71-017 Szczecin, Poland Phone: +48 602 315 835 E-mail: Ernest M. Tyburski, Andrzej Sokolowski, Jerzy Samochowiec, Agnieszka Samochowiec To limit alcohol-related harm and to more effectively help those that bear the consequences of alcohol dependence, classifications of illnesses and disorders are constantly improved. Ongoing research is striving to identify more homogeneous groups of patients that can be targeted with more efficient forms of medical intervention. The latest update of the American DSM-5 has been a notable step forward as it integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications [8]. Revised definitions of alcohol abuse and alcohol-related disorders are also proposed in ICD-11, which is currently being updated [9]. Many countries are changing their attitude to the treatment of alcohol dependence, shifting away from the classical approach assuming total abstinence towards the new harm reduction strategies, mainly through limiting the amount of alcohol use [10]. Proposals for changes of diagnostic criteria in ICD-11 The 11th revision process of the International Classification of Diseases is underway and the final ICD-11 is planned to be released in 2015. The World Psychiatric Association (WPA) and World Health Organization (WHO) have combined their efforts while working on the 5th part on mental disorders, including substance abuse [8]. Topic advisory groups discuss mental health issues including substance abuse disorders. A working group of experts has been set up to review mental disorders. Field trials are being conducted [9–11]. An alpha draft and a beta draft have been developed [12]. The final version is going to be presented in 2014 for WHO approval. The forthcoming classification is going to include the following alcohol-related disorders: acute alcohol intoxication, harmful use, dependence syndrome, withdrawal, mental disorders and alcohol-induced disorders arising from the use of alcohol. Similar codes are to be found in the current version of ICD-10. The new coding of alcohol intoxication defines it as a transient state following alcohol consumption resulting in disturbances in level of consciousness, cognition, perception, affect, behaviour or other psycho-physiological functions and responses. Typical symptoms include mood instability, false judgement, impaired social or professional functioning, and improper sexual or aggressive behaviour. Harmful use of alcohol will probably be defined as a pattern of alcohol use that is causing damage to health following repetitive episodes of intoxication, regular intake of large quantities of alcohol or harmful use of alcohol. The damage may be physical or mental, including violence and self-harmful acts of bodily damage requiring medical intervention. Alcohol dependence is defined as a cluster of phenomena that typically include difficulties in controlling alcohol use that develop after repeated or continuous use of the substance. It includes a strong desire to consume alcohol, impaired control of its use, a higher priority given to alcohol than other activities, frequently increased tolerance and a physical withdrawal state. The latter may be medicated with alcohol to relieve or avoid withdrawal symptoms. Alcohol use becomes a focal point in the life of a person and other activities or hobbies are given up or reduced. Continued alcohol use despite its harmful consequences is a frequent trait of the cluster. Table I presents proposals of new criteria of alcohol dependence syndrome [13]. Ongoing harmonisation of ICD-11 and DSM-5 aims at bringing their diagnostic criteria closer together. Similar results of alcohol-related disorders may be used. Moreover, the harmonisation can facilitate communication between specialists and be conducive to more effective education of clinicians [14]. Comparison of diagnostic criteria in DSM-IV and DSM-5 The latest update of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) w (...truncated)