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Tests and diagnosis
By Mayo Clinic staffTo be diagnosed with alcoholism, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.
Criteria for alcoholism to be diagnosed include a pattern of alcohol abuse leading to significant impairment or distress, as indicated by three or more of the following at any time during one 12-month period:
- Tolerance, indicated by an increase in the amount of alcohol you need to feel intoxicated. As alcoholism progresses, the amount leading to intoxication can also decrease as a result of damage to your liver or central nervous system.
- Withdrawal symptoms when you cut down or stop using alcohol. These signs and symptoms include tremors, insomnia, nausea and anxiety. You may drink more alcohol in order to avoid those symptoms.
- Drinking more alcohol or drinking over a longer period of time than you intended.
- Persistently having a desire to cut down on your alcohol intake or making unsuccessful attempts to do so.
- Spending a great deal of time obtaining, using, or recovering from alcohol use.
- Giving up important social, occupational or recreational activities.
- Continuing to use alcohol even though you know it's causing physical and psychological problems.
Problems often difficult to discover
It's often difficult for doctors to decide which people to screen for an alcohol problem. For example, signs and symptoms such as memory loss or falling might be the result of aging rather than indications of alcohol abuse. Or people may complain to doctors about digestive problems or pain or weakness, but never reveal their abuse of alcohol.
A doctor who suspects an alcohol problem may ask a number of questions regarding drinking habits in order to get an indication of the amount of drinking. If answers to those questions indicate possible alcoholism or alcohol abuse, the doctor may do a short screening test using a standardized questionnaire.
Blood alcohol tests aren't useful in diagnosing alcoholism because the tests indicate consumption only at that particular time. They don't offer clues about long-term alcohol use. Other blood tests that measure the size of red blood cells, which increases with long-term alcohol use, and a factor known as carbohydrate-deficient transferrin may indicate heavy alcohol consumption. Sometimes other tests indicate health problems that may be alcohol-related, such as tests showing liver damage or reduced testosterone levels in men.
Denial is a hallmark of alcoholism, and people with alcohol dependence tend to minimize the extent of their drinking. The doctor may ask for permission to speak with family members or friends. Concerned family members may also contact the doctor on their own to discuss their concerns. However, confidentiality rules prevent the doctor from giving out any information without consent.
