The Relationship Between Excessive Alcohol Consumption and Alcohol Use Disorders According to DSM-IV and DSM-5

Background: Although it seems intuitive that alcohol use disorders (AUDs) include excessive alcohol consumption (EAC), this notion is not well established. This study investigates to which degree EAC (defined as >14/21 drinks weekly for women/men and at least three 5+ drinking days per week) and AUD overlap and whether problematic alcohol use groups (EAC-only, AUD-only, and EAC + AUD) differ from each other and from nonproblematic alcohol users regarding sociodemographics, mental health problems, functioning, and service utilization.

Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study-2, a population-based study including 5,443 current drinkers (aged 18 to 64) interviewed with the Composite International Diagnostic Interview 3.0. Both DSM-IV AUDs and a proxy of DSM-5 AUD are considered.

Results: Of the current drinkers, 3.8% reported 12-month EAC. Twelve-month prevalence of DSM-IV and DSM-5 AUD were 5.4 and 4.4%, respectively. Regarding DSM-IV, only 17.7% of subjects with AUD reported EAC and 25.3% of those with EAC had an AUD. Compared with nonproblematic alcohol users, the 3 groups of problematic alcohol use (EAC-only, AUD-only, and EAC + AUD) were more often associated with mental health problems, poorer functioning, and service utilization. There were few differences between EAC-only and AUD-only regarding these correlates. However, EAC + AUD had strongest associations with above-mentioned correlates compared with the other 3 groups. Compared with DSM-IV findings, DSM-5 AUDs had slightly larger overlap with EAC, but correlates were similarly associated with problematic alcohol use groups.

Conclusions: Findings indicate limited overlap between EAC and AUD. Yet, both dimensions were similarly associated with other problems suggesting that both should be included in future epidemiological research to detect the total group of problematic alcohol users.