[Alcohol use disorder: evolution of the nosography]

Area of Science:

• Psychiatry
• Addiction Medicine
• Behavioral Science

Background:

• The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) used a hierarchical classification for alcohol use.
• This system distinguished between alcohol abuse and alcohol dependence, often carrying stigma.
• The previous model did not fully integrate key concepts like craving.

Purpose of the Study:

• To analyze the nosographic shift in alcohol use disorder classification with the introduction of the DSM-5.
• To highlight the implications of the DSM-5's dimensional approach for understanding and treating addictive behaviors.
• To compare the DSM-5 framework with international standards like the ICD-10 and ICD-11.

Main Methods:

• Comparative analysis of diagnostic criteria between DSM-IV-TR and DSM-5.
• Review of the integration of craving as a diagnostic element.
• Examination of the dimensional perspective in classifying addictive behaviors.

Main Results:

• The DSM-5 abandoned the biaxial view and hierarchical gradation of abuse and dependence.
• The term "dependence" was removed, reducing stigma and clarifying psychic and physical dependency distinctions.
• Craving was integrated, aligning the DSM-5 with the ICD classification systems.

Conclusions:

• The DSM-5 represents a significant evolution in alcohol use disorder nosography, adopting a modern dimensional view.
• This progressive continuum from use to use disorder (mild to severe) allows for dynamic representation of addiction.
• The new framework supports tailored therapeutic strategies, including harm reduction and abstinence as one option.