Handbook for Counselors

Understanding
Alcohol Use Disorder

Katrina Shababb
Caldwell University
 Table of Contents

Alcohol Use Disorder..................................................... 3

Use in the United States................................................ 4

Symptoms of AUD....................................................... 5-6

Treatment................................................................... 7-10

Prevention................................................................ 11-12

Transcript................................................................. 13-14

Resources.................................................................... 15

Appended...................................................................... 16

References.................................................................17-18
 Alcohol Use Disorder
Alcohol Use Disorder (AUD) is a medical condition that
doctors diagnose when a patient’s drinking causes distress
or harm (NIAAA, 2017). The fourth edition of the Diagnostic
and Statistical Manual (DSM–IV), published by the
American Psychiatric Association, described two distinct
disorders—alcohol abuse and alcohol dependence. The
fifth edition, DSM–5, integrates these two disorders into a
single disorder called AUD, with mild, moderate, and
severe sub classifications.

Low-risk for
developing AUD in
women is defined as
no more than 3 drinks
on any single day and
no more than 7 drinks
per week. For men, it
is defined as no more
than 4 drinks on any
single day and no
more than 14 drinks
per week.
Research shows that only about 2 in 100 people who
drink within these limits have AUD (NIAAA, 2017). For
most adults, moderate alcohol use is probably not
harmful. However, about 18 million adult Americans
have an alcohol use disorder. This means that their
drinking causes distress and harm (MEDLINE, 2016).
3
 Use in the United States
According to the 2015 National Survey on Drug Use and Health
(NSDUH), 86.4 percent of people ages 18 or older reported that
they drank alcohol at some point in their lifetime; 70.1 percent
reported that they drank in the past year; 56.0 percent reported
that they drank in the past month (NIAAA, 2017). In 2015, 26.9
percent of people ages 18 or older reported that they engaged in
binge drinking in the past month; 7.0 percent reported that they
engaged in heavy alcohol use in the past month (NIAAA, 2017).
According to the 2015 NSDUH, 15.1 million adults ages 18 and
older had AUD. This includes 9.8 million men, 8.4 percent, and
5.3 million women, 4.2 percent. About 1.3 million adults received
treatment for AUD at a specialized facility in 2015. According to
the 2015 NSDUH, an estimated 623,000 adolescents’ ages
12–17 had AUD. This number includes 298,000 males, 2.3
percent and 325,000 females, 2.7 percent. An estimated 37,000
adolescents received treatment for an alcohol problem in a
specialized facility in 2015.

4
 Symptoms of AUD
The DSM-5 criteria for AUD is based on 11 symptoms. These
symptoms include:

1) Alcohol is often taken in larger amounts or over a longer

period than was intended
2) There is a persistent desire or unsuccessful efforts to cut
down or control alcohol use
3) A great deal of time is spent in activities necessary to obtain
alcohol, use alcohol, or recover from its effects
4) Cravings or strong desire or urge to use alcohol
5) Recurrent alcohol use resulting in a failure to fulfill major role
obligations at work, school, or home
6) Continued alcohol use despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the
effects of alcohol

5
 Symptoms of AUD
7) Important social, occupational, or recreational activities are
given up or reduced because of alcohol use
8) Recurrent alcohol use in situations in which it is physically
hazardous
9) Alcohol use is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by alcohol
10) Tolerance, as defined by either of the following: A need for
markedly increased amounts of alcohol to achieve intoxication
or desired effect or A markedly diminished effect with continued
use of the same amount of alcohol
11) Withdrawal, as manifested by either of the following: The
characteristic withdrawal syndrome for alcohol, Alcohol taken to
relieve or avoid withdrawal symptoms

The presence of at least 2 of these symptoms indicates an AUD.

The severity of an AUD is graded mild, moderate, or severe
(Bergland, 2015). In mild cases, the presence of 2-3 symptoms
must exist. The presence of 4-5 symptoms indicated moderate
severity of AUD, and severe severity of an AUD is presented with
6 or more symptoms (Bergland, 2015).

6
 Treatment

No matter how severe the problem may seem, most people with
an alcohol use disorder can benefit from some form of treatment
(NIAAA, 2014). Research shows that about one-third of people
who are treated for alcohol problems have no further symptoms 1
year later. Many others substantially reduce their drinking and
report fewer alcohol-related problems (NIAAA, 2014). When
asked how alcohol problems are treated, people commonly think
of 12-step programs or 28-day inpatient rehab, but may have
difficulty naming other options. In fact, there are a variety of
treatment methods currently available. Different types of
treatments include: behavioral treatments, medication, and
mutual-support groups.

7
 Behavioral Treatment

Behavioral treatments are aimed at changing

drinking behavior through counseling.Behavioral
treatments share certain features, which can
include: developing the skills needed to stop or
reduce drinking, helping to build a strong support
system, working to set reachable goals, and
coping with or avoiding the triggers that might
cause relapse. The four main types of behavioral
treatments include: Cognitive- Behavioral
Therapy, Motivational Enhancement Therapy,
Marital and Family Counseling, and Brief
Interventions (MIAAA, 2014).

8
 Behavioral Treatment
Cognitive- Behavioral Therapy can take place one-on-one with
a therapist or in small groups. This form of therapy is focused on
identifying the feelings and situations that lead to heavy drinking
and managing stress that can lead to relapse. The goal is to
change the thought processes that lead to excessive drinking
and to develop the skills necessary to cope with everyday
situations that might trigger problem drinking

Motivational Enhancement Therapy is conducted over a short

period of time to build and strengthen motivation to change
drinking behavior. The therapy focuses on identifying the pros
and cons of seeking treatment, forming a plan for making
changes in one’s drinking, building confidence, and developing
the skills needed to stick to the plan

Marital and Family Counseling incorporates spouses and other

family members in the treatment process and can play an
important role in repairing and improving family relationships.
Studies show that strong family support through family therapy
increases the chances of maintaining abstinence (stopping
drinking), compared with patients undergoing individual
counseling

Brief Interventions are short, one-on-one or small-group

counseling sessions that are time limited. The counselor provides
information about the individual’s drinking pattern and potential
risks. After receiving personalized feedback, the counselor will
work with the client to set goals and provide ideas for helping to
make a change.
9
 Medication & Multual-
Support Groups
Three medications are currently approved in the United States
to help people stop or reduce their drinking and prevent relapse.
They are prescribed by a primary care physician or other health
professional and may be used alone or in combination with
counseling (NIAAA, 2014). These medications include:
Naltrexone, Acamprosate, and Disulfiram.Not all people will
respond to medications, but for a subset of individuals, these
medications can be an important tool in overcoming alcohol
dependence.

Alcoholics Anonymous (AA) and other 12-step programs

provide peer support for people quitting or cutting back on their
drinking. Combined with treatment led by health professionals,
mutual-support groups can offer a valuable added layer of
support. Due to the anonymous nature of mutual-support
groups, it is difficult for researchers to determine their success
rates compared with those led by health professionals

10
 Prevention 
The most promising route to effective strategies for the prevention
of alcohol and other drug problems is through a risk-focused
approach (Hawkins, Catalano, & Miller, 1992).

Prevention approaches that target early risk factors include:

-Early childhood and family support programs
Several interventions focusing on the prenatal and early infancy
periods with a variety of components ranging from health care;
nutrition; child care; social support for mothers; educational,
career, and family planning services
-Programs for parents of children and adolescents
Controlled studies have shown that family management problems
and child behavior problems can be reduced through parenting
skills training and functional family therapy.
-Social competence skills training
Evidence shows that aggressive and other behavioral problems is
associated with an increased risk of later alcohol abuse. It has
been argued that children who are aggressive, disruptive, and
rejected by peers in elementary grades are deficient in basic
interpersonal skills that can be taught.

11
 Prevention 

-Academic achievement promotion

Greater academic achievement results in less alcohol and drug
use in later years. Promotion could be done through, early
childhood education, alterations in classroom instructional
practices, and academic tutoring.
-Organizational changes in school
Evidence shows that school organizational factors can be
changed to reduce alcohol abuse risk factors.
-Youth involvement in alternative activities
Activities in the school setting that provide opportunities for
youths to participate. This strategy is expected to increase
commitment to school and to reduce the likelihood of violation of
school standards of behavior, including proscriptions against
alcohol use.
-Comprehensive risk-focused programs
Because drug abuse is a phenomenon influenced by multiple
risk factors, its prevention may be most effectively accomplished
by a combination of interventions promoting consistent
prevention principles across units of socialization.

12
 Transcript
Counselor: Hello Jane, I'm so happy you're here! I really want to get a good
understanding of who you are so I could better understand you and work with you
in the most effective way possible, Therefore, this first session is going to be very
question based, is that okay?
Client: Yes, thats okay thank you
Counselor: Great! Lets talk about what brings you in today.
Client: Well, my family thinks I have a drinking problem
Counselor: Your family thinks you have a drinking problem?
Client: Yeah, so what all started this was my family came to pick me up to go to
my cousins bridal party but I was drunk and couldn't go so they got pretty upset
with me.
Counselor: Do you feel you have a drinking problem
Client: Well, I like to drink I think its okay.
Counselor: Do you mind if I ask you a few questions about your drinking?
Client: Sure thats fine
Counselor: How often to do you drink?
Client: Umm, pretty much everyday. I mean on weekends for sure. During the
week ill go to which ever the best happy hour is. So, ill just go after work, have
some drinks, you know.
Counselor: Do you go to Happy hours on weekends also, what do you usual do?
Clients: I usually just stay to myself ill drink whatever i have in the house, I don't
usually go out on weekends.
Counselor: How much are you drinking, lets say on the weekend.
Client: Maybe like 2-3 cases of beer and if theres any sales in the liquor store I
may get a bottle of vodka to go along with it.
Counselor: Do you feel you drink more than you wish?
Client: I have tried to cut down but I enjoy going to happy hours so its hard for me
to stop. I don't think cutting down will happen.
Counselor: Do you have cravings for alcohol?
Client: Yes, you could say so. When I'm at work or out doing things I always want
to drink.
Counselor: How is your work? Are you staying on top of your job? Is your
performance ok?
Client: I am not at my best I have performed better but I'm not in risk of getting
fired or anything so my work is fine. I come in late every once and a while but
I sneak in so its okay.
13
 Transcript
Counselor: Are there any social problems going on due to your alcohol use?
Client: With my family, yeah. My friends are fine when we go out. Sometimes they
get little mad because I think they're boring. I would rather go out but they would
like to go to a movie and hang out.
Counselor: Have you found that your engagement in activities is dangerous
because of your drinking?
Client: I have fallen down my steps but other than that I've been okay
Counselor: Did you notice a point once you started drinking that you had to
increase the amount to get the same effect?
Client: Yeah all the time. I go through phases where I feel like I need to drink
more.
Counselor: Do you ever feel like you have withdrawn symptoms?
Client: I get more cravings and right now I have a headache but thats about it.
Counselor: Okay thank you so much for answering my questions. I would love to
continue working with you. Would you be interested in having follow up sessions?
Client: Well I think it'll make my mom happy so yeah we could try it out once or
twice and see what happens.
Counselor: Great, I'm going to make a schedule for your next sessions. I am so
happy you opened up and told me whats been going on and I look forward to
working with you.

This is an example of how a counselor may Diagnostically Assess a client

with AUD to better understand the severity of the disorder, in order to move
forward and provide effective counseling.

14
 Resources
Alcoholics Anonymous "is an
international fellowship of men and
women who have had a drinking
problem. It is nonprofessional, self-
supporting, multiracial, apolitical,
and available almost everywhere.
There are no age or education
requirements. Membership is open
to anyone who wants to do
something about his or her drinking
problem."

SMART Recovery "is the leading

self-empowering addiction
recovery support group. Our
participants learn tools for
addiction recovery based on the
latest scientific research and
participate in a world-wide
community which includes free,
self-empowering, science-based
mutual help groups."

15
Appended

16
 References
Alcoholics Anonymous. (2017). Welcome to alcoholics
anonymous. Retrieved from http://www.aa.org
American Addiction Centers. (2017). Alcohol withdrawal treatment,
symptoms, and timeline. Retrieved from
http://americanaddictioncenters.org/withdrawal- timelines-
treatments/alcohol/
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Bergland, C. (2015, January 4). What are the eleven symptoms of
alcohol use disorder [Psychology Today]. Retrieved from
https://www.psychologytoday.com/blog/the- athletes-
way/201506/what-are-the-eleven-symptoms-alcohol-use-
disorder
Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and
protective factors for alcohol and other drug problems in
adolescence and early adulthood: Implications for substance
abuse prevention. Psychological Bulletin, 122(1), 64-105.
MedlinePlus. (2016, September 21). Alcoholism and alcohol
abuse. Retrieved from
https://medlineplus.gov/alcoholismandalcoholabuse.html
National Institute on Alcohol Abuse and Alcoholism. (2014).
Treatment for alcohol problems: Finding and getting help.
Retrieved from https://pubs.niaaa.nih.gov/
publications/treatment/treatment.htm

17
 References
National Institute on Alcohol Abuse and Alcoholism. (2017,
February). Alcohol facts and statistics. Retrieved from
https://www.niaaa.nih.gov/alcohol-health/overview- alcohol-
consumption/alcohol-facts-and-statistics
Smart Recovery- Self Management and Recovery. (2017).
Discover the power of choice. Retrieved from
http://www.smartrecovery.org

18