Topic 3 Definitions, Signs, and Symptoms of Problematic Use of Alcohol among Children and Adolescents

According to European Union Agency for Fundamental Rights, the CRC Committee suggests that the minimum age for the purchase and consumption of alcohol and tobacco should be 18 years (CRC General Comment No. 20, 2016), and in 21 Member States children cannot purchase alcohol, while several states set 16 years as the minimum age for purchasing beverages containing less than 1.2 % of distilled alcohol and 18 years for buying spirits (more than 1.2 % of distilled alcohol). 

When addressing problematic use of alcohol, DSM-5 defines Alcohol Use Disorder as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of diagnostic criteria presented in Table 4; while ICD-11 defines alcohol dependence as a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. Again, in DSM-5, if there are 2-3 symptoms present, it is considered to be a mild form, if there are 4-5 symptoms moderate, and if there are 6 and more severe, and these symptoms should be present for at least 12-months.

Comparison of diagnostic criteria for problematic alcohol use in ICD-11 and DSM-5

Diagnostic criteria ICD-11 Alcohol dependence DSM-5 Alcohol Use Disorder

Consumed in larger amounts or over a longer period than was intended

There is a persistent desire or unsuccessful efforts to cut down or control the use

A great deal of time is spent in activities necessary to obtain or use it

Craving, or a strong desire or urge to use

Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the use

Important social, occupational, or recreational activities are given up or reduced because of the use.

Recurrent use in situations in which it is physically hazardous

Recurrent use resulting in a failure to fulfil major role obligations at work, school, or home

The 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 the use

Tolerance

Withdrawal

Activity 1: Recognize the diagnostic criteria for problematic alcohol use appearing in two classification systems

Select 4 diagnostic criteria for problematic alcohol use in which are appearing both in ICD-11 and DSM-5:

  1. Consumed 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 the use
  3. A great deal of time is spent in activities necessary to obtain or use it
  4. Craving, or a strong desire or urge to use
  5. Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the use
  6. Important social, occupational, or recreational activities are given up or reduced because of the use.
  7. Recurrent use in situations in which it is physically hazardous
  8. Recurrent use resulting in a failure to fulfil major role obligations at work, school, or home
  9. The 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 the use
  10. Tolerance
  11. Withdrawal

Binge drinking is defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 g/dl or above. This typically happens when 4-5 drinks or more are consumed in about 2 hours, and can lead to alcohol intoxication. EMCDDA (2019) considers binge drinking as drinking 6 or more glasses of alcohol on one occasion, and ESPAD research among adolescents defines binge drinking as drinking 5 or more glasses of alcohol on one occasion (ESPAD, 2019).

Alcohol intoxication is a clinically significant transient condition that develops during or shortly after the consumption of alcohol that is characterised by time-limited disturbances in consciousness, cognition, perception, affect, behaviour, or coordination.

Comparison of diagnostic criteria for alcohol intoxication in ICD-11 and DSM-5

Diagnostic criteria ICD-11 DSM-5

Recent ingestion of alcohol

Clinically significant problematic behavioural or psychological changes

Disturbances in consciousness, cognition, perception, affect, behaviour, or coordination

(impaired attention, inappropriate or aggressive behaviour, lability of mood and emotions, impaired judgment, poor coordination, unsteady gait, fine nystagmus and slurred speech)

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance

May facilitate suicidal ideation or behaviour

Since the intensity of these disturbances caused by alcohol intoxication is closely related to the amount of alcohol consumed, it is important to be familiar with symptoms specific for each of the stages presented below.

Stages of alcohol intoxications (adapted from Dubowski, 1977)

Blood alcohol concentration - BAC Stage Symptoms

0.01-0.05 BAC

(1 drink)

Sobriety/Subclinical Intoxication

Judgment and reaction time may be slightly impaired

0.03 - 0.12 BAC

(2-5 drinks)

Euphoria

Difficulty concentrating, Talkativeness, Decreased inhibitions, Brighter colour in the face, Fine motor skills are lacking

0.09 - 0.25 BAC

Excitement

Impaired perception and memory, Poor coordination, Drowsy, Beginnings of erratic behaviour, Slow reaction time, Impaired judgment

0.18 - 0.30 BAC

Confusion

Exaggerated emotions, Difficulty walking, Blurred vision, Slurred speech, Pain is dulled

0.25 - 0.40 BAC

Stupor

Cannot stand or walk, Vomiting, Possible unconsciousness, Decreased response to stimuli, Apathetic

0.35 - 0.45 BAC

Coma

Unconscious, Low body temperature, Shallow breathing, Slow pulse, Possible death (due to respiratory arrest)