Alcohol use disorder conceptualizations and diagnoses reflect their sociopolitical context

Abstract

The present paper highlights how alcohol use disorder (AUD) conceptualizations and resulting diagnostic criteria have evolved over time in correspondence with interconnected sociopolitical influences in the United States. We highlight four illustrative examples of how DSM-defined alcoholism, abuse/dependence, and AUD have been influenced by sociopolitical factors. In doing so, we emphasize the importance of recognizing and understanding such sociopolitical factors in the application of AUD diagnoses. Last, we offer a roadmap to direct the process of future efforts toward the improved diagnosis of AUD, with an emphasis on pursuing falsifiability, acknowledging researchers’ assumptions about human behavior, and collaborating across subfields. Such efforts that center the numerous mechanisms and functions of behavior, rather than signs or symptoms, have the potential to minimize sociopolitical influences in the development of diagnostic criteria and maximize the treatment utility of diagnoses.

Keywords:

• Alcohol use disorder
• diagnosis
• sociopolitical influences

Ethical statement

The research in this paper does not require ethics board approval.

Disclosure statement

Dr. Katie Witkiewitz is a member of the Alcohol Clinical Trials Initiative (ACTIVE) Workgroup, which has been supported previously, but not in the past 36 months, by Abbott/Abbvie, Amygdala Neurosciences, Arbor Pharmaceuticals, GSK, Indivior, Janssen, Lilly, Pfizer, and Schering Plow, but in the past 36 months its activities were supported by Alkermes, Dicerna, Ethypharm, Lundbeck, Mitsubishi, and Otsuka. Dr. Witkiewitz is also on the Scientific Advisory Board for Pear Therapeutics and has consulted with and collaborated on scientific presentations with Alkermes. The other authors have no declarations of interest.

Notes

1 Not all explanations of addiction that center on addiction as a breakdown in self-regulation are moralizing. For example, behavioral economics is consistent with the idea of irrational or disordered choice (e.g. Rachlin et al. 1981) but fails to hold the same moralizing undertones that assume disordered choice is a product of sin or moral failing.

Additional information

Funding

CLB is funded through [K08030301] (Principal Investigator: Boness). VRV is funded through [F31AA029266] (Principal Investigator: Votaw). ALW is funded through [K99AA028306] (Principal Investigator: Watts). MWF is funded through NIDA [T32DA015035] (mPI/Director R. Cunningham-Williams and K. Bucholz).