Diagnosing alcohol use disorder after period of sobriety

[nexus73]

This seems like an obvious question, but I just can't wrap my head around it.

What is the appropriate way to diagnose/code for alcohol use disorder in this scenario, especially regarding severity level? Individual has been sober 4 years, but prior to sobriety met all criteria for alcohol use disorder. They are in sustained remission because it's been more than 12 months not meeting criteria. They met criteria for severe alcohol use disorder 4 years ago when they were still drinking, but now meet no criteria. DSM5 says to code based on current severity which has me confused because they don't currently meet criteria for even mild severity, but clearly have a severe disorder which would likely get bad again if they relapsed.

Would this be Alcohol use disorder, severe, in sustained remission? Or something else?

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[Merovinge]

AUD, severe, in sustained remission. Addiction is a chronic illness which has modifiers to detail how long symptoms have been in remission.

My mother had an early stage bladder cancer removed under local cystoscopy. I assure you the 10th cysto they did to make sure nothing returned was not billed as random cysto.

 

[nexus73]

AUD, severe, in sustained remission. Addiction is a chronic illness which has modifiers to detail how long symptoms have been in remission.

My mother had an early stage bladder cancer removed under local cystoscopy. I assure you the 10th cysto they did to make sure nothing returned was not billed as random cysto.

thanks, i’m just confused about dsm5 saying to code by current severity. i definitely agree it’s a chronic illness.

 

[calvnandhobbs68]

thanks, i’m just confused about dsm5 saying to code by current severity. i definitely agree it’s a chronic illness.

Merovinge is right, you can also look at the ICD-10 codes for this and they lay it out the same way.

2023 ICD-10-CM Diagnosis Code F10.21: Alcohol dependence, in remission

ICD 10 code for Alcohol dependence, in remission. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code F10.21.

www.icd10data.com

F10.20 Applicable To: Alcohol use disorder, moderate; Alcohol use disorder, severe

F10.21 Applicable To: Alcohol use disorder, moderate, in early remission; Alcohol use disorder, moderate, in sustained remission; Alcohol use disorder, severe, in early remission; Alcohol use disorder, severe, in sustained remission

 

[whopper]

What do you diagnose if a person has Depression that's been recurrent, partially improved and now in the moderate level?

MDD Recurrent and Moderate or MDD Recurrent in Partial Remission?

Answer: Whatever bills more.

 

[docksan]

What do you diagnose if a person has Depression that's been recurrent, partially improved and now in the moderate level?

MDD Recurrent and Moderate or MDD Recurrent in Partial Remission?

Answer: Whatever bills more.

This, and I was taught you step down severity before remission for that reason.

 

[smalltownpsych]

i concur that the language in DSM doesn’t make sense with saying to code based on current severity when a client is in sustained remission. I also tend to ignore that language and diagnose based on level of severity during active use. I think the DSM has a bit of bias toward active or acute problems which obviously make sense since that is often what we treat, but so many of our illnesses have both a chronic component and periods of acute exacerbation. I also think that even though a vulnerability is always there, I would like to see some language or way of conceptualizing that could capture the concept of cured.