Term	Source	Definition
Low-risk use/lower risk use	ASAM	Consumption of alcohol below the amount identified as hazardous and in situations not defined as hazardous
Risky/at-risk use	NIAAA	Consumption of alcohol above the recommended daily, weekly, or per-occasion amounts but not meeting criteria for alcohol use disorder For all women and men 65 years or older: No more than 3 drinks per day and no more than 7 drinks per week For men (21 to 64 years): No more than 4 drinks per day and no more than 14 drinks per week Should avoid alcohol completely: Adolescents; women who are pregnant or trying to get pregnant; and adults who plan to drive a vehicle or operate machinery, are taking medication that interacts with alcohol, or have a medical condition that can be aggravated by alcohol For adolescents: NIAAA defines moderate- and high-risk use based on days of alcohol use in the past year, by age group: Moderate risk: Ages 12 to 15 years: 1 day Ages 16 to 17 years: 6 days Age 18 years: 12 days Highest risk: Age 11 years: 1 day Ages 12 to 15 years: 6 days Age 16 years: 12 days Age 17 years: 24 days Age 18 years: 52 days
Unhealthy use	ASAM	Any alcohol use that increases the risk or likelihood of health consequences (hazardous use [see below]) or has already led to health consequences (harmful use [see below])
Hazardous use	WHO	A pattern of substance use that increases the risk of harmful consequences; in contrast to harmful use, hazardous use refers to patterns of use that are of public health significance, despite the absence of a current alcohol use disorder in the individual user
Hazardous use	ASAM	Alcohol use that increases the risk or likelihood of health consequences; does not include alcohol use that has already led to health consequences
Harmful use	WHO	A pattern of drinking that is already causing damage to health; the damage may be either physical (e.g., liver damage from chronic drinking) or mental (e.g., depressive episodes secondary to drinking) The description for ICD-10 code F10.1, also labeled “Alcohol Abuse” in the 2018 ICD-10-CM codebook
Harmful use	ASAM	Consumption of alcohol that results in health consequences in the absence of addiction
Alcohol use disorder	DSM-5	A maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period: Having times when the patient drank more, or longer, than intended More than once wanted to cut down or stop, tried it, but could not Spending a lot of time drinking or being sick/getting over the aftereffects of drinking Wanting to drink so badly that they could not think of anything else Found that drinking (or being sick from drinking) often interfered with taking care of home or family responsibilities, caused problems at work, or caused problems at school Continuing to drink even though it was causing trouble with family and friends Given up or cut back on activities that were important or interesting in order to drink More than once gotten into situations while or after drinking that increased the chances of getting hurt (e.g., driving, swimming, unsafe sexual behavior) Continued to drink even though it was causing depression or anxiety, other health problems, or causing memory blackouts Having to drink much more than previously in order to get the desired effect, or finding that the usual number of drinks had much less effect than previously Experiencing the symptoms of withdrawal after the effects of alcohol were wearing off, such as trouble sleeping, shakiness, restlessness, nausea, sweating, racing heart, or seizure Severity is determined based on the number of symptoms present: Mild: 2 to 3 symptoms Moderate: 4 to 5 symptoms Severe: ≥ 6 symptoms
Binge drinking/heavy drinking episodes*	NIAAA	A pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL, which typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours
Binge drinking/heavy drinking episodes*	SAMHSA	Drinking ≥ 5 alcoholic drinks on the same occasion on at least 1 day in the past 30 days
Heavy drinking	SAMHSA	Drinking ≥ 5 drinks on the same occasion on each of ≥5 days in the past 30 days
Alcohol dependence	WHO/ICD-10-CM	≥ 3 of the following at some time during the previous year: A strong desire or sense of compulsion to take the substance Difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users) Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance, or to recover from its effects Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm