Amendment Statement of Principles

concerning

ALCOHOL USE DISORDER

No. 29 of 2014

for the purposes of the

Veterans’ Entitlements Act 1986

and

Military Rehabilitation and Compensation Act 2004

1. This Instrument may be cited as Amendment Statement of Principles concerning alcohol use disorder No. 29 of 2014.
2. The Repatriation Medical Authority amends, under subsection 196B(8) of the Veterans’ Entitlements Act 1986, Statement of Principles concerning alcohol dependence and alcohol abuse Instrument No. 1 of 2009, by:

(A)        changing the name of this Instrument to "Statement of Principles concerning alcohol use disorder No. 1 of 2009";

(B)         replacing the phrases "alcohol dependence and alcohol abuse" and "alcohol dependence or alcohol abuse" with the words "alcohol use disorder" wherever these phrases appear in this instrument, with the exception of clause 2(a);

(C)         replacing the definition of "alcohol dependence and alcohol abuse" in clause 3 with the definition of "alcohol use disorder" as follows:

'"alcohol use disorder" means a mental disorder that meets the following diagnostic criteria (derived from DSM-5):

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least four of the following, occurring within a 12-month period:

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. Craving, or a 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.
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:

(i)                 A need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or

(ii)              A markedly diminished effect with continued use of the same amount of alcohol.

K.                Withdrawal, as manifested by either of the following:

(i)                 The characteristic withdrawal syndrome for alcohol; or

(ii)              Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

The definition of alcohol use disorder excludes acute alcohol intoxication in the absence of alcohol use disorder.';

(D)        revising the existing definition of "a clinically significant psychiatric condition" in clause 9 as follows:

'"a clinically significant psychiatric condition" means a specified disorder of mental health, which is of sufficient severity to warrant ongoing management, which may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner;';

(E)         inserting definitions of "a specified disorder of mental health" and "DSM-5" in clause 9 as follows:

'"a specified disorder of mental health" means:

(a)               a bipolar disorder or related disorder;

(b)               a depressive disorder;

(c)               a disruptive, impulse-control or conduct disorder;

(d)               a dissociative disorder;

(e)               a feeding disorder or eating disorder;

(f)                a neurocognitive disorder;

(g)               a neurodevelopmental disorder;

(h)               a paraphilic disorder;

(i)                 a personality disorder;

(j)                 a schizophrenia spectrum disorder or other psychotic disorder;

(k)               a sexual dysfunction;

(l)                 a sleep-wake disorder;

(m)            a somatic symptom disorder or related disorder;

(n)               a trauma and stressor-related disorder;

(o)               an anxiety disorder;

(p)               an obsessive compulsive disorder or related disorder; or

(q)              gender dysphoria;'; and

'"DSM-5" means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  Arlington, VA, American Psychiatric Association, 2013;'; and

(F)          deleting the definition of "DSM-IV-TR" in clause 9.

3.                     The amendments made by this instrument apply to all matters to which Instrument No. 1 of 2009, section 120A of the Veterans’ Entitlements Act 1986 and section 338 of the Military Rehabilitation and Compensation Act 2004 apply.

4.                     The amendments made by this instrument take effect from 26 March 2014.

Dated this   twenty-first   day of   March   2014

The Common Seal of the  )

Repatriation Medical Authority )

was affixed at the direction of: )

PROFESSOR NICHOLAS SAUNDERS AO

CHAIRPERSON