A 43-year-old married man is admitted to an inpatient hospital for acute hepatitis. The PMHNP is consulted for a psychiatric evaluation after he admits to a long history of alcohol use beginning in college. He has gradually increased his nightly alcohol intake from a single 6-pack of beer to two 12-packs of beer, and his drinking has caused him to oversleep and miss work on occasion. He has had his wife phone in sick for him from time to time. He has tried to cut down on his drinking with little success. He admits he does have tremors and becomes anxious when he doesn't drink. Which diagnosis appears to be appropriate for this patient, based on this information?

Choice A reason: "Alcohol dependence" is an outdated term replaced by "alcohol use disorder" in DSM-5. While it reflects chronic use, it lacks the diagnostic precision of the current classification. Choice B reason: Mild alcohol use disorder involves 2–3 DSM-5 criteria. This patient meets significantly more: tolerance, withdrawal, unsuccessful attempts to cut down, continued use despite problems, and interference with responsibilities. Choice C reason: Moderate alcohol use disorder involves 4–5 criteria. This patient exceeds that threshold, indicating a more severe pattern. Choice D reason: Severe alcohol use disorder is diagnosed when 6 or more DSM-5 criteria are met. This patient demonstrates tolerance, withdrawal, impaired control, neglect of responsibilities, continued use despite harm, and deception (having his wife call in sick), meeting the criteria for severe classification.