Alcohol dependence is a previous psychiatric diagnosis in which an
individual is physically or psychologically dependent upon drinking
alcohol. In 2013 it was reclassified as alcohol use disorder along with alcohol
abuse in DSM-5. Definition and diagnosis
According to the DSM-IV criteria for alcohol dependence, at least three out
of seven of the following criteria must be manifest during a 12-month period:
Tolerance Withdrawal symptoms or clinically
defined alcohol withdrawal syndrome Use in larger amounts or for longer
periods than intended Persistent desire or unsuccessful
efforts to cut down on alcohol use Time is spent obtaining alcohol or
recovering from effects Social, occupational and recreational
pursuits are given up or reduced because of alcohol use
Use is continued despite knowledge of alcohol-related harm
= Screening = The Alcohol Use Disorders Identification
Test is considered the most accurate alcohol screening tool for identifying
potential alcohol misuse, including dependence. It was developed by the
World Health Organisation, designed initially for use in primary healthcare
settings with supporting guidance. Its use has replaced older screening tools
such as CAGE but there are many shorter alcohol screening tools, mostly derived
from the AUDIT. The Severity of Alcohol Dependence Questionnaire is a more
specific twenty-item inventory for assessing the presence and severity of
alcohol dependence. = Other alcohol-related disorders =
Because only 3 of the 7 DSM-IV criteria for alcohol dependence are required, not
all patients meet the same criteria and therefore not all have the same symptoms
and problems related to drinking. Not everyone with alcohol dependence,
therefore, experiences physiological dependence. Alcohol dependence is
differentiated from alcohol abuse by the presence of symptoms such as tolerance
and withdrawal. Both alcohol dependence and alcohol abuse are sometimes referred
to by the less specific term alcoholism. However, many definitions of alcoholism
exist, and only some are compatible with alcohol abuse. There are two major
differences between alcohol dependence and alcoholism as generally accepted by
the medical community. Alcohol dependence refers to an entity
in which only alcohol is the involved addictive agent. Alcoholism refers to an
entity in which alcohol or any cross-tolerant addictive agent is
involved. In alcohol dependence, reduction of
alcohol, as defined within DSM-IV, can be attained by learning to control the
use of alcohol. That is, a client can be offered a social learning approach that
helps them to 'cope' with external pressures by re-learning their pattern
of drinking alcohol. In alcoholism, patients are generally not presumed to
be 'in remission' unless they are abstinent from alcohol.
The following elements are the template for which the degree of dependence is
judged: Narrowing of the drinking repertoire.
Increased salience of the need for alcohol over competing needs and
responsibilities. An acquired tolerance to alcohol.
Withdrawal symptoms. Relief or avoidance of withdrawal
symptoms by further drinking. Subjective awareness of compulsion to
drink. Reinstatement after abstinence.
Treatment Treatments for alcohol dependence can be
separated into two groups, those directed towards severely
alcohol-dependent people, and those focused for those at risk of becoming
dependent on alcohol. Treatment for alcohol dependence often involves
utilizing relapse prevention, support groups, psychotherapy, and setting
short-term goals. The Twelve-Step Program is also a popular process used
by those wishing to recover from alcohol dependence.
Epidemiology About 12% of American adults have had an
alcohol dependence problem at some time in their life. In the UK the NHS
estimates that around 9% of men and 4% of UK women show signs of alcohol
dependence. History
The term 'alcohol dependence' has replaced 'alcoholism' as a term in order
that individuals do not internalize the idea of cure and disease, but can
approach alcohol as a chemical they may depend upon to cope with outside
pressures. The contemporary definition of alcohol
dependence is still based upon early research. There has been considerable
scientific effort over the past several decades to identify and understand the
core features of alcohol dependence. This work began in 1976, when the
British psychiatrist Griffith Edwards and his American colleague Milton M.
Gross collaborated to produce a formulation of what had previously been
understood as ‘alcoholism’ – the alcohol dependence syndrome.
The alcohol dependence syndrome was seen as a cluster of seven elements that
concur. It was argued that not all elements may be present in every case,
but the picture is sufficiently regular and coherent to permit clinical
recognition. The syndrome was also considered to exist in degrees of
severity rather than as a categorical absolute. Thus, the proper question is
not ‘whether a person is dependent on alcohol’, but ‘how far along the path of
dependence has a person progressed’. See also
Alcohol dementia Alcohol intoxication
Alcoholic beverage High-functioning alcoholic
Long-term effects of alcohol Questionnaires
Alcohol Use Disorders Identification Test
CAGE questionnaire CRAFFT Screening Test
Paddington Alcohol Test Severity of Alcohol Dependence
Questionnaire Notes
External links Arnold Little, MD Alcohol Dependence -
extensive article SADD - Short Alcohol Dependence Data
Questionnaire. A brief, self-administered questionnaire
sometimes utilised in individual or group treatments.
R.R.Garifullin Using coding therapy to treat alcohol and drug addiction.
Manipulations in psychotherapy. Rostov-on-Don, Feniks, 251 p. 2004. 251
p. ISBN 5-222-04382-7