Alcohol dependence
Encyclopedia
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis (a substance related disorder DSM-IV) describing an entity in which an individual uses alcohol
despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.
as a disease because it has a characteristic set of signs and symptoms and a progressive course.
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’.
(SAD-Q) is a more specific twenty item inventory for assessing the presence and severity of alcohol dependence.
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.
The following elements are the template for which the degree of dependence is judged:
Questionnaires
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.
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 (physical or psychological)
History and epidemiology
About 12% of American adults have had an alcohol dependence problem at some time in their life. Alcohol dependence is acknowledged by the American Medical AssociationAmerican Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
as a disease because it has a characteristic set of signs and symptoms and a progressive course.
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’.
Screening tools
The Alcohol Use Disorders Identification Test (AUDIT) is 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 QuestionnaireSeverity of Alcohol Dependence Questionnaire
The Severity of Alcohol Dependence Questionnaire is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.It is divided into 5 sections:* Physical withdrawal symptoms* Affective withdrawal symptoms...
(SAD-Q) is a more specific twenty item inventory for assessing the presence and severity of alcohol dependence.
Comparisons with 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 abuseAlcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...
by the presence of symptoms such as tolerance and withdrawal
Withdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
. Both alcohol dependence and alcohol abuse are sometimes referred to by the less specific term alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
. 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, remission as defined within DSM-IV can be attained despite continued use of alcohol. That is, a patient can be in full sustained remission yet still be drinking alcohol so long as the patient does not meet the noted criteria. 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.
See also
- AlcoholismAlcoholismAlcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
- alcohol abuseAlcohol abuseAlcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...
- Long-term effects of alcoholLong-term effects of alcoholThe long term effects of alcohol range from possible health benefits for low levels of alcohol consumption to severe detrimental effects in cases of chronic alcohol abuse...
- Alcohol dementiaAlcohol dementiaAlcohol dementia, which is sometimes associated with Wernicke-Korsakoff syndrome, is a form of dementia caused by long-term or excessive drinking resulting in neurological damage and memory loss. Other names for the condition are alcoholic dementia, alcohol related dementia and alcohol-induced...
- High-functioning alcoholicHigh-functioning alcoholicA High-functioning alcoholic is a form of alcoholism where the alcoholic is able to maintain their outside life such as jobs, academics, relationships etc. all while drinking alcoholically. Many HFAs are not viewed by society as alcoholics because they do not fit the common alcoholic stereotype...
Questionnaires
- Alcohol Use Disorders Identification TestAlcohol Use Disorders Identification TestThe Alcohol Use Disorders Identification Test is a simple ten-question test developed by the World Health Organization to determine if a person's alcohol consumption may be harmful. The test was designed to be used internationally, and was validated in a study using patients from six countries...
- CAGE questionnaireCAGE questionnaireThe CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism.The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism...
- CRAFFT Screening TestCRAFFT Screening TestCRAFFT Screening Test is a short, self-administered behavioural health screening tool developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. It is considered an effective screening tool intended to assess whether further assessment is warranted...
- Paddington Alcohol TestPaddington alcohol testThe Paddington Alcohol Test was first published in the Journal of Accident and Emergency Medicine in 1996. It was designed to identify alcohol-related problems amongst those attending Accident and Emergency departments...
- Severity of Alcohol Dependence QuestionnaireSeverity of Alcohol Dependence QuestionnaireThe Severity of Alcohol Dependence Questionnaire is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.It is divided into 5 sections:* Physical withdrawal symptoms* Affective withdrawal symptoms...
External links
- SADD - Short Alcohol Dependence Data Questionnaire. A brief, self-administered questionnaire sometimes utilised in individual or group treatments.