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Alcohol: Abuse, Dependence

By: Roger J. Gregoire, CAC

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Every field of study has their own language, terms that are used within the field that the general public may have other definitions for. With respect to addiction medicine, this can lead to confusion at best and a misdiagnosis at worse. Understanding the terminology of alcoholism will help you in understanding the different aspects and treatments of the disease. Some of the differences are subtle and unfortunately others are not yet industry standards.

For example, the clinical definitions of alcohol dependence and alcohol abuse are quite different. Some use the terms interchangeably, but they have very different meanings and treatments. The following will explain some of these terms, understanding the difference is critical in understanding today's treatments.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a hand book published by the American Psychiatric Association (APA) and contains the standard classification of mental disorders used by many mental health professionals in the United States. First published in 1952, with the latest version (DSM-IV) in 1994, it is a widely used book that standardizes some, but not all, of the terminology in addiction medicine. There is still ongoing controversy and debate over many of the terms used in the manual, but understanding them will provide a good base.

The evolution of diagnostic criteria for behavioral disorders involving alcohol reached a turning point in 1980 with the publication of the DSM-III, for the first time, the term "alcoholism" was dropped in favor of two distinct categories labeled "alcohol abuse" and "alcohol dependence" 1,2

Alcohol Abuse = harmful alcohol use, alcohol misuse
Alcohol Dependence= Alcoholism, alcohol addiction

A person can abuse alcohol without actually being "alcohol dependent" --that is, he or she may drink too much and too often but still not be dependent on alcohol. Some of the problems linked to alcohol abuse include not being able to meet work, school, or family responsibilities; drunk-driving arrests and car crashes; and drinking-related medical conditions. Under some circumstances, even social or moderate drinking is dangerous--for example, when driving, during pregnancy, or when taking certain medications.3 Proper diagnosis is essential in determining the appropriate treatment and should be made by a physician trained in addiction medicine.

 Alcohol Abuse (DSM-IV Criteria): 4

  1. A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:
    • Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
    • Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).
    • Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
    • Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).
  1. These symptoms must never have met the criteria for alcohol dependence.

Alcohol Dependence (DSM-IV Criteria) 4

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:

  1. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
    • Markedly diminished effect with continued use of the same amount of alcohol.
  1. Withdrawal, as defined by either of the following:
    • The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).
    • Alcohol is taken to relieve or avoid withdrawal symptoms.
  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or there are 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. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  5. 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 the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

References:

  1. Schuckit, M.A. DSM-IV: Was it worth all the fuss? Alcohol and Alcoholism. (Supp. 2):459-469, 1994.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Washington, D.C.: The Association, 1980
  3. NIAAA  http://www.niaaa.nih.gov/FAQs/General-English/default.htm
  4. American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV). Washington, D.C.: APA.

This page was last modified on : 10/28/2013

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