Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship. For a person to meet criteria for Alcohol Dependence (303.90) within the criteria listed in the DSM-IV, they must meet 3 of a total 7 possible criteria within a 12 month period.
The first 2 criteria are related to physiological dependence: tolerance and withdrawal. The 3rd and 4th criteria establish a pattern of losing control of drinking by breaking drinking rules or failing at attempts to quit or cut back. The 5th and 6th criteria are indicative of a progression of addiction as more and more time is spent on drinking and lifestyle changes result. The seventh criteria for Alcohol Dependence is met when a person continues to drink despite being aware that their drinking is causing or excacerbating some psychological or physiological problem(s).
It is important to note that because only 3 criteria of 7 are required in order to be diagnosed with Alcohol Dependence, not all 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.
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 Association 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 three 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’.
The following elements are the template for which the degree of dependence is judged:
The CAGE questionnaire is a tool used to assess individuals for potential alcohol problems, including dependence. It is useful because it involves 4 simple questions, of which only 2 need to be answered positively for the individual to be indicated as possibly alcohol dependent.
The SAD-Q is a more specific 20 item inventory for assessing the presence and severity of alcohol dependence.
