Alcohol Abuse and Alcohol Dependence

Diagnosing Addiction

Just because a person occasionally drinks too much alcohol does not necessarily mean that they are addicted. It can actually be quite difficult to diagnose a person who has a drinking problem. It is common for such individuals to conceal the true amount of their alcohol consumption. Denial is another barrier for those trying to diagnose alcohol problems.

Alcohol Abuse and Alcohol Dependence

Not every individual who abuses alcohol is physically addicted. It is possible to abuse booze in the short term without developing physiological dependence. The individual might get into trouble because of their drinking, but they have not yet reached a stage where their body reacts poorly to not having this drug. Some people develop a physical addiction after a relatively short period of alcohol abuse, while for others it can take longer. Once the individual has become physically addicted they will experience withdrawal symptoms should they stop drinking. It will then be a lot harder for them to give up alcohol.

The Importance of Dependence Diagnosis

In order to properly treat any problem, it is necessary to get a diagnosis. For instance, just assuming that an individual is an alcoholic because they have a DUI is not a good approach. Dependence involves a set of behaviors and physical changes within the body. Some people might go through a period where they overindulge in alcohol but later snap out of this. Sending such individuals to a rehab would not be appropriate.

If somebody is diagnosed as just abusing alcohol they will not require the same treatment as someone who is alcohol dependent. Overindulgence can be dealt with through education where the individual can be made aware of the dangers of continued abuse. Information is often all the individual who abuses alcohol needs to change their ways. A person who is diagnosed with alcohol dependence will often require a far more intensive intervention. They are at risk of physical withdrawals and will find it a lot harder to walk away from alcohol. Many of those with physical dependence will require some type of residential program.

Dependence Diagnosis Tools

Different dependence diagnosis criteria have been developed to make assessments of individuals who may be having problems with alcohol. A psychiatric diagnosis will assess for physical dependence as well as other signs of dysfunction. There are also self-reporting questionnaires which the individual can use to decide if they have a problem. The most respected dependence diagnosis tool is the fourth edition of the DSM-IV.

DSM-IV and Alcohol Dependence

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders uses the following criteria for determining alcohol dependence:

* Tolerance for alcohol
* Withdrawal Symptoms when the individual stops drinking
* Inability to cut down the amount of alcohol consumed
* Continued usage despite harmful consequences
* Loss of interest in other areas of life such as hobbies or career
* Increasing amounts of time lost to alcohol or drugs. This time might be spent actually abusing or recovering from the effects.
* The inability to control alcohol use. This can mean drinking more than what was intended or spending more time at it then was planned.

If more than three of the above criteria apply to the individual for a period longer than one year, they would be considered to be dependent.

DSM-IV and Alcohol Abuse

As well as describing the criteria for alcohol dependence, the DSM-IV also provides the same for alcohol abuse. The signs of this include:

* The individual gets into dangerous situations due to alcohol — this could involve such behavior as sexual promiscuity or drunk driving
* A failure to meet responsibilities, for instance, the individual might be neglecting their family or turning up late to work
* The individual continues to drink despite serious negative consequences of doing this.
* A history of legal problems related to alcohol usage

If any of the above applies to an individual during a one year period, it is a sign of alcohol abuse.


The International Classification of Diseases-10 also provides criteria for diagnosing dependence. If any three of the following criteria apply to an individual during a 1 year period, then it indicates alcohol dependence.

* A strong compulsion to drink alcohol
* The individual finds it hard to control alcohol intake
* Continued use despite evidence of harmful consequences
* Evidence of tolerance
* Physical withdrawal symptoms
* Loss of interest in other activities

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