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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.

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)

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 abuseby 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. 1. 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. 2. 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: 1. Narrowing of the drinking repertoire. 2. Increased salience of the need for alcohol over competing needs and responsibilities. 3. An acquired tolerance to alcohol.

4. Withdrawal symptoms. 5. Relief or avoidance of withdrawal symptoms by further drinking. 6. Subjective awareness of compulsion to drink. 7. Reinstatement after abstinence.



Diagnostic and Statistical Manual of Mental Disorders Fourth Edition The DSM IV, was published in May 1994 by the American Psychiatric Association. The DSM IV has been referred to as the "bible" of psychiatric diagnosis because it provides definitions, symptoms and characteristics for mental disorders that are recognized by clinicians from around the world. The DSM IV calls for clinicians to evaluate individuals on five levels or axes. Axis I identifies mental disorders; Axis II identifies personality disorders and mental retardation. Axis III identifies relevant physical diseases and conditions. Axis IV identifies the individuals psychosocial and environmental issues; and Axis V is used by the clinician to assess an individual's overall functioning based on the 100-point scale called the Global Assessment of Functioning (GAF). "Getting the right treatment almost always depends on having the right diagnosis ... Catching symptoms early makes them easier to treat, less likely to come back, and less able to damage your life... One in five people has a psychiatric problem at any given moment, and half will have one in a lifetime. But most people who need it never get adequate treatment and there is usually a lag of many years before the right diagnosis is made. This exacts a great toll of personal and family misery and societal cost. The changes in health care delivery make it especially important for you to be an informed consumer. Because managed care has radically reduced the time doctors spend with patients, psychiatric disorders are more likely than ever to fall through the cracks... Knowledge is still power. You are more likely to get good care if you are educated about your problem, understand its usual course, and know what can be done about it... It is certainly no fun having a psychiatric disorder, but it is something you can learn to control and mange gracefully." (Your Mental Health: A Layman's Guide to the Psychiatrist's Bible by Allen Frances, MD and Michael B. First, MD, 1998, Scribner) (

Signs and symptoms of alcoholism (alcohol dependence)

Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms of alcohol abuse, but it also involves another element: physical dependence on alcohol. If you rely on alcohol to function or feel physically compelled to drink, youre an alcoholic.

Tolerance: The 1st major warning sign of alcoholism

Do you have to drink a lot more than you used to in order to get buzzed or to feel relaxed? Can you drink more than other people without getting drunk? These are signs of tolerance, which can be an early warning sign of alcoholism. Tolerance means that, over time, you need more and more alcohol to feel the same effects.

Withdrawal: The 2nd major warning sign of alcoholism

Do you need a drink to steady the shakes in the morning? Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism and a huge red flag. When you drink heavily, your body gets used to the alcohol and experiences withdrawal symptoms if its taken away. These include:

Anxiety or jumpiness Shakiness or trembling Sweating Nausea and vomiting Insomnia

Depression Irritability Fatigue Loss of appetite Headache

Other signs and symptoms of alcoholism (alcohol dependence)

Youve lost control over your drinking. You often drink more alcohol than you wanted to, for longer than you intended, or despite telling yourself you wouldnt. You want to quit drinking, but you cant. You have a persistent desire to cut down or stop your alcohol use, but your efforts to quit have been unsuccessful. You have given up other activities because of alcohol. Youre spending less time on activities that used to be important to you (hanging out with family and friends, going to the gym, pursuing your hobbies) because of your alcohol use. Alcohol takes up a great deal of your energy and focus. You spend a lot of time drinking, thinking about it, or recovering from its effects. You have few if any interests or social involvements that dont revolve around drinking. You drink even though you know its causing problems. For example, you recognize that your alcohol use is damaging your marriage, making your depression worse, or causing health problems, but you continue to drink anyway.