Alcohol dependence is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences (e.g, liver disease or depression caused by drinking).
- continued hazardous and harmful drinking can result in alcohol dependence.
- alcohol dependence is also associated with increased criminal activity and domestic violence, and an increased rate of significant mental and physical disorders
ICD-10 defines dependency as:
“a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.”.
In earlier disease-classification systems this has been referred to as ‘alcoholism’.
Alcohol dependence is also a category of mental disorder in DSM–IV, although the criteria are slightly different from those used by ICD–10 (1)
Although alcohol dependence is defined in ICD-10 and DSM-IV in categorical terms for diagnostic and statistical purposes as being either present or absent, in reality dependence exists on a continuum of severity. However, it is helpful from a clinical perspective to subdivide dependence into categories of mild, moderate and severe
- mild alcohol dependence
- people with mild dependence (those scoring 15 or less on the Severity of Alcohol Dependence Questionnaire; SADQ) usually do not need assisted alcohol withdrawal
- moderate alcohol dependence
- people with moderate dependence (with a SADQ score of between 15 and 30) usually need assisted alcohol withdrawal, which can typically be managed in a community setting unless there are other risks
- severe alcohol dependence
- people who are severely alcohol dependent (with a SADQ score of more than 30) will need assisted alcohol withdrawal, typically in an inpatient or residential setting. In this guideline these definitions of severity are used to guide selection of appropriate interventions
Griffith Edwards and Gross(1976) defined some simple markers of alcoholism. These are:
- dependent drinkers have a narrow repertoire of alcohol consumption: alcohol is used to avoid withdrawal symptoms
- drinking overtakes the individual's activities to the exclusion of everything else, leading to theft, begging and borrowing
- withdrawal symptoms include trembling, fear, insomnia, nightmares, sweating and hallucinations.
- tolerance develops so that the dependent drinker consumes quantities which might make non-drinkers unconscious
- dependent drinkers know that they cannot control their alcohol use
- there is a high tendency to relapse after abstinence
Alcohol withdrawal symptoms occur within 12 hours of the last drink.