Alcoholism Disease
Defined by Two Diagnoses

Alcoholism Disease: Diagnosing Alcohol Abuse and Dependence

While people commonly refer to all alcohol-related conditions as alcoholism disease, medical professionals differentiate the health problem as two separate conditions:

1. Alcohol Abuse: a chronic condition whereby the drinker refuses to stop even though there are consequences to family, friends and work commitments.

   Alcohol abuse leads to alcohol dependence without proper treatment.

2. Alcohol Dependence: a progressive and potentially fatal disease that leads to dangerous behaviors with medical, psychological, and/or social implications.

   This alcoholism disease is earmarked by an insatiable need for greater amounts of alcohol, increased tolerance and an inability to reduce or control consumption.

The diagnostic criteria for these two alcoholism health problems are detailed in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DMV-IV) as follows.

DSM-IV Diagnostic Criteria for Alcohol Abuse

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:

1. 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).

2. Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).

3. Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).

4. 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).

These symptoms must never have met the criteria for alcohol dependence.

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:
   1. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
   2. Markedly diminished effect with continued use of the same amount of alcohol.

2. Withdrawal, as defined by either of the following:
   1. The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).
   2. Alcohol is taken to relieve or avoid withdrawal symptoms.

3. Alcohol is often taken in larger amounts or over a longer period than was intended.

4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.

5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.

6. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

7. 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).

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