Alcoholism

Worldwide, alcoholism is a leading preventable cause of morbidity and mortality. The chronic effects of alcohol overuse are destructive to bodily organs, families, and communities alike. Although the numbers of persons consuming alcohol is great, constituting a majority of the population in certain cultures, a small minority of these will develop problems with alcohol.

Alcoholism is defined by the U.S. National Council on Alcoholism and the American Society of Addiction Medicine as a “primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.” The criteria for alcoholism, as defined by this group, are as follows:

• impaired control over drinking
• preoccupation with the drug alcohol
• use of alcohol despite adverse consequences
• distortion of thinking, most notably denial

The term alcoholism encompasses the Diagnostic and Statistical Manual, 4th edition (DSM-IV) definitions of alcohol abuse and dependence, terms used to more clearly define types of alcoholism. Both are characterized as maladaptive patterns of alcohol abuse, with separate criteria. Alcohol abuse involves one or more of the following:

• failure to fulfill work, school, or social obligations;
• recurrent substance use in physically hazardous situations;
• recurrent legal problems related to substance use;
• continued use despite alcohol-related social or interpersonal problems.

Alcohol dependence involves three or more of the following:

• tolerance
• withdrawal
• substance taken in larger quantity than needed
• persistent desire to cut down or control use
• time is spent obtaining, using, or recovering from the substance
• social, occupational, or recreational tasks are sacrificed
• use continues despite physical and psychological problems

The three definitions—alcoholism, alcohol abuse, and alcohol dependence—all represent maladaptive [Page 56]use of alcohol that compromise the ability to function and fulfill obligations. While the distinctions between the three are useful in research, they are often indistinguishable in the clinical setting. Moreover, because they are treated similarly, health professionals will often focus on developing an individualized treatment plan based more on individual needs, rather than the diagnostic category. In addition, while the three overlap in many individuals, a unique feature of alcohol dependence is worth mentioning. In contrast to alcohol abuse, alcohol dependence involves signs of physiological dependence on alcohol characterized by an inability to quit or decrease usage of alcohol, despite a desire to do so. This article will use the convention chosen by many and will define alcoholism to be the disease of alcohol abuse and/or dependence, as outlined by the DSM-IV criteria.