Alcoholism

Definitions

Alcoholism has been defined in many different ways over the years. Authors such as John Saunders have reviewed shifting trends in the prominence of these various definitions. For instance, during the 19th century, it was widely accepted that alcoholism represented a moral failing. A contrasting view is the disease model of alcoholism, in which the condition is viewed as biologically determined and having a predictable progression of symptoms over time. E. M. Jellinek is perhaps the best-known proponent of the disease model, which gained its highest levels of prominence in the 1940s and 1950s but fell out of favor in the 1960s and 1970s.

In 1976, Griffith Edwards and Milton Gross described the seminal concept of the alcohol dependence syndrome (ADS). In contrast with prior approaches, Edwards and Gross's goal was description, rather than taking a firm stance as to how the syndrome develops. Impairment of control over drinking is a central symptom of ADS, which is characterized by both physiological (e.g., tolerance and withdrawal) and psychological aspects (e.g., awareness of compulsive drinking behavior). In Edwards and Gross's view, ADS is one type of alcohol problem with the other type comprising alcohol-related consequences such as injuries or legal trouble. These two types of alcohol problems were viewed as distinct but related, co-occurring in some but not all heavy drinkers. The concept of the ADS was highly influential and had a great impact on the formation of later editions of the two most widely utilized classification schemes for alcohol use disorders: the DSM and the ICD manuals.

The DSM and ICD each contain a list of criteria, some of which need to be met in order for a diagnosis of an alcohol use disorder to be made. The goal of these and other classification systems was to attempt to create a common language among clinicians and researchers, to increase the reliability and validity with which patients are diagnosed, and to obtain accurate statistics as to the prevalence of problem drinking. Although the institution of the DSM and ICD has led to progress with respect to these goals, debate continues as to which characteristics of problem drinking should be emphasized and de-emphasized.

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