View source for Alcohol dependence

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[[File:Fetal Alcohol Syndrome.svg|thumb|Women drinking during pregnancy can cause a [[fetal alcohol spectrum disorder]].]]
[[File:Alcohol diagram.png|thumb|The effects of alcohol has on the body.]]
'''Alcohol dependence''' is a previous ([[DSM-IV]] and ICD-10) psychiatric diagnosis in which an individual is [[physical dependence|physically]] or [[psychological dependence|psychologically]] [[substance dependence|dependent]] upon [[alcohol (drug)|alcohol]] (also chemically known as [[ethanol]]).

In 2013, it was reclassified as [[Alcohol Use Disorder|alcohol use disorder]] in [[DSM-5]],<ref name="NIH2013">{{cite web|title=Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5|url=https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm|access-date=9 May 2015|date=November 2013}}</ref> which combined alcohol dependence and [[alcohol abuse]] into this diagnosis.

== Definition ==
{{Addiction glossary}}

=== Diagnosis ===
{{see also|Alcohol abuse#Diagnosis|Alcoholism#Diagnosis}}

==== DSM: Alcohol dependence ====
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)<ref>{{cite web |url=http://www.alcoholcostcalculator.org/business/about/dsm.html |url-status=usurped |archive-url=https://web.archive.org/web/20050324082018/http://www.alcoholcostcalculator.org/business/about/dsm.html |archive-date=2005-03-24 |title=DSM-IV Criteria for Alcohol Abuse and Alcohol Dependence}}</ref>

==== Other alcohol-related disorders ====
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 abuse]] by the presence of symptoms such as [[Drug tolerance|tolerance]] and [[alcohol withdrawal|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.

# 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.
# In alcohol dependence, reduction of alcohol, as defined within DSM-IV, can be attained by learning to control the use of alcohol. That is, a client can be offered a social learning approach that helps them to 'cope' with external pressures by re-learning their pattern of drinking alcohol. 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:

# Narrowing of the drinking repertoire.
# Increased salience of the need for alcohol over competing needs and responsibilities.
# An acquired tolerance to alcohol.
# Withdrawal symptoms.
# Relief or avoidance of withdrawal symptoms by further drinking.
# Subjective awareness of compulsion to drink.
# Reinstatement after abstinence.<ref>Clark, David, Background Briefing, Alcohol Dependence, Drink and Drug News, 7 February 2005, p. 11</ref>

=== Screening ===
{{see also|Alcohol abuse#Screening}}

AUDIT has replaced older screening tools such as CAGE but there are many shorter alcohol screening tools,<ref>{{cite web|url=https://www.gov.uk/government/publications/alcohol-use-screening-tests|title=Alcohol use screening tests – GOV.UK|website=www.gov.uk|access-date=8 April 2018}}</ref> mostly derived from the AUDIT. The [[Severity of Alcohol Dependence Questionnaire]] (SAD-Q) is a more specific twenty-item inventory for assessing the presence and severity of alcohol dependence.

==== AUDIT ====
The [[Alcohol Use Disorders Identification Test]] (AUDIT) is considered the most accurate alcohol screening tool for identifying potential alcohol misuse, including dependence.<ref>{{cite web|url=http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/?parent=4444&child=4896|title=AUDIT – Alcohol Use Disorders Identification Test|date=28 June 2010|publisher=Alcohol Learning Centre|access-date=3 June 2012|archive-date=17 March 2012|archive-url=https://web.archive.org/web/20120317084233/http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/?parent=4444&child=4896|url-status=dead}}</ref> It was developed by the World Health Organization, designed initially for use in primary healthcare settings with supporting guidance.<ref>{{cite web|url=http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf|archive-url=https://web.archive.org/web/20040423200607/http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf|url-status=dead|archive-date=April 23, 2004|title=World Health Organization|website=World Health Organization|access-date=8 April 2018}}</ref>

==== CAGE ====
The [[CAGE questionnaire]], the name of which is an acronym of its four questions, is a widely used method of screening for alcohol dependence.

* [http://psychology-tools.com/cage-alcohol-questionaire/ Online version of the CAGE questionnaire]

==== SADQ ====
The [[Severity of Alcohol Dependence Questionnaire]] (SADQ or SAD-Q) is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.<ref>{{cite web|title=SADQ or SAD-Q Questionnaire – find out if you are dependent on alcohol|url=http://www.markjayalcoholdetox.co.uk/sadq.php|website=www.markjayalcoholdetox.co.uk|language=en|access-date=2017-09-26|archive-url=https://web.archive.org/web/20170707094654/http://www.markjayalcoholdetox.co.uk/sadq.php|archive-date=2017-07-07|url-status=dead}}</ref>

== Withdrawal ==
Withdrawals from alcohol dependence is a common side effect that occurs when a person with the dependency stops drinking abruptly or even cuts back on their drinking after a prolonged period of indulgence. Withdrawal from alcohol dependence can vary from mild, moderate to severe, depending on several factors such as: how long the person has been drinking, whether they are a [[Binge drinking|binge drinker]], whether they relapse chronically, and how much they drink daily. All these factors can vary from one person to the next depending on [[psychological]], [[Biophysical environment|environmental]], and [[biological]] factors.<ref name=":6">{{Cite journal|last=Becker|first=Howard C.|date=2008|title=Alcohol Dependence, Withdrawal, and Relapse|journal=Alcohol Research & Health|volume=31|issue=4|pages=348–361|issn=1535-7414|pmc=3860472|pmid=23584009}}</ref> Some common [[Drug withdrawal|withdrawal]] side effects are as listed:

=== Mild ===
* [[Nausea]]
* [[Vomiting]]
* Rapid heartbeat
* Elevated blood pressure
* [[Fatigue]]
* Body aches / tremors
* [[Anxiety]] / [[Irritability]] / [[Depression (mood)|Depression]]
* Fuzzy brain
* Issues with sleeping

=== Severe ===
[[File:Tactile_hallucination.jpg|thumb|Hallucinations from alcohol withdrawal.]]

* Vomiting
* [[Hypertensive crisis]]
* [[Seizure]]s / Tremors
* [[Delusion]]s / [[Hallucination]]s
* [[Dehydration]]
* [[Fever]]
* [[Chills]] / Shakes
* Extreme [[mood lability]]
* Mental pandemonium
* Little to no appetite

The spectrum of alcohol withdrawal symptoms range from such minor symptoms as [[insomnia]] and [[Tremor|tremulousness]] to severe complications such as withdrawal seizures and [[delirium tremens]].<ref name=":9">{{Cite journal|last1=Bayard|first1=Max|last2=McIntyre|first2=Jonah|last3=Hill|first3=Keith|last4=Woodside|first4=Jack|date=2004-03-15|title=Alcohol Withdrawal Syndrome|url=https://www.aafp.org/afp/2004/0315/p1443.html|journal=American Family Physician|volume=69|issue=6|pages=1443–1450|pmid=15053409|issn=0002-838X}}</ref> Alcohol withdrawal syndrome can be very tricky to diagnose, due to other preliminary conditions that may exist from individual to individual.

== Treatment ==
Treatments for alcohol dependence can be separated into two groups, those directed towards severely alcohol-dependent people, and those focused for those at risk of becoming dependent on alcohol.  Treatment for alcohol dependence often involves utilizing [[relapse prevention]], [[support group]]s, [[psychotherapy]],<ref>{{cite web|url=http://www.icap.org/LinkClick.aspx?fileticket=1%2bMZHEUwVUU%3d&tabid=177|title=Alcohol Dependence and Treatment|work=ICAP Blue Book|publisher=International Center for Alcohol Policies|access-date=2 June 2012|archive-url=https://web.archive.org/web/20130227043227/http://www.icap.org/LinkClick.aspx?fileticket=1%2bMZHEUwVUU%3d&tabid=177|archive-date=27 February 2013|url-status=dead|df=dmy-all}}</ref> and setting [[short-term goal]]s.<ref>{{cite web | title = Alcohol use disorder | publisher = Mayo Clinic | url = https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250 | access-date = 4 October 2020}}</ref> The [[Twelve-Step Program]] is also a popular faith-based process used by those wishing to recover from alcohol dependence.<ref>{{cite web|url=http://www.medicalbug.com/what-is-alcohol-addiction-what-causes-alcohol-addiction/#more-164|title=What is Alcohol Addiction: What Causes Alcohol Addiction?|date=6 January 2012|publisher=MedicalBug|access-date=2 June 2012|archive-url=https://web.archive.org/web/20120519200721/http://www.medicalbug.com/what-is-alcohol-addiction-what-causes-alcohol-addiction/#more-164|archive-date=19 May 2012|url-status=dead}}</ref>

The ultimate goal when it comes to treating alcohol dependence or as the [[DSM-5]] now calls it [[Alcohol Use Disorder|alcohol use disorder]], is to help with establishing [[Abstinence pledge|abstinence]] from drinking. There are several other benefits that come along with [[Drug rehabilitation|treatment]]. For some, it is reconnecting with themselves and obtaining [[self-esteem]] and [[confidence]], a healthier lifestyle (physically and mentally), creating new relationships with other like-minded people as well as rekindling or mending old relationships if possible. The treatment process consists typically of two parts short-term and long-term. First, there is the path to [[Abstinence pledge|abstinence]] and/or recovery. There are several reasons why someone with alcohol use disorder or alcohol dependency would seek treatment. This can either be a personal reason or because of law enforcement. There is a series of different levels of treatment processes depending on the severity subtype. Some would or could benefit from medication treatment with psychosocial treatment, while others could just benefit from psychosocial treatment. Listed below are some different types of treatments that are used with treating alcohol dependency/alcohol use disorder depending on several factors that vary from person to person.<ref name=":14">{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/approach-to-treating-alcohol-use-disorder|access-date=2021-05-18|website=www.uptodate.com}}</ref>
[[File:Al-Anon Essen.JPG|thumb|Treatment and support]]
'''Types of treatments:'''

* Withdrawals (no medication aid needed)
* Withdrawals (depending on severity of symptoms, could be accompanied with supervision by medical personal and medication)
* [[Psychosocial|Psychosocial treatment]] (counseling, [[Cognitive behavioral therapy|CBT]], psychoeducation, [[assertive community treatment]])
* [[Alcoholics Anonymous]]
* Inpatient or outpatient programs
* [[Social services]] (case management)
* [[Al-Anon/Alateen]]
* Acceptance and mindfulness-based interventions 

Acceptance and mindfulness-based interventions show evidence of efficacy in being used to target Alcohol Use Disorder. These types of interventions are often most effectively delivered in group settings, however, they are also proven effective in individual therapy contexts. Overall, this is crucial in helping individuals who are dependent on alcohol because it raises awareness, provides a non-judgemental environment for people to express their thoughts, and allows individuals to be heard and accepted in the present moment. <ref name=":22">{{Cite journal|last1=Witkiewitz|first1=K.|last2=Litten|first2=R.|last3=Leggio|first3=L.|date=2019-09-25|title=Advances in the science and treatment of Alcohol Use Disorder|journal=Science Advances|volume=69|issue=6|pages=1443–1450|doi=10.1126/sciadv.aax4043 |pmid=15053409|issn=0002-838X|pmc=6760932|bibcode=2019SciA....5.4043W }}</ref>

== Epidemiology ==
[[File:The Drunkard's Progress 1846.jpg|thumb|"The Drunkard's Progress", 1846]]
About 12% of American adults have had an alcohol dependence problem at some time in their life.<ref>{{cite journal |author=Hasin D |title=Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States |journal=Archives of General Psychiatry |volume=64 |issue=7 |year=2007 |pages=830–42 |doi=10.1001/archpsyc.64.7.830 |pmid=17606817|display-authors=etal|doi-access= }}</ref> In the UK the [[National Health Service|NHS]] estimates that around 9% of men and 4% of UK women show signs of alcohol dependence.<ref>{{cite web|url=http://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/mental-health/alcohol-dependence|title=Alcohol dependence and withdrawal}}</ref>

==Genetic factors==
A 2015 study found that alcohol dependency may have genetic risk factors. Linkage disequilibrium between an AD-associated GABA receptor gene cluster, GABRB3/GABRG3, and eye color genes, OCA2/HERC2, as well as between AD-associated GRM5 and pigmentation-associated TYR, were all associated with alcohol dependency.<ref>{{cite journal |last1=Sulovari |first1=Arvis |last2=Kranzler |first2=Henry R. |last3=Farrer |first3=Lindsay A. |last4=Gelernter |first4=Joel |last5=Li |first5=Dawei |title=Eye color: A potential indicator of alcohol dependence risk in European Americans |journal=American Journal of Medical Genetics Part B: Neuropsychiatric Genetics |date=July 2015 |volume=168 |issue=5 |pages=347–353 |doi=10.1002/ajmg.b.32316 |pmid=25921801 |url=https://onlinelibrary.wiley.com/doi/10.1002/ajmg.b.32316 |language=en |issn=1552-4841|url-access=subscription }}</ref> GABA downregulation may decrease sensitivity to the toxic effects of alcohol, leading to increased alcohol consumption in blue-eyed individuals.<ref name="e685">{{cite journal | last=Eissenberg | first=Joel C. | title=More than Meets the Eye: Eye Color and Alcoholism | journal=Missouri Medicine | publisher=Missouri State Medical Association | volume=113 | issue=2 | date=2024-03-14 | pages=98–103 | pmid=27311215 | pmc=6139948 }}</ref>

== History ==
The term 'alcohol dependence' has replaced 'alcoholism' as a term in order that individuals do not internalize the idea of cure and disease, but can approach alcohol as a chemical they may depend upon to cope with outside pressures.

The contemporary definition of alcohol dependence is still based upon early research.  There has been considerable scientific effort over the past several decades to identify and understand the core features of alcohol dependence.<ref name="WeinerFreedheim2003">{{cite book|author1=Irving B. Weiner|author2=Donald K. Freedheim|author3=George Stricker|author4=Thomas A. Widiger|title=Handbook of Psychology: Clinical psychology|url=https://books.google.com/books?id=dVauuLKZar4C&pg=PA201|access-date=16 April 2010|year=2003|publisher=John Wiley and Sons|isbn=978-0-471-39263-7|pages=201–}}</ref> This work began in 1976, when the British psychiatrist Griffith Edwards and his American colleague Milton M. Gross <ref>Edwards G. & Gross MM, Alcohol dependence: provisional description of a clinical syndrome, BMJ 1976; i: 1O58-106</ref> collaborated to produce a formulation of what had previously been understood as 'alcoholism' – the ''alcohol dependence syndrome''.

The alcohol dependence syndrome was seen as a cluster of seven elements that concur. It was argued that not all elements may be present in every case, but the picture is sufficiently regular and coherent to permit clinical recognition. The syndrome was also considered to exist in degrees of severity rather than as a categorical absolute. Thus, the proper question is not 'whether a person is dependent on alcohol', but 'how far along the path of dependence has a person progressed'.

== See also ==
* [[Alcohol intoxication]]
* [[Alcoholic drink]]
* [[Alcohol-related dementia]]
* [[CRAFFT Screening Test]]
* [[Disulfiram-like drug]]
* [[High-functioning alcoholic]]
* [[Long-term effects of alcohol consumption]]
* [[Paddington alcohol test]]

== Notes ==
{{Reflist}}

== External links ==
{{Medical resources
|  ICD10 = {{ICD10|F|10||f|10}}.2
|  ICD9  = {{ICD9|303}}
|  OMIM  = 103780
}}
* [https://web.archive.org/web/20140407091906/http://www.mediconum.com/alcohol-dependence/ Arnold Little, MD Alcohol Dependence – extensive article]
* [http://hamsnetwork.org/app2/ SADD – Short Alcohol Dependence Data Questionnaire] {{Webarchive|url=https://web.archive.org/web/20160811064547/http://www.hamsnetwork.org/app2/ |date=2016-08-11 }}. A brief, self-administered questionnaire sometimes utilised in individual or group treatments.
*[[Garifullin Ramil Ramzievich|R.R.Garifullin]] [https://elibrary.ru/item.asp?id=19521992 Using coding therapy to treat alcohol and drug addiction. Manipulations in psychotherapy. Rostov-on-Don, Feniks, 251 p. 2004. 251 p.] {{ISBN|5-222-04382-7}}

{{Psychoactive substance use|state=expanded}}
{{Addiction}}
{{Dependence treatment}}
{{Alcohealth}}

[[Category:Drinking culture]]
[[Category:Alcohol abuse]]
[[Category:Substance dependence]]
[[Category:Disorders due to use of alcohol]]