Alcohol dependence and
abuse
The DSM-IV TR diagnosis
of alcohol dependence is able to be given when an individual has met
three or more of the seven criteria associated with the disorder. The
physiological aspects of alcohol dependence are associated with a much
greater potential for medical problems such as acute alcohol
withdrawal. The first criteria usually associated with alcohol
dependence are considered to be tolerance and alcohol withdrawal. The
remaining criteria usually are defined as behavioral and cognitive
dimensions of alcohol dependence including: (1) impaired control when
an individual consumes larger amounts of alcohol over longer periods
of time than they intend to, and when persistent desires or
unsuccessful attempts to cut down or control drinking are not
successful despite knowledge of a persistent recurrent physical or
psychological problem, and (2) alcohol use becomes incredibly
important to the individual, including spending a great deal of time
drinking, recovering from its effects, or when important social and
occupational activities are given up or reduced because of drinking.
These are all key criteria in the diagnosis of alcohol dependence.
When a diagnosis of
alcohol dependence is given, there is usually some reference made to
its developmental course. Early remission is used if of no
criteria or fewer than three symptoms of alcohol dependence are
present for at least one month, but less than 12 months. Sustained
remission is referred to when either none or fewer than three
symptoms of alcohol dependence are present for at least 12 months. The
term "in a controlled environment" is added to define
when an individual is in a setting in which he or she has no access to
alcohol.
Alcohol abuse
is defined as when an individual's drinking pattern has never met the
criteria for alcohol dependence, but demonstrates a pattern of
drinking that leads to a level of clinically significant impairment or
distress.
Alcohol intoxication
The DSM-IV TR
diagnosis of alcohol intoxication is given when shortly after
consumption there are maladaptive behaviors such as aggression,
inappropriate sexual behavior or psychological changes such as
drastically fluctuating moods and impaired judgment. Clinical signs of
alcohol intoxication include slurred speech, lack of coordination,
unsteady gait, impairment of attention and memory, and in some very
severe cases, stupor and coma. Alcohol intoxication may also present
with disturbances in consciousness and cognition, which could even
potentially lead to such experiences as alcohol intoxication delirium,
which may occur when large amounts of alcohol have been ingested or
after alcoholic intoxication has been maintained for extended periods
of time. Usually, these severe disturbances subside shortly after
alcohol intoxication ends. Clinicians will usually conduct physical
and mental status examinations which allow them to rule out general
medical conditions or mental disorders which may mimic this condition.
Urine toxicology is a valuable tool in ruling out intoxication with
benzodiazepines, barbiturates, and other sedatives that may present a
similar clinical picture. Additional information collected from
relatives or friends confirming the ingestion of alcohol is also
useful and should be actively pursued by the clinician.
Blood alcohol level is
frequently used as a measure of intoxication, although this is not
considered to be a reliable measure for people with a high degree of
tolerance to alcohol. Alcohol is usually metabolized in the average
adult at a rate of 1 ounce or 7 to 10 g/hour. When alcohol is ingested
above this clearance rate, signs of alcohol intoxication then begin to
appear. Between the range of 0.01 and 0.10%, euphoria, mild deficits
in coordination, attention and cognition may be observed. As the level
of intoxication increases beyond this range, an individual will
experience marked deficits in coordination, psychomotor skills,
decreased attention, ataxia, impaired judgment, slurred speech and a
great variability of mood. Severe alcohol intoxication includes a lack
of coordination, incoherent thoughts, confusion, nausea and vomiting,
which frequently is observed at blood alcohol levels between 0.20 and
0.30. However, some heavy drinkers are still able to perform
relatively well at these higher blood alcohol levels due to their
developed tolerance. When blood alcohol levels get between the range
of 0.30 and 0.40 stupor and loss of consciousness often occur. Beyond
this level, many individuals experience coma, respiratory depression
and death may be possible. It is probably also important to note that
along with alcohol intoxication there is frequently toxicity and
overdose with other drugs, particularly those that depress the central
nervous system.