Alcohol Dependence

Definition and common characteristics of Alcohol Dpendence

A simple and informal definition of alcohol dependence is that it is a condition resulting from the prolonged and usually intense consumption of alcohol which has resulted in psychological and/or physiological dependence on alcohol consumption. This dependence results in significant problems in one or more areas of the person’s life.

A more specific and formal definition of alcohol abuse can be formulated using the Diagnostic and Statistical Manual, 4th Edition, of the American Psychiatric Association, (DSM-IV, 1994).

Using the DSM-IV criteria for substance dependence but applying it to the case where the substance is specifically alcohol, the diagnosis of alcohol dependence is made when one or more of the following occurs over a one year period:

  • Tolerance which is defined by increased amounts of alcohol to achieve same degree of intoxication
  • Withdrawal which is defined by a set of symptoms which includes anxiety, autonomic hyperactivity e.g. sweating, hand tremor, insomnia, nausea, hallucinations, and grand mal seizures.
  • Alcohol is imbibed in greater amounts or over longer time periods than intended
  • There is a persistent desire and or attempts to reduce or stop alcohol use but these are not successful.
  • A great deal of time is spent making sure of the availability of alcohol, drinking alcohol, or recovering from the negative consequences of alcohol use example the hangover.
  • Important social, occupational, or recreational activities are diminished or given up completely because of alcohol dependence.
  • Alcohol use continues despite awareness of causing persistent physical or psychological problems which have either been caused by or intensified by drinking alcohol.

Alcohol abuse differs from alcohol dependence

Research has shown important differences between alcohol abuse and alcohol dependence (Hartford and Muthen, 2001). For example, in alcohol abuse there is no significant psychological or physiological dependence on alcohol whereas dependence and associated symptoms are characteristic of alcohol dependence. Also because of these differences in the nature of alcohol abuse and alcohol dependence, there are critical differences between the treatments of these two distinct conditions.

Prevalence

The lifetime prevalence for alcohol dependence was found to be 5.4% in a large epidemiological study carried out recently in the United States (Kessler et al, 2005). Hence alcohol dependence is a bit less than half as prevalent as alcohol abuse which had a lifetime prevalence of 13.2% in this same study.

Alcohol dependence and codependence (developmental trauma)

The presence of an addiction of some kind has long been held as a main secondary symptom of codependency. Other names for codependency are developmental trauma and complex PTSD.

There is indeed a lot of evidence that many individuals, who abuse or become dependent to any substance be it alcohol or illicit drugs, have often been exposed to previous trauma during their childhood or thereafter.

For example, a study of borderline personality disorder, a severe form of what many call codependence, in patients with recent deliberate self-harm in Hong Kong, found they were more likely to suffer from a current alcohol and substance use disorder Wong (2010).

Also, research by Boriskin (2008) found that 25 to 50 percent of clients with a substance use disorder also meet the conditions for a diagnosis of post traumatic stress disorder (PTSD).

Hence there is strong reason to conclude that a person who experienced repeated or prolonged trauma during their childhood (and hence is likely codependent) is at greater risk of developing drug/alcohol abuse or dependence in adulthood.

Treatments available for alcohol dependence

Fortunately there are a number of effective treatments for alcohol dependence. It is to be noted that there are important differences in the treatment of alcohol abuse and dependence (Hartford and Muthen, 2001). Treatment approaches include the following:

  • Psychotherapy: individual or group. Many psychotherapeutic modalities e.g. cognitive behavioural therapy are used to treat alcohol dependence with varying degrees of success.
  • Individual psychotherapy can be very useful but only if there is a strong additional component of group psychotherapy or attendance at a self-help group such as Alcoholics Anonymous.

    A limitation of individual psychotherapy is its cost particularly in the case of addictions where extended treatment with a maintenance component is generally necessary.
  • Self-help groups such as Alcoholics Anonymous (AA) are effective as demonstrated by the facts that they have existed for decades and that many people (at least a million) have recovered through them.

    There is no evidence that self-help groups are less effective than formal treatment by a mental health worker.

    The self-help groups have the advantage of being free which makes it possible and easy for the recovered alcoholic to maintain their abstinence by weekly attendance at AA meetings for extended periods of time.
  • Detoxification facilities where the alcohol dependent person can withdraw under medical care e.g. vigilance of seizures and appropriate medical intervention including anti-seizure medications.
  • Rehabilitation and self-help residential homes have proved useful and involve a total drug-free environment, charismatic role-models, direct confrontation in group therapy, and separate the alcoholic from social contacts with practicing alcoholics .
  • Individual or group psychotherapy for underlying complex PTSD (codependency). Individuals who have been traumatized as children or adults have greater risk of developing a problem with alcohol abuse as discussed below.

    For such a-risk individuals who have become alcohol dependent, psychotherapy for their trauma is the treatment of choice because it has the advantage of working through the lingering effects of traumatization and therefore reducing risk of relapse.

References

Boriskin, J. A. (2008, March). Effective treatments of complex PTSD and addiction. Paper presented at the meeting of Addiction, Trauma, and Co-Occurring Disorders, San Diego.

Harford, T. C., & Muthen, B. O. (2001). The dimensionality of alcohol abuse and dependence: A multivariate analysis of DSM-IV symptom items in the National Longitudinal Survey of Youth. Journal of Studies on Alcohol, 62, 150–157.

Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merikangas, K. R., Walters, Ellen E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602.

Wong, Hiu-Mei; Leung, Henry Chi-Ming; Chow, Lai-Yin; Kam, Wai-Kwo & Tang, Alan Ka-Lam. (2010) Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm. Journal of Personality Disorders, 24(6), 800-811.


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