Alcohol dependence
303.90 Alcohol Dependence
Refer, in addition, to the general text and criteria for Substance Dependence (see p. 192). Physiological dependence on alcohol is indicated by evidence of tolerance or symptoms of Withdrawal. Especially if associated with a history of withdrawal, physiological dependence is an indication of a more severe clinical course overall (i.e., earlier onset, higher levels of intake, more alcohol-related problems).
Alcohol Withdrawal (see p. 215) is characterized by withdrawal symptoms that develop 4-12 hours or so after the reduction of intake following prolonged, heavy, alcohol ingestion. Because Withdrawal from alcohol can be unpleasant and intense, individuals with Alcohol Dependence may continue to consume alcohol, despite adverse consequences, often to avoid or to relieve the symptoms of withdrawal. Some withdrawal symptoms (e.g., sleep problems) can persist at lower intensities for months. A substantial minority of individuals who have Alcohol Dependence never experience clinically relevant levels of Alcohol Withdrawal, and only about 5% of individuals with Alcohol Dependence ever experience severe complications of withdrawal (e.g., delirium, grand mal seizures). Once a pattern of compulsive use develops, individuals with Dependence may devote substantial periods of time to obtaining and consuming alcoholic beverages. These individuals often continue to use alcohol despite evidence of adverse psychological or physical consequences (e.g., depression, blackouts, liver disease, or other sequelae).
Specifiers
The following specifiers may be applied to a diagnosis of Alcohol Dependence (see p. 195 for more details):
- With Physiological Dependence
- Without Physiological Dependence
- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission
- In a Controlled Environment