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.