Alcohol Dependence

Alcohol use is very common in our culture.  The “social drinker” is one who may only drink around other people, limit the quantity of alcohol consumed, never get out of control physically, mentally or emotionally from the effects of the alcohol, and who can be satisfied with a small amount and walk away from the rest.  Alcohol is like a side dish at dinner – it is never the entrée.

Alcohol dependence has a more serious, driven quality to it.  Alcohol is seen as a necessary part of life, a way of coping that lifts the mood and is looked forward to with great anticipation as a kind of solution or remedy to the interactions of the day.

Do you drink every day, even “only one beer”?  Would you feel distressed if you did not have that daily alcohol?  Do you use it to alter your mood or to deal with social anxiety?  If so, you may be moving in the direction of Alcohol Dependence.  A definition of substance dependence can be found in the DSM-IV from the American Psychiatric Association.  It is “a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 or more of the following, occurring at any time in the same 12-month period:

  1. tolerance, as in (a) a need for markedly increased amounts of the substance  to achieve intoxication (b) markedly diminished effect with continued use of the same amount of the substance.
  2. withdrawal, as in (a) the classic withdrawal symptoms when the substance is not taken and (b) the substance is continued to be taken to prevent withdrawal.
  3. the substance is taken in larger amounts or over a longer time period than was expected.
  4. there is a persistent desire or unsuccessful efforts to cut down or control the use
  5. a great deal of time is spent in activities necessary to obtain the substance, use the substance, hide the use of the substance or recover from using the substance.
  6. important social, occupational or recreational activities are given up or reduced because of the substance use.
  7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or made worse by the substance.

    Next month we will talk about alcohol addiction.  Please consult your health care provider if you think you may have a dependence on alcohol or other substances.