Questionnaire

What should be the legal age for drinking?

Concepts & Definitions

 

Alcohol dependence was earlier termed as ‘alcoholism’. The term alcoholism was however dropped later as it was considered to be vague and had a negative connotation. Magnus Huss was the first person to systematically classify the damage that was attributable to alcohol ingestion. The concept and classification of alcohol dependence has undergone a series of changes over the decades, which can be summarized under


Jellinek’s  classification of alcoholism

Cloninger’s classification of alcoholism

DSM and ICD Classification of alcohol use disorders

Present definitions and terminology used in the field alcohol use 

 

Jellinek’s Classification of Alcoholism

Jellinek suggested the expression “disease concept of alcoholism” and thereby led to the movement towards medicalization of drunkenness and alcohol habituation. He proposed five species of alcohol dependence based of pattern of use. These were:

  • Alpha alcoholism – this involved excessive and inappropriate drinking to relieve physical and/or emotional pain. There was no loss of control and the ability to abstain was present
  • Beta alcoholism – this involved excessive and inappropriate drinking, with physical complications like cirrhosis due to cultural drinking patterns and poor nutrition. This subtype did not have dependence
  • Gamma alcoholism – also called malignant alcoholism. It had a progressive course marked by physical dependence with tolerance and withdrawal symptoms as well as psychological dependence with an inability to control drinking
  • Delta alcoholism – it involves an inability to abstain with presence of tolerance and withdrawal symptoms. The amount of alcohol consumed can be controlled and there is minimal social disruption
  • Epsilon alcoholism – characterized by dipsomania or compulsive drinking and spree drinking

 

Back to the top

 

Cloninger's Classification of Alcoholism 

Cloninger classified alcoholism into two broad categories: Type I and Type II alcoholism based on genetic and environmental factors

  • Type I alcoholism – this occurred in both sexes, with age of onset less than 25years, possible family history of alcoholism and strong influence of both genetic and environmental factors. It was marked with psychological dependence and presence of guilt. The pre-morbid personality traits were harm avoidance and reward dependence.
  • Type II alcoholism – this was limited to males, with age of onset older than 25 years and possibility of parental alcoholism and antisocial behavior. Genetic and environmental influences were limited. Additional features included no loss of control, drinking followed by aggressive behavior and spontaneous alcohol seeking. Pre-morbid personality traits of novelty seeking were usually present

 

Back to the top

 

DSM and ICD classification of alcohol Use

The Diagnostic Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD-10) define alcohol use disorders of the basis of dependence and abuse. Earlier classifications editions included only alcoholism in descriptive terms but not with diagnostic criteria. To standardize the diagnostic practices, specific diagnostic criteria were suggested.

The table below gives a comparison of the diagnostic criteria for alcohol dependence and alcohol abuse/harmful use

 

Diagnostic Statistical Manual of Mental Disorders (DSM-IV)

International Classification of Diseases (ICD-10)

Alcohol Dependence:

Clustering Criteria

(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12–month period:

(A) Three or more of the following: occurring together for at least 1 month, or if less than 1 month, occurring together repeatedly within a 12–month period:

Tolerance

  • Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol
  • Need for significantly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol
 

Withdrawal

  • The characteristic withdrawal syndrome for alcohol (or a closely related substance) or drinking to relieve or avoid withdrawal symptoms
  • Physiological symptoms characteristic of the withdrawal syndrome for alcohol; or use of alcohol (or closely related substance) to relieve or avoid withdrawal symptoms
 

Impaired Control

  • Persistent desire or one or more unsuccessful efforts to cut down or control drinking
  • Drinking in larger amounts or over a longer period than intended
  • Difficulties in controlling drinking in terms of onset, termination, or levels of use; drinking in larger amounts or over a longer period than intended; or a persistent desire or unsuccessful efforts to reduce or control drinking
 

Neglect of Activities

  • Important social, occupational, or recreational activities given up or reduced because of drinking
  • Important alternative pleasures or interests given up or reduced because of drinking
 

Time Spent in Alcohol-Related Activity

  • A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking
  • A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking
 

Continued Use Despite Problems

  • Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking
  • Persisting with drinking despite clear evidence and knowledge of harmful physical or psychological consequences
 

Compulsion

  • None
  • A strong desire or sense of compulsion to drink
 

Alcohol Dependence:

Duration Criteria

(B) No duration criterion separately specified, but several dependence criteria must occur repeatedly as specified by duration qualifiers associated with criteria (e.g., “persistent,” “continued”).

(B) Three or more of dependence criteria occurring for at least 1 month, or if less than 1 month, occurring together repeatedly within a 12–month period.

Alcohol Use/Harmful Use

(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress as manifested by at least one of the following occurring within a 12–month period:

 

  • Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol–related absences, suspensions, or expulsions from school; neglect of children or household)
  • Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use)
  • Recurrent alcohol–related legal problems (e.g., arrests for alcohol–related disorderly conduct)
  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication)

 

(B) Never met criteria for alcohol dependence.

(A) [Harmful use] Clear evidence that alcohol use contributed to physical or psychological harm, which may lead to disability/adverse consequences

 

(B) The nature of harm should be clearly identifiable (and specified)

 

(C) The pattern of use has persisted for at least 1 month or has occurred repeatedly within a 12–month period

 

(D) Symptoms do not meet criteria for any other mental or behavioral disorder related to alcohol in the same time period (except for acute intoxication).

 

Back to the top

 

Present definitions and terminology used in the field alcohol use 

In 1994 the World Health Organization developed a lexicon which aims to provide a set of definitions of terms concerning alcohol, tobacco and other drugs, which is useful to clinicians, administrators, researchers, and other interested parties in this field.

 

 Main diagnostic categories in the field are defined, as are key concepts in scientific and popular use. Social, as well as health, aspects of drug use and problems related to use are covered. The lexicon does not provide comprehensive coverage of every term; areas that have been excluded are, for example, production and marketing terms and slang terms. Click below to view the terms and definitions used in the field of alcohol use:

 

Lexicon of alcohol and drug terms: in English pdf, 2.85Mb

 

Back to the top

 

Sources:

Ahuja, N. A short textbook of psychiatry. New Delhi: Jaypee, 2006

Hasin, D. Classification of alcohol disorders. National Institute of Alcohol Abuse and Alcoholism, 2003.

Babor, T.F. The classification of alcoholics: typology theories from the 19th century to the present. National Institute of Alcohol Abuse and Alcoholism, 1996.