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Alcoholism Signs

How can you tell if someone has a problem?

Answering the following four questions can help you find out if you or a loved one has a drinking problem:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health care provider right away. They can help you determine if a drinking problem exists and plan the best course of action.

Diagnostic Criteria for Alcohol Abuse and Dependence

Diagnosis is the process of identifying and labeling specific conditions such as alcohol abuse or dependence. Diagnostic criteria for alcohol abuse and dependence reflect the consensus of researchers as to precisely which patterns of behavior or physiological characteristics constitute symptoms of these conditions. Diagnostic criteria allow clinicians to plan treatment and monitor treatment progress; make communication possible between clinicians and researchers; enable public health planners to ensure the availability of treatment facilities; help health care insurers to decide whether treatment will be reimbursed; and allow patients access to medical insurance coverage.
Diagnostic criteria for alcohol abuse and dependence have evolved over time. As new data become available, researchers revise the criteria to improve their reliability, validity, and precision. This Alcohol Alert traces the evolution of diagnostic criteria for alcohol abuse and dependence through the current standards of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Alcoholism Signs

At least 39 diagnostic systems had been identified before 1940. In 1941 Jellinek first published what is considered a groundbreaking theory of subtypes of what was, until 1980, termed alcoholism Jellinek associated these subtypes with different degrees of physical, psychological, social, and occupational impairment.

In response to perceived deficiencies in DSM-I and DSM-II, the Feighner criteria were developed in the 1970's to establish a research base for the diagnostic criteria of alcoholism (5,13). These criteria were the first to be based on research rather than on subjective judgment and clinical experience alone (5). Though designed for use in clinical practice, they were primarily developed to stimulate continued research for the development of even more useful diagnostic criteria (5). Several years later, Edwards and Gross focused solely on alcohol dependence (8). They considered essential elements of dependence to be a narrowing of the drinking repertoire, drink-seeking behavior, tolerance, withdrawal, drinking to relieve or avoid withdrawal symptoms, subjective awareness of the compulsion to drink, and a return to drinking after a period of abstinence (8)

Alcoholism Symptoms

Researchers and clinicians in the United States usually rely on the DSM diagnostic criteria. The evolution of diagnostic criteria for behavioral disorders involving alcohol reached a turning point in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (14). In DSM-III, for the first time, the term "alcoholism" was dropped in favor of two distinct categories labeled "alcohol abuse" and "alcohol dependence”. In a further break from the past, DSM-III included alcohol abuse e and dependence in the category "substance use disorders" rather than as subsets of personality disorders.

National Institute on Alcohol Abuse and Alcoholism No. 30 PH 359 October 1995

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