Appendix 3

Diagnostic criteria of alcohol abuse and alcohol dependence

The Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association establishes criteria for the diagnosis of substance dependence and substance abuse. The criteria for substance dependence are:

(1) tolerance as defined by either of the following:

• a need for markedly increased amounts of the substance to achieve intoxication or desired effect
• markedly diminished effect with continued use of the same amount of the substance

(2) withdrawal, as manifested by either of the following:

• the characteristic withdrawal syndrome for the substance
• the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.

(6) important social, occupational or recreational activities given up or reduced because of substance use.

(7) continued substance use despite knowledge of having had a persistent or recurrent physical or psychological problem that is likely to have been caused by the substance

The criteria for substance abuse are:

A A maladaptive pattern of substance use leading to clinically significant impairment or distress, manifested by one or more of the following, occurring at any time during a twelve month period:

• recurrent substance use resulting in a failure to fulfil major role obligations at work, school or home
• recurrent substance use in situations in which it is physically hazardous
• recurrent substance-related legal problems
• continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

B The symptoms have never met the criteria for Substance Dependence for this class of substance.

There is also the concept of alcohol-related disabilities. These are subdivided into social disabilities (eg impaired social relationships), psychological disabilities (eg anxiety depression) and physical disabilities (eg liver damage).