Assessment and Differential Diagnosis - Alcohol Use Disorders

Assessment and Differential Diagnosis

Phenomenology and Variations in Presentation

The DSM-IV-TR diagnosis of alcohol dependence is given when three or more of the seven criteria are present (see DSM-IV-TR for alcohol dependence). Because physiological dependence is associated with greater potential for acute medical problems (particularly acute alcohol withdrawal), the first criteria to be considered are tolerance and withdrawal. The remaining criteria reflect behavioral and cognitive dimensions: a) impaired control (i.e., alcohol is consumed in larger amounts or over a longer pe-riod of time than was intended; there is a persistent desire or un-successful efforts to cut down or control drinking; the individual continues to drink despite knowledge of a persistent or recurrent physical or psychological problem), and b) increase salience of alcohol (i.e., a great deal of time spent drinking or recovering from its effects; important social, occupational, or recreational activities are given up or reduced due to drinking).

Once a diagnosis of alcohol dependence is given, a speci-fication is made concerning course. Early remission is used if no criteria (full remission) or fewer than three symptoms (par-tial remission) of alcohol dependence are present for at least 1 month, but less than 12 months. Sustained remission is used if no symptoms (full remission) or fewer than three symptoms (partial remission) of alcohol dependence are present for at least 12 months. Finally, if the individual is in a setting in which he or she has no access to alcohol, the course specifier in a controlled environment is added.

Alcohol abuse is considered to be present only if the in-dividual’s drinking pattern has never met criteria for alcohol dependence and he or she demonstrates a pattern of drinking that leads to clinically significant impairment or distress, as evi-denced by one or more of the four criteria in DSM-IV for alcohol abuse.

In addition to alcohol abuse and dependence, there is an-other important group of alcohol-related disorders described in DSM-IV as alcohol-induced disorders. These will be described briefly before returning to a discussion of assessment issues.