Alcoholism Health Article

Definition

Alcoholism, or alcohol dependence, is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as "A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress."

That maladaptive pattern is manifested, according to the DSM-IV, by the following behaviors occurring any time within one 12-month period:

• tolerance for alcohol
• withdrawal from alcohol
• alcohol taken in larger amounts and over a longer period of time than was intended
• persistent desire or unsuccessful efforts to cut down or control alcohol use
• much time spent in activities necessary to obtaining alcohol
• various important activities, for example, in socializing or at work, are given up or reduced because of alcohol use
• alcohol use continued regardless of the pattern of physical or psychological problems that it causes or worsens

Alcohol abuse has the same definition but is manifested by one (or more) of the following behaviors occurring within the same 12-month period:

• repeated alcohol use leading to failure to fulfill major role obligations at work, school, or home
• repeated alcohol use in situations in which it is physically hazardous
• repeated alcohol-related legal problems
• persistent alcohol use despite its causing social and interpersonal problems or exacerbating them

This definition and the criteria established by DSMIV apply to both adults and children. The American Academy of Pediatrics (AAP) states that the pattern of use and abuse of alcohol in children and adolescents is not observably different from what is manifested in young people using marijuana or cocaine.

Description

The AAP divides the progression into childhood alcoholism into three stages:

• Stage 1: Experimentation with alcohol. Normally there is no change noted in physical status or behavior, and the drinking usually occurs only on weekends during social occasions with peers, making it the least detectable of the three. Peer pressure to use alcohol "just for fun."
• Stage 2: Actively trying to obtain alcohol. Alcohol use happens during the week to provide relief when stress is felt or to "feel good" when depressed.
• Stage 3: Preoccupation with alcohol. The child or adolescent has nearly lost the capacity for controlling alcohol use. Setting limits results in withdrawal symptoms, including depression, moodiness, or irritability. Severe withdrawal can result in serious medical problems, including delirium tremens.