ALCOHOL ABUSE AND DEPENDENCE
Approximately 9-10 million Americans either abuse or are addicted to alcohol which functions as a central nervous system depressant. The DSM-III has differentiated between alcohol dependence or true alcoholism and alcohol abuse. In advanced alcohol dependence, there are clear signs of a physical addiction to alcohol in that withdrawal symptoms begin within 8-72 hours after the person has stopped drinking. These range from extreme tremulousness (the “shakes”) to severe forms of withdrawal such as delirium treatments (the DTs) in which the person may have vivid and frightening hallucinations of small animals, snakes, or insects. In some cases the withdrawal is so severe the person can die without medical attention.
Because tolerance to alcohol develops such that larger amounts are required to have an effect, an addicted person might consume large amounts of alcohol and have a high blood alcohol level without showing any gross signs of intoxication. Although the person might not appear intoxicated or drunk, there are usually behavioral indications of dependence such as a chronic urge to drink, repeated failures at trying to stop drinking, disturbances in meeting responsibilities, hiding liquor for later use, or early morning drinking to stop withdrawal symptoms. The alcoholic is also likely to show certain physical complications due to the excessive and chronic use of alcohol. Cirrhosis of the liver, hepatitis, severe gastrointestinal problems, and some brain dysfunctions are some of the more serious physical problems encountered inadvanced alcoholics who have maintained excessive drinking patterns for years. As a result of the physical complications it is not uncommon for such persons to look much older than their age. Furthermore, the alcoholic’s life expectancy is about 10-12 years shorter than that of nonalcoholic. The criteria for alcoholism (physical alcohol dependence) according to the DSM- III, therefore, center on these four signs: signs of physical addiction, tolerance, psychological dependence, and medical complications.
Individuals who have problems associated with alcohol but have not developed a physical dependence are considered to have the problem of alcohol abuse. These individuals often have a multitude of problems: with the law—arrests for drunken driving or public drunkenness; on the job—work missed due to hangovers; with family or friends—fighting, child abuse, or wife abuse while drinking; or with extreme drinking rates—a fifth or more of liquor a day. Others experience difficulties from drinking only in certain situations, such as becoming drunk before all social occasions.