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Alcohol dependence

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Alcohol dependence is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences (e.g, liver disease or depression caused by drinking).

  • continued hazardous and harmful drinking can result in alcohol dependence.
  • alcohol dependence is also associated with increased criminal activity and domestic violence, and an increased rate of significant mental and physical disorders

ICD-10 defines dependency as:

“a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.”.

In earlier disease-classification systems this has been referred to as ‘alcoholism’.

Alcohol use disorder (AUD) was estimated to affect approximately 18% of the general population lifetime and 5% annually (3)

  • DSM-5 definition of alcohol use disorder (AUD) combined DSM-IV alcohol abuse and dependence symptoms (4)
  • estimated that almost 20% of adult patients in the emergency rooms suffer from AUD and that the incidence of alcohol withdrawal syndrome (AWS) in patients admitted to surgical Intensive Care Unit (ICU) varies from 8 to 40%, and seems to be associated with infectious complications and a higher mortality rate
  • up to 50% of AUD patients experience withdrawal symptoms, a minority of whom requires medical treatment

Griffith Edwards and Gross(1976) defined some simple markers of alcoholism. These are:

  • dependent drinkers have a narrow repertoire of alcohol consumption: alcohol is used to avoid withdrawal symptoms
  • drinking overtakes the individual's activities to the exclusion of everything else, leading to theft, begging and borrowing
  • withdrawal symptoms include trembling, fear, insomnia, nightmares, sweating and hallucinations.
  • tolerance develops so that the dependent drinker consumes quantities which might make non-drinkers unconscious
  • dependent drinkers know that they cannot control their alcohol use
  • there is a high tendency to relapse after abstinence

Alcohol withdrawal symptoms occur within 12 hours of the last drink.

Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis, including in patients who have already progressed to high-risk portal hypertension (5)


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