Alcohol Dependence

by

Shulamith Lala Ashenberg Straussner, Sarina Beth Straussner

Introduction

Millions of individuals use alcohol every day; however, not everyone experiences a problem due to such use. It is therefore helpful to conceptualize alcohol use as ranging on a continuum from nonproblematic social use (e.g., a glass of wine with dinner) to alcohol misuse (e.g., a one-time incident of binge drinking), to abuse (e.g., excessive use of alcohol that results in a negative impact on the life of the individual and those around him or her, such as frequent driving under the influence of alcohol), and finally, to dependence or addiction to alcohol (e.g., a chronic disorder that may require physical detoxification and/or formal treatment). The term alcohol dependence is synonymous with the commonly used term alcoholism, or the compulsive use of alcohol, and implies a progressive deterioration of the individual’s social, physical, and mental status combined with the inability to stop using alcohol even when wishing to do so. Although the professional literature on alcohol dependence problems is extensive and can be found in almost every country in the world, the terminology used is often confusing, and there is a tremendous overlap with literature on topics such as alcohol-related problems, substance use disorders, alcohol abuse, substance abuse, and addiction. Research studies in the United States indicate a general decrease in the proportions of individuals with “pure” alcohol dependence and an increase among those using multiple substances. Consequently, the topic of alcohol dependence needs to be considered within the context of the literature on abuse and dependence of a variety of other chemical substances as well as other addictions, such as gambling. It also needs to take into account co-occurring mental disorders; age, gender, and sexual identity of users; socioeconomic and psychological issues; family dynamics; and ethnocultural factors. Finally, research and treatment focusing on alcohol dependence must be viewed within the context of governmental policies, which vary over time and different locations.

General Overviews

The literature in this section provides general background information on the nature of alcohol dependence and its prevalence in both the United States and other countries. The first reference is to the US government publication Alcohol Research & Health, which is available on the National Institute of Alcohol Abuse and Alcoholism website and provides state-of-the-art publications on a variety of topics related to alcohol use disorders. Heather, et al. 2001 and Straussner 2004 offer overviews of the issues involved in understanding alcohol problems and the process for assessing and helping individuals impacted by such problems. The National Institute for Health and Clinical Excellence 2011; Grant, et al. 2006; and Kim, et al. 2008 are good sources for recent prevalence rates of alcohol problems in the United Kingdom, United States, and Hong Kong, respectively. Willenbring 2010 summarizes the progress made in this field through well-known research studies over the past four decades. Vaillant 2003 is a classic longitudinal study documenting the effects on alcoholic men over a sixty-year time span.

• Alcohol Research & Health.

  E-mail Citation »

  A quarterly, peer-reviewed scientific journal (formerly known as Alcohol Health & Research World), offering a wealth of rigorously researched studies focusing on alcohol and related topics.

• Grant, Bridget F., Deborah A. Dawson, Frederick S. Stinson, S. Patricia Chou, Mary C. Dufour, and Roger P. Pickering. 2006. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Alcohol Research & Health 29.2: 79–91.

  E-mail Citation »

  Prevalence of alcohol abuse and dependence in the United States during 1991 to 1992 and 2001 to 2002 is compared; although alcohol abuse increased, dependence declined over time. Dependence is highest among males and younger respondents and varies by ethnicity: highest in whites, Native Americans, and Hispanics, and increasing among young black females and Asian males.

• Heather, Nick, Timothy J. Peters, and Tim Stockwell, eds. 2001. International handbook of alcohol dependence and problems. Chichester, UK: John Wiley.

  E-mail Citation »

  This handbook provides a comprehensive coverage of the entire field of alcohol studies from neurochemistry to sociology. Basic mechanisms of alcohol metabolism and dependence, theories of drinking and drinking problems, alcohol-related problems, forms of treatment, recovery, and methods for prevention are clearly presented.

• Kim, Jean H., Sing Lee, Julie Chow, et al. 2008. Prevalence and the factors associated with binge drinking, alcohol abuse, and alcohol dependence: A population-based study of Chinese adults in Hong Kong. Alcohol and Alcoholism 43.3: 360–370.

  DOI: 10.1093/alcalc/agm181E-mail Citation »

  The relationship among binge drinking, alcohol abuse, and dependence in Hong Kong Chinese is examined. Prevalence of alcohol dependence for men was 2.3 percent versus 0.7 percent for women. Younger age groups had the highest prevalence, and smoking was associated with alcohol dependence for both genders. Changing lifestyles point to increasing numbers of alcohol-related problems.

• National Institute for Health and Clinical Excellence. 2011. Alcohol-use disorders: The NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical practice guidelines 115. Leicester, UK: British Psychological Society.

  E-mail Citation »

  About 4 percent of the United Kingdom population is alcohol dependent. This new guideline reviews the evidence for the assessment and diagnosis of alcohol use disorders, organization and delivery of care, assisted alcohol withdrawal, and psychological and pharmacological interventions.

• Straussner, Shulamith L. A., ed. 2004. Assessment and treatment of clients with alcohol and other drug abuse problems: An overview. In Clinical work with substance-abusing clients. 2d ed. Edited by Shulamith L. A. Straussner, 3–36. New York: Guilford.

  E-mail Citation »

  This chapter provides an overview of the issues related to the scope, diagnosis, assessment, and treatment of alcohol problems (and other drugs) as they relate to social work clinicians.

• Vaillant, George E. 2003. A 60-year follow-up of alcoholic men. Addiction 98.8 (August): 1043–1051.

  DOI: 10.1046/j.1360-0443.2003.00422.xE-mail Citation »

  Describes the course of problems for male alcoholics from age twenty to age eighty of two community cohorts: Harvard students and inner-city adolescents. By age seventy, chronic alcohol dependence in each group was rare due either to death or stable abstinence. Alcoholics Anonymous attendance predicted sustained abstinence. Available online for purchase or by subscription.

• Willenbring, Mark L. 2010. The past and future of research on treatment of alcohol dependence. Alcohol Research & Health 33.1–2: 55–63.

  E-mail Citation »

  Over the past forty years, alcoholism treatment research has moved from anecdotal findings to well-designed studies. The National Institute on Alcohol Abuse and Alcoholism’s Project MATCH and Project COMBINE, as well as data from the National Epidemiologic Survey on Alcohol and Related Conditions, provided the foundation for problem definitions and new treatment approaches.