Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

76 III. SUBSTANCES OF ABUSE(Dufour, 2001). Consumption of more than five drinks per day is consistentlyassociated with acute and chronic adverse consequences (Midanik, Tam,Greenfield, & Caetano, 1996) Cross-sectional surveys of drinking behavior inthe United States have determined that at least 65% of Americans are currentdrinkers and average 88 drinking days per year. The average number of heavydrinking days per year is 13 (Greenfield, 2000).DIAGNOSISAlcohol use may lead to two alcohol-use disorders (abuse or dependence) and11 alcohol-induced disorders (see section on clinical features). The fourth textrevised edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR; American Psychiatric Association, 2000) requires that three ormore criteria for dependence occur at any time within a 12-month period. Thenecessity for occurrence of three or more criteria within a 12-month time frameis more diagnostically rigorous than the criteria of the DSM-III-R. In contrastto DSM-III-R, DSM-IV-TR lists only seven criteria under dependence; a formercriterion—“substance often taken to relieve or avoid withdrawal symptoms”—hasbeen subsumed under the withdrawal criteria; and the criteria onfailure to fulfill major role obligations at work, school, or home have beenshifted to the abuse criteria.Alcohol abuse criteria have been expanded from two criteria in DSM-III-Rto four criteria in DSM-IV-TR. Alcohol abuse requires at least one of the criteriato have occurred within a 12-month period.Proper diagnosis requires adherence to these criteria. The distinctionsbetween alcohol abuse and alcohol dependence (alcoholism) are clinically useful.For example, if only criteria for abuse are met, it can be assumed that thepatient is not alcohol-dependent (and is, therefore, not an “alcoholic”). Suchan individual is more likely to benefit from controlled drinking strategies and tobe able to return to nonpathological use of alcohol than is the person whoreaches criteria for dependence, where abstinence would be the preferred treatmentgoal. Higher rates of remission can be expected for clients with alcoholabuse compared to clients with alcohol dependence, even in the presence of asevere mental disorder.The symptoms associated with alcohol abuse and alcohol dependence arefar-ranging and involve biological, psychological, and social domains. The presentingsymptoms vary from patient to patient, and such heterogeneity shouldbe appreciated by the clinician making a diagnosis.In assessing a patient for alcoholism, the clinician should consider problemsrelated to the drinker, the family, and the community. Problems for thedrinker may include declining job performance, joblessness, divorce, arrests(especially for driving while intoxicated and public intoxication), accidents,