Alcohol dependence and alcohol problems 

The problem of excessive alcohol consumption is a major cause of public health concern in most countries of the world today. Heavy consumption, which involves far more than ‘dependence’, can cause untold misery to the individual, who is usually affected by other physical, psychological, and social disabilities as well. As early as 1950, the World Health Organization (WHO) viewed the lack of a commonly accepted terminology as a serious obstacle to international action in the alcohol field. Definitions of ‘alcoholism’ have been proposed by a range of professional and other bodies, from biomedical scientists, medical doctors and psychiatrists, psychologists, sociologists, patients in treatment, to the general public. Terms such as ‘alcoholism’, ‘addiction’, and ‘chemical dependence’, have passed into everyday speech, becoming ‘popularly enriched’ and ‘technically impoverished’. These terms mean different things to different people and often have pejorative connotations. The lack of a precise definition of ‘drinking problems’ has hampered interdisciplinary communication. In this section, the evolution of the term ‘alcohol dependence’ will be traced and put into context as but one aspect of a wider spectrum of alcohol-related problems. The concept of the alcohol dependence syndrome (ADS) will be introduced and its influence on the 10th revision of the International Classification of Diseases (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual of Diseases (DSM-IV) will be reviewed. The terms ‘harmful use’ (ICD-10) and ‘alcohol abuse’ (DSM-IV) will also be discussed. Finally ‘alcohol-related problems’ will be considered.