DSM-IV Criteria for Alcohol Dependence
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
- Tolerance, as defined by either of the following:
- a need for markedly increased amounts of the substance to achieve intoxication or desired effect
- markedly diminished effect with continued use of the same amount of the substance
- the characteristic withdrawal syndrome for the substance
- the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
Tolerance to alcohol builds to both physical and psychological dependence after continued abuse. It causes dependence in much the same way as any other central nervous system depressant, such as a barbiturate. This dependence is the first sign that the heavy drinker has developed a progressive problem that is now out of control.
Tolerance is a physical sign and symptom that is inherited, not a personality factor such as low self-esteem or inferiority complex or other deep-rooted psychological problem. Those with a low risk for alcoholism do not adapt well to the presence of alcohol in their brains. The reaction to the lack of tolerance is dysphoria, or a disturbed mood, nausea, headache, maybe vomiting and general ill feeling that only gets worse with alcohol. The nonalcoholic actually feels better as the alcohol leaves the body so there appears to be little reinforcement to drink more alcohol. The alcoholic, on the other hand, feels better as the blood-alcohol level rises in the body and brain so that the motivation is to drink more.
Tolerance to alcohol or the lack of it appears to be inherited. Whether someone is likely to develop alcoholism appears to depend on whether he or she has the genes for alcohol. If someone has tolerance for alcohol, he or she may be at risk for developing alcoholism. The opposite may also be true; if someone lacks tolerance to alcohol, he or she probably will not develop alcoholism.
Researchers now believe that the brain areas responsible for responding to alcohol with a positive feeling, reward and attention may be determined by genetic makeup.