This paper traces the diagnostic concepts of alcoholism featured in the major classification systems over the past 40 years. The description of alcoholism as a diagnostic concept has undergone considerable transformation over this time, but an international consensus now exists in the DSM-IIIR [2] criteria and ICD-10 [3]. Alcoholism is equated with alcohol dependence, and both definitions draw largely on the description of the alcohol dependence syndrome by Edwards and Gross [4]. Although the presence of withdrawal symptoms and relief use (key aspects of so-called physical addiction) is part of both systems, they are not necessary to make the diagnosis in either. Future directions and clinical implications of these developments are discussed.
References
1.
MorseDMFlavinDK.The definition of alcoholism. Journal of the American Medical Association1992; 268:1012–1014.
2.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third edition, revised. Washington DC: American Psychiatric Association, 1987.
3.
The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organisation, 1992.
4.
EdwardsGGrossMM.Alcohol dependence: provisional description of a clinical syndrome. British Medical Journal1976; 1:1058–1061.
5.
SchuckitMA.Diagnosis of alcoholism. Medical Clinics of North America1988; 72:1133–1153.
6.
WellsJEBushnellJAHornblowARJoycePROakley-BrowneMA.Christchurch Psychiatric Epidemiology Study, Part 1: Methodology and lifetime prevalence for specific psychiatric disorders. Australian and New Zealand Journal of Psychiatry1989; 23:315–326.
7.
Oakley-BrowneMAJoycePRWellsJEBushnellJAHornblowAR.Christchurch Psychiatric Epidemiology Study Part 2: Six month and other period prevalences of specific psychiatric disorders. Australian and New Zealand Journal of Psychiatry1989; 23:327–340.
8.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Third Edition. Washington DC: American Psychiatric Association, 1980.
9.
World Health Organization: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, 6th revision, Geneva: World Health Organisation, 1948.
10.
World Health Organization: Manual of the International List of Causes of Death, 5th revision, Geneva: World Health Organisation, 1939.
11.
StengelE.Classification of mental disorders. Bulletin of the World Health Organization1959; 21:601–663.
12.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, First Edition, Washington DC: American Psychiatric Association, 1952.
13.
GoodwinDW.The gene for alcoholism. Journal of Studies on Alcohol1989; 50:397–398.
14.
JellinekEM.The disease concept of alcoholism. New Brunswick NJ: Hillhouse Press, 1960.
15.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 2nd ed.Washington DC: American Psychiatric Association, 1968.
16.
World Health Organization: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death. 8th revision. Geneva: World Health Organisation, 1969.
17.
World Health Organization: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death. 9th revision. Geneva: World Health Organisation, 1977.
18.
FeighnerJPRobinsEGuzeSBWoodruffRAWinokurGMunozR.Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry1972; 26:57–63.
19.
SpitzerRLEndicottJRobinsE.Clinical criteria for psychiatric diagnosis and DSM-III. American Journal of Psychiatry1975; 132:1187–1192.
20.
GalanterM.Consensual support for abstinence, an integral component of alcoholism treatment. British Journal of Addiction1987; 82:841–842.
21.
GoodwinDW.Familial alcoholism: a separate entity. Substance and Alcohol Actions/Misuse1983; 4:129–136.
22.
CloningerCR.Neurogenetic adaptive mechanisms in alcoholism. Science1987; 236:410–416.
23.
von KnorringA-LBohmanMvon KnorringLOrelandL.Platelet MAO activity as a biological marker in subgroups of alcoholism. Acta Psychiatrica Scandinavica1985; 72:51–58.
24.
CloningerCRBohmanMSigvardssonS.Inheritance of alcohol abuse: cross fostering analysis of adopted men. Archives of General Psychiatry1981; 38:861–868.
25.
MerikangasKR.The genetic epidemiology of alcoholism. Psychological Medicine1990; 20:11–22.
26.
TarterREKabeneMEscallierEALairdSBJacobT.Temperament deviation and risk for alcoholism. Alcoholism: Clinical and Experimental Research1990; 14:380–382.
27.
BaborTFHofmannMdel BocaFKHesselbrockVMeyerREDolinskyZSRounsavilleB.Types of alcoholics 1: evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry1992; 49:599–608.
28.
LittMDBaborTFdel BocaFKKaddenRMCooneyNL.Type of alcoholics 2: application of an empirically derived typology to treatment matching. Archives of General Psychiatry1992; 49:609–614.
