.

Clinical Terms: The clinical world uses specific criteria to diagnose alcoholism and alcohol abuse. As a recognized mental disorder, alcoholism falls under the guidelines established in the Diagnostic and Statistical Manual of Mental Disorders (DSM). There are regular revisions of the manual. We currently rely upon the DSM-IV. A clinician will review the patient’s past 12-months of behavior, and determine if either of the following two categories of abuse exist:(1)

Alcohol Abuse involves one occurrence of the following:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Alcohol addiction involves three or more of the following occurrences
1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Cautionary Terms: By the time these clinical definitions are met, the child has already progressed a long-way down the road towards a lifetime of addiction. Underage drinkers are up to 400% more likely to become alcoholics than are their non-drinking teen counterparts.(2) Neither high school graduation, nor the 21st birthday, represent the finish line for children. For many of today’s underage drinkers, alcoholism is not likely to exist, or meet a clinical definition, until they are well into adulthood. The health care industry today is just starting to come to grips with the flood of Baby Boomers who are entering rehabilitation programs as 50 year-olds.

Parents and counselors are well advised to plot the current behavior of a given teen on a map, and follow the projected course of their use patterns into adulthood. Research has proven that kids who do not abuse alcohol or drugs prior to the age or twenty-one, are nearly certain to never abuse. (3) The statistics for those who engage in underage drinking are far less promising.

Be alert for signs that alcohol has become a major element of your child’s daily or weekly routine. Be particularly cognizant of:

• Loss of interest in previous hobbies, activities, friends
• Hiding or storing alcohol in the home
• Drinking when alone
• Drinking quickly, or to extreme excess, craving heavy intoxication
• Openly bragging about drinking habits
• Claiming that alcohol is an essential aspect of social activity and/or that “all” normal teenagers drink

Alcohol Tutorial: Page 22 of 23

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Sources:

1. American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183)
2. Grant BF, Dawson DA: Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiological Survey. J Subst Abuse 1997; 9:103–110
3. Califano, Joseph Jr. 2009. How to Raise a Drug Free Kid, The Straight Dope for Parents: Simon and Shuster. NY, NY.