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Alcoholism is a multifactorial disorder in which genetic, biologic, and sociocultural factors interact.

  • Alcohol dependence: defined in DSM-IV as repeated alcohol-related difficulties in at least three of seven areas of functioning that cluster together over the same 12-month period; tolerance and withdrawal are two of these seven areas and are associated with a more severe course.

  • Alcohol abuse: defined as repetitive problems with alcohol in any one of four life areas—social, interpersonal, legal, and occupational—or repeated use in hazardous situations such as driving while intoxicated.


Lifetime risk for alcohol dependence is 10–15% for men and 5–8% for women. Typically, the first major life problem from excessive alcohol use appears in early adulthood, followed by periods of exacerbation and remission. The course is not hopeless; following treatment, between half and two-thirds of pts maintain abstinence for years and often permanently. If the alcoholic continues to drink, life span is shortened by an average of 10 years due to increased risk of death from heart disease, cancer, accidents, or suicide.

Screening for alcoholism is important given its high prevalence. Probe for marital or job problems, legal difficulties, history of accidents, medical problems, and evidence of tolerance to alcohol. Standardized questionnaires can be helpful in busy clinical practices including the 10-item Alcohol Use Disorders Identification Test (AUDIT) (see Table 211-1).


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