Alcoholism Diagnosis

Although there is no specific diagnosis for alcoholism, there have been many efforts at diagnostic approaches to alcohol dependence, abuse and complications associated with chronic alcohol consumption.

In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic."

The DSM IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism, one more closely based on specifics than the 1992 JAMA article. In part this is to assist in the development of research protocols in which findings can be compared with one another, but the DSM definition is the one in general use from a diagnostic standpoint. That definition is: maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae.

Note that many sedative agents are cross-tolerant with alcohol (meaning that these agents can be taken instead of alcohol to relieve withdrawal symptoms or to maintain the level of sedation provided by alcohol). A more general diagnosis than alcohol dependence is that of sedative dependence. Whether an individual uses alcohol or another sedative, if they meet the criteria above, the process is likely the same.

Screening

Several tools may be used to detect the habitual abuse of alcohol. The CAGE questionnaire, developed by Dr. John Ewing and named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.

Two "yes" responses indicate that the respondent should be investigated further.

The questionnaire asks the following questions:

1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Another screening questionnaire is the Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization.

The Alcohol Dependence Data Questionnaire is a more sensitive diagnostic test than the CAGE test. The Alcohol Dependence Data Questionnaire serves to distinguish a diagnosis of alcohol dependence from one of alcohol abuse.

Blood tests

Although there is no blood test specific for alcohol abuse or alcohol dependence (alcoholism), prolonged heavy alcohol consumption may lead to several abnormalities, including:

• Macrocytosis (enlarged MCV)1
• Elevated GGT2
• Moderate elevation of AST and ALT and an AST:ALT ratio of 2:1.
• High carbohydrate-deficient transferrin2

The disease model

The disease model of alcoholism was first proposed by Dr. Benjamin Rush of Philadelphia. Prior to Benjamin Rush, drunkenness was viewed as a moral lapse and a sinful choice.

Whether or not alcoholism is a systemic problem that can be legitimately described as a disease remains a controversial subject in the medical field. However the consequences of chronic alcoholism have a clearly defined course of physical debilitation that can end in death. The controversy over the disease hypothesis exists partly because of these various characterizations and uses of the words "alcoholism" and "disease", and not all participants in the debate are without self-interest. For example, if alcoholism is not considered a disease, third-party payments to physicians and hospitals for its treatment might cease. Programs such as Rational Recovery also reject the "disease model" for a variety of reasons, one claim being that there is no medical procedure to determine if one has alcoholism as a disease. Many "alcoholism as a disease model" critics such as Stanton Peele, PhD also reject the notion that excessive drinking is rooted in a biological disease. Herbert Fingarette, PhD, has written extensively on the subject including Heavy Drinking: The Myth Of Alcoholism as a Disease.

The American Society of Addiction Medicine and the American Medical Association both maintain extensive policy regarding alcoholism. The American Psychiatric Association recognizes the existence of "alcoholism" as the equivalent of alcohol dependence. With the publication of the DSM-III in 1980, two separate syndromes of alcohol dependence and alcohol abuse replaced the earlier category of alcoholism. The World Health Organization dropped the diagnostic category "alcoholism" in 1979, replacing it with the diagnostic categories "alcohol dependence" and "harmful use" (ICD-9, ICD-10). The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease.

The causes for alcohol abuse and dependence cannot be easily explained. However, the belief that the roots are from moral or ethical weakness on the part of the sufferer has been largely superseded.

In contrast, in a 1988 U.S. Supreme Court decision on whether alcohol dependence is a condition for which the U.S. Veterans Administration should provide benefits (Traynor v. Turnage), Justice Byron R. White agrees with the U.S. District Court that there exists "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility."

Although many people and medical organizations define alcoholism as a disease (with organic, biological and even genetic roots), there is currently no test or procedure to determine or diagnose alcoholism. In view of this medical professionals diagnose proveable alcohol related conditions such as alcohol dependence, alcohol abuse and alcohol withdrawal.