Is alcohol dependence a chronic relapsing disorder?

apples and oranges?

To me, there’s a lot in this article that intimates an ideological agenda, but it makes an important point.

Insufficient attention has been paid to the entire distribution of those with alcohol dependence. We believe that a chronic relapsing disorder model is not a useful conception for understanding the experience of the majority of people who have difficulties with alcohol dependence at some point in their life and that the influence of age and age-associated problems linked to dependence would benefit from further elaboration.

DSM dependence is not interchangeable with alcoholism and addiction. Alcoholism and addiction as many of us conceptualize them are chronic conditions, while DSM dependence often is not.

We need to do a better job distinguishing addiction/alcoholism from dependence and look at improving DSM criteria to help with this distinction. Loss of control, over an extended period of time that returns after periods of abstinence is the key to me. Addicts/alcoholics are not people making poor decisions about their drug and alcohol use, they are people who have lost the ability to make execute decisions related to drug and alcohol use.

What does this say about the applicability of research on dependence? Does it apply to alcoholics? Does it apply to heavy users who meet dependence criteria but are likely to mature out?

UPDATE: the authors were worried about the implications of non-alcoholic who meet dependence criteria getting subjected to generalizations based on alcoholics. This cuts both ways. Just yesterday, I read something about addiction that emphasized the natural remission rates of heroin dependent returning Vietnam vets. The only problem is that they weren’t addicts and their lessons probably don’t illuminate much about how addicts recover. So . . . I completely agree about the need to distinguish between chronic dependence and non-chronic dependence.

4 thoughts on “Is alcohol dependence a chronic relapsing disorder?

  1. I think some of the confusion stems from the NIAAA’s recent decision to kind of formally lump together problem social drinkers together and confirmed alcoholics. At that point, of course, you can question things like chronic relapse, etc. Alcohol abuse lies on a spectrum, and yes, some cases are fuzzy. But at the strongly addictive end of the spectrum, the term “chronic relapsing disorder” is valid and useful, seems to me.

    1. Thanks for the comment!

      I’m concerned about the spectrum approach. We’re already seeing studies reporting 20 million Americans “in recovery”, advocates are seizing upon this, but the real question is, “recovery from what?”

      Is someone who met DSM criteria when they were 21 and no longer meets criteria in recovery? Even if they meet DSM criteria and become abstinent without any help from professionals or mutual aid groups, are they in recovery?

      We’re now in this weird position of having chronic dependence and non-chronic dependence, which, to my mind, are completely different animals. There isn’t even a specifier for chronic or non-chronic. To me, the hallmark of addiction is loss of control. But the two DSM criteria related to loss on control are just 2 of the 7 criteria. They aren’t necessary and have no special status.

      The DSM V just muddies the waters more, creating even less of a distinction between alcoholics and uncle Joe who drank too much when he was in his 20s, got a couple of OUILs, used to miss days at work because of hangovers and then “straightened out” when aunt Millie packed her bags and threatened to leave him.

      1. Couldn’t agree more, Jason. IMO, this institutional confusion is basically embedded in the very title of the nation’s premier alcohol research agency: National Institute on Alcohol Abuse and Alcoholism. It’s like they couldn’t decide exactly what they were going to study right from the very start.

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