Is alcohol dependence a chronic relapsing disorder?
Posted Oct 18 2011 5:40am
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.