ABSTRACT
Alcohol use disorders can be classified according to the Diagnostic and Statistical Manual of Mental Disorders-4th Ed. (DSM-IV; American Psychiatric Association, 1994) as either alcohol abuse or alcohol dependence. Alcohol abuse is defined primarily by the occurrence of negative consequences that are the result of alcohol use. These can include recurrent problems with fulfilling responsibilities at work, school, or home; using substances in situations that may result in a physical harm (e.g., driving a car, operating large machinery); legal difficulties; and interpersonal conflicts. Alcohol dependence is usually considered a more severe disorder than alcohol abuse and is generally diagnosed when an individual experiences signs of tolerance, withdrawal, and difficulty controlling consumption. Tolerance occurs when an individual requires increasing amounts of alcohol to achieve the same level of physical or psychological effects. Withdrawal results when an individual stops drinking or greatly reduces alcohol intake after having consumed large amounts of alcohol over an extended period of time. Symptoms of alcohol withdrawal can include autonomic hyperactivity (e.g., sweating, racing pulse); hand tremor; insomnia; nausea/vomiting; visual, tactile, or auditory hallucinations; psychomotor agitation; anxiety; and grand mal seizures. Withdrawal usually begins fairly rapidly, within 4–12 hours after stopping alcohol consumption; however, it can start as late as 60 hours following abrupt cessation or reduction in alcohol use. Symptoms usually peak during the second day of abstinence. If a delirium develops in which the individual experiences significant memory deficits, disorientation, or language disturbance, it is likely that a serious medical condition may be present, such as liver failure, pneumonia, or gastrointestinal bleeding, and a medical evaluation is necessary.
