出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/04/23 00:14:53」(JST)
| Alcohol dependence | |
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| Classification and external resources | |
| Specialty | psychiatry |
| ICD-10 | F10.2 |
| ICD-9-CM | 303 |
| OMIM | 103780 |
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[edit on Wikidata]
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Alcohol dependence is a previous psychiatric diagnosis in which an individual is physically or psychologically dependent upon drinking alcohol. In 2013 it was reclassified as alcohol use disorder (alcoholism) along with alcohol abuse in DSM-5.[1]
| Addiction and dependence glossary[2][3][4][5] |
|---|
| • addiction – a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences |
| • addictive behavior – a behavior that is both rewarding and reinforcing |
| • addictive drug – a drug that is both rewarding and reinforcing |
| • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake) |
| • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose |
| • drug withdrawal – symptoms that occur upon cessation of repeated drug use |
| • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens) |
| • psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia) |
| • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them |
| • rewarding stimuli – stimuli that the brain interprets as intrinsically positive or as something to be approached |
| • sensitization – an amplified response to a stimulus resulting from repeated exposure to it |
| • substance use disorder - a condition in which the use of substances leads to clinically and functionally significant impairment or distress |
| • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose |
| (edit | history) |
According to the DSM-IV criteria for alcohol dependence, at least three out of seven of the following criteria must be manifest during a 12-month period:
The Alcohol Use Disorders Identification Test (AUDIT) is considered the most accurate alcohol screening tool for identifying potential alcohol misuse, including dependence.[7] It was developed by the World Health Organisation, designed initially for use in primary healthcare settings with supporting guidance.[8] Its use has replaced older screening tools such as CAGE but there are many shorter alcohol screening tools,[9] mostly derived from the AUDIT. The Severity of Alcohol Dependence Questionnaire (SAD-Q) is a more specific twenty-item inventory for assessing the presence and severity of alcohol dependence.
Because only 3 of the 7 DSM-IV criteria for alcohol dependence are required, not all patients meet the same criteria and therefore not all have the same symptoms and problems related to drinking. Not everyone with alcohol dependence, therefore, experiences physiological dependence. Alcohol dependence is differentiated from alcohol abuse by the presence of symptoms such as tolerance and withdrawal. Both alcohol dependence and alcohol abuse are sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse. There are two major differences between alcohol dependence and alcoholism as generally accepted by the medical community.
The following elements are the template for which the degree of dependence is judged:
Treatments for alcohol dependence can be separated into two groups, those directed towards severely alcohol-dependent people, and those focused for those at risk of becoming dependent on alcohol. Treatment for alcohol dependence often involves utilizing relapse prevention, support groups, psychotherapy,[11] and setting short-term goals. The Twelve-Step Program is also a popular process used by those wishing to recover from alcohol dependence.[12]
About 12% of American adults have had an alcohol dependence problem at some time in their life.[13] In the UK the NHS estimates that around 9% of men and 4% of UK women show signs of alcohol dependence.[14]
The term 'alcohol dependence' has replaced 'alcoholism' as a term in order that individuals do not internalize the idea of cure and disease, but can approach alcohol as a chemical they may depend upon to cope with outside pressures.
The contemporary definition of alcohol dependence is still based upon early research. There has been considerable scientific effort over the past several decades to identify and understand the core features of alcohol dependence.[15] This work began in 1976, when the British psychiatrist Griffith Edwards and his American colleague Milton M. Gross [16] collaborated to produce a formulation of what had previously been understood as ‘alcoholism’ – the alcohol dependence syndrome.
The alcohol dependence syndrome was seen as a cluster of seven elements that concur. It was argued that not all elements may be present in every case, but the picture is sufficiently regular and coherent to permit clinical recognition. The syndrome was also considered to exist in degrees of severity rather than as a categorical absolute. Thus, the proper question is not ‘whether a person is dependent on alcohol’, but ‘how far along the path of dependence has a person progressed’.
Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
Substance-use disorder: A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe.
Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)
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Reinforcement disorders: Addiction and Dependence
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Alcohol and health
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Note: see Template:Psychoactive substance use for diagnoses
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| リンク元 | 「アルコール依存症」「アルコール依存」 |
| 拡張検索 | 「alcohol-dependence deterrent」 |
| 関連記事 | 「dependence」「alcohol」 |