The most common model of addiction in usage today is the Alcohol Dependence Syndrome. The model, originally suggested by a british and an american psychiatrist, is the one that most medical addiction professionals would use to make a diagnosis. as it describes the main alcoholism signs and symptoms. This syndrome consists of the following seven elements.
The seven alcoholism signs of the Alcohol Dependence Syndrome are as follows:
1/ narrowing of the drinking repertoire,
2/ salience of drink-seeking behaviour,
3/ increased tolerance,
4/ repeated withdrawal symptoms,
5/ subjective awareness of a compulsion to drink,
6/ relief or avoidance drinking,
7/ reinstatement of dependence after abstinence.
A syndrome is a collection of signs and symptoms that are usually found together, in this case alcoholism signs. Unlike a disease, not all elements need to be present to the same degree, or indeed present at all. However the more elements that a person shows, the greater the likelihood that they have an alcohol problem. So normally for a diagnosis of alcohol dependence to be made 3 or more of the elements would be present.
Narrowing of the Drinking Repertoire This element concerns how an individual drinks in different situations (ie their repertoire of drinking patterns). Most people will match their drinking behavour to the situation. For example we would probably expect to see different drinking patterns at a celebration than at a formal gathering. However according to the ADS model, the behaviour of the dependent drinker will become similar in every situation (narrowing of the repertoire), thus drinking to excess at innappropriate times. The model implies that there is a loss of control, or at least impaired control.
Salience of Drink-seeking Behaviour This describes how the time given over to thinking about drinking, obtaining the means to drink and actually seeking drink increases. In other words, drinking may become an all-consuming passion, the most important thing in a person’s life with a detrimental effect as other activities and duties are neglected.
Increased Tolerance Tolerance describes how the same amount of alcohol has a reduced effect and it takes a progressively larger amounts of alcohol to obtain the same effect.
Repeated Withdrawal Symptoms Periods of abstinence result in both physical and psychological dis-comfort. For example, the person may feel anxious and tense, have shaky hands and suffer from excessive sweating and insomnia. The frequency and severity of these withdrawal symptoms may increase and be experienced after any drinking bouts rather than only the heavier ones.
Subjective Awareness of a Compulsion to Drink This element concerns craving, which is usually described as an abnormally powerful desire to drink which is often described by the alcoholic as all-consuming. The description again implies the loss of, or impaired, control of drinking.
Relief or Avoidance Drinking This element concerns the practice of drinking either to alleviate or to avoid withdrawal symptoms. It is often characterised by drinking in the morning. Sometimes, it involves top-up drinking, ie, the person drinks at a steady pace, never becoming completely drunk, but never actually being sober. There are, then, no withdrawals until the person remains abstinent for any reason, for example, after admission to hospital.
Reinstatement of Dependence after Abstinence This element indicates that the dependent drinker is no longer able to return to normal social drinking. Even after a lengthy period of abstinence, a resumption of drinking leads again to a similar, or even worse, state of alcohol dependence.
