Alcohol Dependence

Alcohol abuse and dependence is a major risk factor for serious health, social, and economic problems (167). Early identification of those who are dependent on alcohol increases the possibility of successful treatment, and brief intervention by the forensic physician seems both feasible and acceptable (124,168). Although not yet validated in police custody, brief interventions show a high acceptance among drinkers in licensed premises (169).

However, obtaining accurate and reliable information about a person's drinking habits can be extremely difficult because heavy drinkers tend to underestimate or deliberately lie about their alcohol consumption (170). Use of the Alcohol Use Disorders Identification Test identifies persons whose alcohol consumption has become harmful or hazardous to health (171); self-report questionnaires, such as the Michigan Alcohol Screening Test (172,173) and CAGE (174,175) may help to identify those with alcohol dependency and should prevent the doctor falling into the trap of assuming that alcohol abuse is synonymous with alcohol dependence (Appendix 5). DSM-IV (165) distinguishes between these two diagnostic categories. The main features differentiating alcohol dependence from alcohol abuse are evidence of tolerance, the presence of withdrawal symptoms, and the use of alcohol to relieve or avoid withdrawal. Treatment may be required for detainees who show signs of alcohol dependence. However, there is no need to treat those who simply abuse alcohol and who do not have a history of alcohol withdrawal.

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