Alcohol dependence
A chronic alcohol-use disorder in which neuroadaptation, impaired control and continued drinking despite harm create a potentially dangerous withdrawal syndrome when alcohol is reduced or stopped.
Definition
Alcohol dependence is a pattern of alcohol use with impaired control, craving, tolerance and withdrawal, often accompanied by continued drinking despite harm and prioritisation of alcohol over other activities. It is a clinical syndrome within alcohol-use disorder and must be distinguished from intoxication and harmful use without dependence.
First principles
Dependence is a neuroadaptive state, not simply heavy drinking
Repeated alcohol exposure changes inhibitory and excitatory signalling so that the brain functions in the presence of alcohol. Tolerance, craving, impaired control and withdrawal are clinical consequences of this adaptation; a person can therefore be at risk even when their current presentation is not intoxicated.
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