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consequences generalises to the female population. With reference to the criteria for alcohol dependence in this study, the authors used “symptoms that are commonly found in alcoholic samples and frequently used for the diagnosis of alcoholism” (Polich et al. 1981 p. 46). These commonly agreed symptoms are tremors, morning drinking, loss of control, blackouts, missing meals and continuous drinking. Something of the circularity mentioned earlier therefore seems to have been retained in this study. They noted that the symptom of loss of control was controversial, and did not include it at admission or 18 month follow-up. However they did retain the symptom of ‘continuous drinking’ and it is not entirely clear in what way this is not a loss of control item. Remaining items have much to do with tolerance and withdrawal and little to do with the psychological aspects of dependence that were beginning to be discussed at the time and are included in the introduction to the study. The authors did claim that the extent to which individual symptoms change over time was the subject of continuing empirical investigation and this question will be dealt with at a later stage of this report.
The Polich et al. (1981) study was a landmark study in several ways. This was an empirical endeavour to separate dependence from adverse consequences and to establish the separate dimensions of problem drinking (or ‘alcoholism’ as it was then known to be). It has been claimed that the multi-axial model not only allows a more realistic account of the spectrum of drinkers and their problems (Skinner 1990) but that it also has greater clinical utility in that problems can be more accurately targeted when the different dimensions are used both to determine treatment goal as well as provide criteria for choice of intervention.
This study was of further importance in its time in that it demonstrated that the condition previously known as ‘alcoholism’ was not an inevitably progressive one, that people drinking in a dependent way at first contact could be drinking in a harm-free way at four year follow-up. In spite of the enduring limitations in the study definition of dependence, this finding nonetheless constituted a complete departure from the previously held view that ‘alcoholism’, a hallmark sign of which was the manifestation of tolerance and withdrawal, was arrestable but incurable (Jellinek 1960). The alcohol dependence syndrome came into being as an official diagnosis included in the ninth revision of the International Classification of Diseases after being approved by the WHO in January 1979. The syndrome description was subsequently incorporated into DSM-III-R (American Psychiatric Association 1987).
The nature of the dependence syndrome as it was originally described consisted of seven markers, namely: narrowing of drinking repertoire, salience of drink related behaviour, increased tolerance to alcohol, repeated withdrawal symptoms, relief or avoidance of withdrawal symptoms
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