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F A C T    S H E E T                                                              JULY 2006


   There is broad consensus that alcohol dependence (also known as alcoholism) is a
   serious public health issue. There is debate, however, about what exactly alcohol
   dependence is and what causes it. While much work has been done in relation to the
   classification of drug and alcohol problems and levels of dependence, it remains that no
   single set of accepted definitions sufficiently describe the range of problems that exist
   and the level of dependence present (Shand et al 2003).
   An ‘excessive drinker’, for example, refers to drinkers who consume alcohol beyond the
   currently defined ‘low risk’ levels defined by the National Health and Medical Research
   Council Guidelines. Broadly speaking alcohol dependence is present when one of the
   following is present:
   • A strong desire or compulsion to use alcohol
   • Difficulty controlling alcohol use
   • Withdrawal symptoms (eg anxiety, tremors, sweating) even when drinking is ceased
   • Tolerance (eg drinks large amounts of alcohol without appearing intoxicated)
   • Continued alcohol use despite harmful consequences

Extent of the Problem
   Australian estimates of key alcohol and drug-use disorders provided the following
   • 6.5% of Australian adults had an alcohol use disorder (3.0% with harmful use and
   3.5% with dependence). More males (9.4%) than females (3.7%) had an alcohol-use
   disorder within the past 12 months.
   • Men were at higher risk than women of developing alcohol use disorders and the
   prevalence decreased with age.
   • Alcohol-use disorders were more prevalent among the unemployed (12.7%) than the
   employed (7.8%)
   • Alcohol-use disorders were more prevalent among those who had never married
   (13.0%) compared with those who were separated or divorced (9.4%) or those who were
   married (4.5%)
   • Alcohol-use disorders were more prevalent among those born in Australia (7.1%) and
   other English-speaking countries (6.2%) compared with those born in non-English-
   speaking countries (3.3%)
   • 73% of persons with alcohol dependence reported tolerance to the effects of alcohol
   but only 50% reported that they had either experienced withdrawal symptoms from
   alcohol, or had used alcohol to avoid or relieve withdrawal symptoms (Teeson et al

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Fact Sheet: Alcohol Dependence                                 NSW Office of Drug and Alcohol Policy | July 2006

Assessment and Screening for Alcohol Dependence
     Assessment for alcohol problems is undertaken in a range of settings in NSW, from
     general health care workers through to a range of more structured treatment programs.
     Significant cost- benefits may be gained from routine screening in settings where
     prevalence of excessive drinkers is likely to be highest. These include medical practices,
     general hospitals, the workplace and in welfare and general counselling.

From Drinking to Disorder
     With the first episode of intoxication likely to occur in the mid-teens, many people who
     are alcohol dependent experience onset of the disease in their 20s to mid-30s. The first
     withdrawal experience generally does not occur until after other aspects of the disease —
     such as tolerance and forfeiture of other activities because of alcohol use — have
     The course of alcohol dependence and abuse differs from person to person and often
     includes periods of remission and relapse. Someone with the disorder may stop drinking
     for a time (usually after a crisis), then move on to shorter periods of controlled or non-
     problematic drinking. Ultimately, consumption is likely to increase rapidly and severe
     problems soon develop or recur.
     Prognosis for recovery varies according to the severity of the illness. For many, the goal
     of treatment is abstinence, which has proven difficult to maintain; as many as 35% of
     people who undergo treatment do not remain abstinent for more than a year. Long-term
     abstinence rates can be as low as 10 to 20%.
     Recovery is a lifelong process, and relapse is always a possibility. With the majority of
     people unable to maintain abstinence in the long term, researchers and treatment
     professionals are seeking new therapies that can help people overcome their alcohol
     dependence (Hester & Sheehy 1990).
     It is recognised that a range of treatment approaches is required in dealing with alcohol
     dependence and no single modality currently exists. The general aim is to match the
     diversity of patients with an appropriate treatment option.

         •   Hester, R K & Sheehy, N (1990). The grand unification theory of alcohol abuse: It’s
             time to stop fighting each other and start working together. In R. Engs (Ed.),
             Controversy in the addiction field (pg 2-9). Dubuque, IA: Kendall-Hunt.
         •   National Health and Medical Research Council [ (2001) Australian Alcohol
             Guidelines: Health Risks and Benefits. Commonwealth Department of Health and
             Aged Care, Canberra (10 Sept 2005 < >
         •   Shand F, Gates J, Fawcett J & Mattick R (2003) The Treatment of Alcohol
             Problems: A Review of the Evidence. Department of Health and Ageing and the
             National Drug and Alcohol Research Centre, Canberra
         •   (10 July 2003 www.
         •   Teeson M, Hall W, Lysnkey M & Degendhardt L (1999) Alcohol and drug-use
             disorders in Australla: Implications of the National Survey of Mental Health and
             Wellbeing. National Drug and Alcohol Research Centre, Sydney
                                                NSW HEALTH
                                           LAST UPDATED: 9/11/05

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