Old wine, new bottle. The alcohol dependence syndrome

The alcohol dependence syndrome is at once a fresh approach and a restatement of established clinical lore. It is, perhaps, old wine in a new bottle. Nonetheless, behavioral researchers in this field have needed some clinically sound criteria to differentiate between subjects to account for the variability of behavioral and psychophysiologic responses to alcohol in the laboratory. Cross-cultural researchers, and those interested in the genetics of alcoholism, have needed culture-free criteria for the diagnosis of alcoholism that might help them to separate aspects of the disorder that are genetically determined from those that are influenced by culture, immediate environment, and psychopathology. The beauty of the alcohol-dependence syndrome construct is its apparent specificity and its potential clinical usefulness. The difficulty with the concept is that no questionnaire has proven entirely satisfactory in defining the severity of alcohol dependence nor have biologic variables been identified that can provide valid and reliable indicators of severity. Nonetheless, advances in biomedical research frequently await the development of a nomenclature that will permit replicable scientific investigation. The evolving definition of the alcohol dependence syndrome is consistent with this tradition.