Diagnostic criteria for alcohol dependence are subsumed within the DSM-IV's general criteria for substance dependence. There are special considerations when applying DSM-IV criteria to older adults with alcohol problems.
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Criteria
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Special Considerations for Older Adults
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| 1. Tolerance |
May have problems with even low intake due to increased sensitivity to alcohol and higher blood alcohol levels. |
| 2. Withdrawal |
Many late-onset alcoholics do not develop physiological dependence. |
| 3. Taking larger amounts or over a longer period than was intended |
Increased cognitive impairment can interfere with self-monitoring; drinking can exacerbate cognitive impairment and monitoring. |
| 4. Unsuccessful efforts to cut down or control use |
Same issues across lifespan. |
| 5. Spending much time to obtain and use alcohol and to recover from effects |
Negative effects can occur with relatively low use. |
| 6. Giving up activities due to use |
May have fewer activities, making detection of problems more difficult. |
| 7. Continuing use despite physical or psychological problem caused by use |
May not know or understand that problems are related to use, even after medical advice. |