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A critique of the concept of the alcohol dependence syndrome.

Summary 
 
The term ‘alcoholism’ has been dropped from the International Classification of Diseases and replaced by the concept of the ‘alcohol dependence syndrome’. Four justifications for the syndrome idea are examined. It has been claimed that (1) the syndrome's existence was supported by scientific evidence, but only psychobiological alterations were truly supported by evidence; (2) dependence was not considered as all or none, but other statements contradicted this; (3) the syndrome idea had clinical usefulness, but it can be argued that the concept would be superfluous within a thorough assessment, and would likely confuse rather than enlighten a patient; (4) the syndrome concept synthesised research findings which contradicted the alcoholism concept, but this might inhibit further research by concentrating on ‘impaired control’ and neglecting the process of the development of drinking problems. Since both the validity and the utility of the concept of the alcohol dependence syndrome are questionable, it is suggested that the WHO's formal support for it was partly a political decision, and that the assertion that dependence is an illness might be an attempt to rejuslify the role of medical expertise in this area.