Challenges to diagnosing alcohol use

Challenges to diagnosing alcohol use A complicating factor for diagnosis and treatment of alcohol diffi culties is
the developmental stage of most undergraduate college students. At this age
students typically feel invulnerable, and thus the consequences of substance
abuse may have little or no impact on them. Also, since high-risk drinking is
normative within some college circles, one might ask, “How do you tell the
diff erence between abuse and dependence?” Th e simple answer is, “Sometimes
you can’t.” However, as a clinical rule of thumb, true alcohol dependence
will declare itself over time. Th us it makes sense to give an assessment
time to unfold and to allow a student to “collect data.” Clinicians do not have
to convince clients that they are alcohol dependent if they’re not ready to hear
it—the reality may become self-evident later. In the meantime, one timehonored
technique to help students’ self-assessment is to invite them to set
a limit. If they can stick with it for, say, 6 months or more without suff ering
any adverse consequences, then there is evidence that the problem may be
alcohol abuse rather than dependence. However, if students cannot maintain
drinking within their own specifi ed limit, or they stay within the limit but
experience negative consequences anyway, there is evidence for dependence.
Th is conclusion is relevant because there are diff erent treatment implications
depending on diagnosis.