Alcohol dependence: provisional description of a clinical syndrome.

Anyone concerned with treating drinking problems must find that his patients often tell him more than is in the textbooks. Each tells a different story, but there are also repeated patterns. Much of the varied experience that is recounted can be inter preted as the patient's astute observation of the alcohol depen dence syndrome-a condition certainly far better described by the average alcoholic than in any book. To attempt a definitive description of this syndrome would be premature; much is still only at the stage of "clinical impression." Routine clinical questions may impose a pattern on patients' accounts, and patients may themselves organise their uncertain recall of events in terms of expectations given to them. To link the clinical syndrome with information on the psychobiological basis of dependence is difficult, though scientific understanding has advanced recently. Our aim here is to help further to delineate the clinical picture. This is far from the first attempt to describe the syndrome. Jellinek's classification of alcoholism into types stands supreme.' The American National Council on Alcoholism has recently analysed diagnostic criteria,'2 nd a World Health Organisation group is preparing a report that seeks to define this syndrome and examine its importance.* Furthermore, we take the term syndrome to mean no more than the concurrence of phenomena. Not all the elements need always be present, nor always present with the same intensity. No assumptions need be made about