diesel2
Member
Dvla are being selective and misleading in their guide, and are failing to point out that 3 of the criteria need to be present together.
Dvla guide to definition of misuse:-
There is no single definition to embrace all the variables within alcohol misuse – but the DVLA offers the following:
“A state that causes, because of consumption of alcohol, disturbance of behaviour, related disease or other consequences likely to cause the patient, their family or society present or future harm and that may or may not be associated with dependence.”
The World Health Organization’s classification (ICD-10) code F10.1 is relevant.
Definition of controlled drinking
Drinking within government recommended health guidelines (currently 14 units per week).
Guide to definition of dependence
There is no single definition to embrace all the variables within alcohol dependence – but the DVLA offers the following:
“A cluster of behavioural, cognitive and physiological phenomena that develop after repeated alcohol use, including:
■ a strong desire to take alcohol
■ difficulties in controlling its use
■ persistent use in spite of harmful consequences
■ and with evidence of increased tolerance and sometimes a physical withdrawal state.”
Indicators may include any history of withdrawal symptoms, tolerance, detoxification or alcohol-related seizures.
The World Health Organization’s classification (ICD-10) code F10.2 is relevant.
Compare this to the full text from WHO bluebook, https://www.who.int/classifications/icd/en/bluebook.pdf
F1x.1 Harmful use
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).
Diagnostic guidelines
The diagnosis requires that actual damage should have been caused to the mental or physical health of the user.
Harmful patterns of use are often criticized by others and frequently associated with adverse social consequences of various kinds. The fact that a pattern of use or a particular substance is disapproved of by another person or by the culture, or may have led to socially negative consequences such as arrest or marital arguments is not in itself evidence of harmful use.
Acute intoxication (see F1x.0), or "hangover" is not in itself sufficient evidence of the damage to health required for coding harmful use.
Harmful use should not be diagnosed if dependence syndrome (F1x.2), a psychotic disorder (F1x.5), or another specific form of drug- or alcohol-related disorder is present.
F1x.2 Dependence syndrome
A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take psychoactive drugs (which may or may not have been medically prescribed), alcohol, or tobacco.
There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.
Diagnostic guidelines
A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:
(a) a strong desire or sense of compulsion to take the substance;
(b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
(c) a physiological withdrawal state (see F1x.3 and F1x.4) when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
(d )evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
(e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
(f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.
Narrowing of the personal repertoire of patterns of psychoactive substance use has also been described as a characteristic feature (e.g. a tendency to drink alcoholic drinks in the same way on weekdays and weekends, regardless of social constraints that determine appropriate drinking behaviour).
It is an essential characteristic of the dependence syndrome that either psychoactive substance taking or a desire to take a particular substance should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use. This diagnostic requirement would exclude, for instance, surgical patients given opioid drugs for the relief of pain, who may show signs of an opioid withdrawal state when drugs are not given but who have no desire to continue taking drugs.
The dependence syndrome may be present for a specific substance (e.g. tobacco or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of different substances (as for those individuals who feel a sense of compulsion regularly to use whatever drugs are available and who show distress, agitation, and/or physical signs of a withdrawal state upon abstinence).
Dvla guide to definition of misuse:-
There is no single definition to embrace all the variables within alcohol misuse – but the DVLA offers the following:
“A state that causes, because of consumption of alcohol, disturbance of behaviour, related disease or other consequences likely to cause the patient, their family or society present or future harm and that may or may not be associated with dependence.”
The World Health Organization’s classification (ICD-10) code F10.1 is relevant.
Definition of controlled drinking
Drinking within government recommended health guidelines (currently 14 units per week).
Guide to definition of dependence
There is no single definition to embrace all the variables within alcohol dependence – but the DVLA offers the following:
“A cluster of behavioural, cognitive and physiological phenomena that develop after repeated alcohol use, including:
■ a strong desire to take alcohol
■ difficulties in controlling its use
■ persistent use in spite of harmful consequences
■ and with evidence of increased tolerance and sometimes a physical withdrawal state.”
Indicators may include any history of withdrawal symptoms, tolerance, detoxification or alcohol-related seizures.
The World Health Organization’s classification (ICD-10) code F10.2 is relevant.
Compare this to the full text from WHO bluebook, https://www.who.int/classifications/icd/en/bluebook.pdf
F1x.1 Harmful use
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).
Diagnostic guidelines
The diagnosis requires that actual damage should have been caused to the mental or physical health of the user.
Harmful patterns of use are often criticized by others and frequently associated with adverse social consequences of various kinds. The fact that a pattern of use or a particular substance is disapproved of by another person or by the culture, or may have led to socially negative consequences such as arrest or marital arguments is not in itself evidence of harmful use.
Acute intoxication (see F1x.0), or "hangover" is not in itself sufficient evidence of the damage to health required for coding harmful use.
Harmful use should not be diagnosed if dependence syndrome (F1x.2), a psychotic disorder (F1x.5), or another specific form of drug- or alcohol-related disorder is present.
F1x.2 Dependence syndrome
A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take psychoactive drugs (which may or may not have been medically prescribed), alcohol, or tobacco.
There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.
Diagnostic guidelines
A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:
(a) a strong desire or sense of compulsion to take the substance;
(b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
(c) a physiological withdrawal state (see F1x.3 and F1x.4) when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
(d )evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
(e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
(f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.
Narrowing of the personal repertoire of patterns of psychoactive substance use has also been described as a characteristic feature (e.g. a tendency to drink alcoholic drinks in the same way on weekdays and weekends, regardless of social constraints that determine appropriate drinking behaviour).
It is an essential characteristic of the dependence syndrome that either psychoactive substance taking or a desire to take a particular substance should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use. This diagnostic requirement would exclude, for instance, surgical patients given opioid drugs for the relief of pain, who may show signs of an opioid withdrawal state when drugs are not given but who have no desire to continue taking drugs.
The dependence syndrome may be present for a specific substance (e.g. tobacco or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of different substances (as for those individuals who feel a sense of compulsion regularly to use whatever drugs are available and who show distress, agitation, and/or physical signs of a withdrawal state upon abstinence).