The diagnosis of dependence presented in this bulletin was qualified further in an important way. Because the withdrawal criterion of alcohol dependence is defined in DSM–IV as a withdrawal syndrome (i.e., a cluster of symptoms), at least two symptoms of withdrawal, which met the duration criterion, had to occur during the past 12 months. It should be noted, however, that withdrawal is not required for a DSM–IV diagnosis of dependence. The DSM–IV diagnostic category for dependence could be specified further by evidence of physiological dependence (i.e., evidence of either tolerance or withdrawal, including drinking to relieve or avoid withdrawal) or no physiological dependence (i.e., no evidence of tolerance and withdrawal).
