By the mid-1980s DSM-III and ICD-9 were undergoing reviews for the purposes of revision.(32) The diagnostic criteria for dependence were broadened in DSM-IIIR(5) to incorporate the elements of the alcohol dependence syndrome as hypothesized by Edwards and Gross.(3) Here, nine items were included in the diagnostic criteria for dependence, the majority focusing on evidence of loss of control, overuse of the substance, a willingness to give up important events in order to take the substance, and consumption of alcohol despite consequences. Out of the nine items, three related to the presence of tolerance or withdrawal, but these were not required for a diagnosis as they had been in DSM-III. To meet the criteria for dependence, individuals had to fulfil three of the nine items for a period of at least 1 month.

The essential feature of the DSM-IIIR dependence category is defined in the text as a 'cluster of cognitive, behavioural, and physiological symptoms, indicating that the person has impaired control over drinking and continues to drink despite adverse consequences' ( Table.2).

Table 2 DSM-IIIR criteria for substance dependence

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