Category: F10 F11 F12 F13 F14 F15 F16 F17 F18 F19
F10 — Mental and behavioural disorders due to use of alcohol: facilitator sheet
Teaching objective
The classification question F10 most often turns on is not "does this person drink a lot?" but "has alcohol use produced a specific cluster of features — a strong desire to drink, difficulty controlling it, tolerance, a physiological withdrawal state, neglect of other interests, and continued drinking despite clear harm — occurring together, typically over the past year?" That cluster is dependence syndrome (F10.2). A pattern of drinking that is damaging health but does not yet show that cluster is harmful use (F10.1) — a distinct, lower threshold, not an earlier stage automatically implied by heavy drinking alone.
Choose material
Worked example · Case: More than just heavy drinking? · Case: Shaking hands, familiar pattern — but which substance? · Case: How worried should we be about this withdrawal?
Worked example
Show scenario
A 42-year-old office manager has been drinking six to eight beers most evenings for the past 18 months, up from two or three a year earlier. He has tried to cut down twice this year, both times finding he drank more than intended within a few days. On mornings after heavier drinking he notices his hands shake until he has a drink, which settles it. He has missed two family events recently because he was drinking instead, though he says he still values his family highly. Recent blood tests show mildly raised liver enzymes.
Reveal step 1
Step 1 — Check for tolerance: he now drinks more than double his amount from a year ago to get a similar effect, meeting the tolerance criterion.
Reveal step 2
Step 2 — Check for a withdrawal state: morning shaking relieved specifically by drinking suggests a physiological withdrawal state, a second criterion.
Reveal step 3
Step 3 — Check for difficulty controlling use: two failed attempts to cut down, despite intending to, meets a third criterion.
Reveal step 4
Step 4 — Check for neglect of alternative interests: missing family events he says he still values, in favour of drinking, supports a fourth criterion.
Reveal step 5
Step 5 — Weigh against harmful use alone: the raised liver enzymes show physical harm, but harm alone would only support F10.1 — here it is one part of a broader cluster, not the whole picture.
Reveal step 6
Conclusion — With four criteria present together within the past year (well past the three-criterion threshold), this is best classified as dependence syndrome (F10.2), not harmful use, because the fuller cluster — not just health damage — is demonstrated.
Comparison points
F10 is distinguished from harmful use by whether the fuller dependence cluster (not just health damage) is present, from F13 by cross-tolerance and pharmacological similarity but a separate substance identity, and its withdrawal-with-delirium state (F10.4, delirium tremens) from delirium of other causes (F05, which explicitly excludes alcohol-induced delirium) by the clear temporal link to alcohol reduction or cessation.
Misconception prompt
Treating any harm from substance use as automatic dependence: "It's caused a problem, so it must be dependence."
Ask the class why this reasoning fails before revealing the explanation below.
Reveal why it fails
Harmful use and dependence syndrome are distinct thresholds, not two degrees of the same thing. Harmful use requires demonstrable harm from a pattern of use; dependence syndrome requires three or more of six specific criteria (desire/compulsion, control difficulty, tolerance, withdrawal, neglect of alternatives, continued use despite harm) present together within the past year. A single instance of harm, however real, does not by itself establish the fuller dependence cluster.
Discussion prompts
Prompt 1
Without looking back at the page, name three of the six dependence-syndrome criteria.
Prompt 2
State the one feature that separates harmful use from dependence syndrome.
Prompt 3
Explain in one sentence why frequency or quantity of drinking alone cannot establish dependence.
Summary
A cluster of features — desire, control difficulty, tolerance, withdrawal, neglect of alternatives, continued use despite harm — with three or more present together in the past year, distinguishes dependence syndrome from harmful use (health damage alone) or simple heavy drinking.