Statement of Principles
concerning
 
ALCOHOL DEPENDENCE AND ALCOHOL ABUSE
No. 2 of 2009
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
           
Title
1.                  This Instrument may be cited as Statement of Principles concerning alcohol dependence and alcohol abuse No. 2 of 2009.
 
Determination
2.                  The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 18 of 2008 concerning alcohol dependence and alcohol abuse; and
(b)       determines in its place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about alcohol dependence and alcohol abuse and death from alcohol dependence and alcohol abuse.
(b)       For the purposes of this Statement of Principles:
 
"alcohol dependence " means a psychiatric condition that meets the following diagnostic criteria (derived from DSM-IV-TR):
A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
(1)       Tolerance, as defined by either of the following: 
(a)       a need for markedly increased amounts of the alcohol to achieve intoxication or desired effect; or
(b)       markedly diminished effect with continued use of the same amount of the alcohol.
(2)       Withdrawal, as manifested by either of the following:
(a)       the characteristic withdrawal syndrome for the alcohol; or
(b)       the same (or a closely related) alcohol is taken to relieve or avoid withdrawal symptoms.
 (3)      The alcohol is often taken in larger amounts or over a longer period than was intended.
(4)       There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
(5)       A great deal of time is spent in activities necessary to obtain the alcohol, use the alcohol or recover from its effects.
(6)       Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
(7)       The alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
 
"alcohol abuse" means a psychiatric condition that meets the following diagnostic criteria (derived from DSM-IV-TR):
A.         A maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
(1)       Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household).
(2)       Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use).
(3)       Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
(4)       Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication, physical fights).
B.         The symptoms have never met the criteria for alcohol dependence.
 
The definitions for alcohol dependence and alcohol abuse exclude acute alcohol intoxication in the absence of alcohol dependence or alcohol abuse.
Basis for determining the factors
4.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that alcohol dependence or alcohol abuse and death from alcohol dependence or alcohol abuse can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
 
Factors that must be related to service
5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
 
Factors
6.         The factor that must exist before it can be said that, on the balance of probabilities, alcohol dependence or alcohol abuse or death from alcohol dependence or alcohol abuse is connected with the circumstances of a person’s relevant service is:
 
(a)               having a clinically significant psychiatric condition at the time of the clinical onset of alcohol dependence or alcohol abuse; or
 
(b)              experiencing a category 1A stressor within the two years before the clinical onset of alcohol dependence or alcohol abuse; or
 
(c)              experiencing a category 1B stressor within the two years before the clinical onset of alcohol dependence or alcohol abuse; or
 
(d)              experiencing the death of a significant other within the five years before the clinical onset of alcohol dependence or alcohol abuse; or
 
(e)              being the recipient of severe childhood abuse within the ten years before the clinical onset of alcohol dependence or alcohol abuse; or
 
(f)               having a clinically significant psychiatric condition at the time of the clinical worsening of alcohol dependence or alcohol abuse; or
 
(g)              experiencing a category 1A stressor within the two years before the clinical worsening of alcohol dependence or alcohol abuse; or
 
(h)              experiencing a category 1B stressor within the two years before the clinical worsening of alcohol dependence or alcohol abuse; or
 
(i)                experiencing the death of a significant other within the five years before the clinical worsening of alcohol dependence or alcohol abuse; or
 
(j)                being the recipient of severe childhood abuse within the ten years before the clinical worsening of alcohol dependence or alcohol abuse; or
 
(k)              inability to obtain appropriate clinical management for alcohol dependence or alcohol abuse.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(f) to 6(k) apply only to material contribution to, or aggravation of, alcohol dependence or alcohol abuse where the person’s alcohol dependence or alcohol abuse was suffered or contracted before or during (but not arising out of) the person’s relevant service.
 
Inclusion of Statements of Principles
8.                  In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
 
Other definitions
9.                  For the purposes of this Statement of Principles:
 
"a clinically significant psychiatric condition" means any Axis 1 or Axis II disorder of mental health that attracts a diagnosis under DSM-IV-TR which is sufficient to warrant ongoing management, excluding alcohol-related disorders. The ongoing management may involve regular visits (for example, at least monthly), to a psychiatrist, clinical psychologist or general practitioner;
 
"a category 1A stressor" means one or more of the following severe traumatic events:
(a)              experiencing a life-threatening event;
(b)              being subject to a serious physical attack or assault including rape and sexual molestation; or
(c)              being threatened with a weapon, being held captive, being kidnapped, or being tortured;
 
"a category 1B stressor" means one of the following severe traumatic events:
(a)               being an eyewitness to a person being killed or critically injured;
(b)              viewing corpses or critically injured casualties as an eyewitness;
(c)              being an eyewitness to atrocities inflicted on another person or persons;
(d)              killing or maiming a person; or
(e)              being an eyewitness to or participating in, the clearance of critically injured casualties;
 
"a significant other" means a person who has a close family bond or a close personal relationship and is important or influential in one’s life;
 
"an eyewitness" means a person who observes an incident first hand and can give direct evidence of it.  This excludes a person exposed only to media coverage of the incident;
 
"death from alcohol dependence or alcohol abuse" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s alcohol dependence or alcohol abuse;
 
"DSM-IV-TR" means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.  Washington, DC, American Psychiatric Association, 2000;
 
"relevant service" means:
(a)       eligible war service (other than operational service) under the VEA;
(b)       defence service (other than hazardous service) under the VEA; or
(c)       peacetime service under the MRCA;
 
"severe childhood abuse" means:
(a)              serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or
(b)              neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;
where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child;
 
"terminal event" means the proximate or ultimate cause of death and includes:
(a)     pneumonia;
(b)     respiratory failure;
(c)     cardiac arrest;
(d)     circulatory failure; or
(e)          cessation of brain function.
 
Application
10.       This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
 
Date of effect
11.       This Instrument takes effect from 14 January 2009.
 
Dated this  nineteenth  day of   December         2008
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON