Alcohol abuse
Alcohol abuse encompasses a spectrum of alcohol-related substance abuse, ranging from the consumption of more than 2 drinks per day on average for men, or more than 1 drink per day on average for women, to binge drinking or alcohol use disorder.[1]
For chronic alcohol abuse that results in significant health problems, see Alcoholism.Alcohol abuse
Relationship difficulties, legal problems, problems at work or school, insomnia, irritability, chronic fatigue.
Clinical history, DSM-5 criteria
Contingency management, motivational interviewing, Alcoholics Anonymous meeting attendance
Alcohol abuse was a psychiatric diagnosis in the DSM-IV, but it has been merged with alcohol dependence in the DSM-5 into alcohol use disorder.[2][3]
Globally, excessive alcohol consumption is the seventh leading risk factor for both death and the burden of disease and injury,[4] representing 5.1% of the total global burden of disease and injury, measured in disability-adjusted life years (DALYs).[5] After tobacco, alcohol accounts for a higher burden of disease than any other drug. Alcohol use is a major cause of preventable liver disease worldwide, and alcoholic liver disease is the main alcohol-related chronic medical illness.[6] Millions of people of all ages, from adolescents to the elderly, engage in unhealthy drinking.[7] In the United States, excessive alcohol use costs more than $249 billion annually.[8] There are many factors that play a role in causing someone to have an alcohol use disorder: genetic vulnerabilities, neurobiological precursors, psychiatric conditions, trauma, social influence, environmental factors, and even parental drinking habits.[9]
Risky drinking (also called hazardous drinking) is defined by drinking above the recommended limits:
Binge drinking is a pattern of alcohol consumption that brings blood alcohol concentration ≥ 0.08%, usually corresponding to:
In the DSM-IV, alcohol abuse and alcohol dependence were defined as distinct disorders from 1994 to 2013. The DSM-5 combined those two disorders into alcohol use disorder with mild, moderate, and severe sub-classifications of severity. The term "alcoholism" is no longer a diagnosis in medical care.[11]
Alcohol misuse is a term used by United States Preventive Services Task Force to describe a spectrum of drinking behaviors that encompass risky drinking, alcohol abuse, and alcohol dependence (similar meaning to alcohol use disorder but not a term used in DSM).[12]
Cultural influences[edit]
Individualistic cultures such as the United States or Australia are amongst some of the highest consumers of alcohol in the whole world,[4] however this rate of consumption does not necessarily coincide with the rate of abuse as countries like Russia which are highly collectivist see the highest rates of alcohol use disorder. Research suggests that people who score highly on individualism, a trait commonly fostered by the culture, report a lower rate of alcohol abuse and alcohol related disorders so much so that the association was negative, however a higher average consumption of alcohol per week. It is implied that individuals will drink more in a given setting, or on average because they are less receptive towards negative social attitudes surrounding excessive consumption. This however acts on another component, by where individualism protects from maladaptive consumption by lowering the need to drink socially. The final axis by which individualism protects from abusive consumption is that it promotes higher degrees of individualization and achievement values which promote personally suited rewards, this allow the individual to be more cognizant of potential alcohol abuse, and therefore protect from damaging mentalities in those who already identify as drinkers.[66]
Alcohol use disorder also has a variety of biosocial implications, such as the physiologically effects of a detox, how the detox period interacts with ones social life and how these interactions can make overcoming addiction a complex, difficult process. Alcohol use disorder can lead to a number of physical issues and may even create a mental health condition, leading to a double classification for the alcoholic. The stress, the social perceptions of these issues may reinforce abusive drinking habits.
Social stigma[edit]
Several research studies suggest that stigmatization of substance use disorder is partially rooted in the belief that addiction is not a chronic illness but rather a conscious decision indicative of poor self-control or lacking restraint. Necessarily, public and internalized stigma surrounding alcoholism can have widespread effects. In an epidemiological survey of individuals with reported alcohol use disorder, the desire to both initiate and complete treatment were severely impacted by the stigma of substance use disorder. Participants conveyed fears pertaining to social rejection and discrimination, job loss, and potential legal consequences.
Men's issues with alcohol are shockingly common, yet societal norms often downplay the severity of this problem. Prevailing cultural images of men as stoic figures who can handle their alcohol perpetuate the dangerous myth that excessive drinking is a sign of strength. However, the reality is far from this stereotype, as men face unique challenges contributing to their struggles with alcohol, such as societal expectations, workplace pressures, and traditional notions of masculinity that discourage vulnerability.[75]
A major barrier to seeking treatment for those struggling with alcohol abuse is the stigma associated with alcohol abuse itself. Those who struggle with alcohol abuse are less likely to utilize substance (or alcohol) abuse treatment services when they perceived higher stigma with alcohol abuse.[76] Additionally, study participants described the physical act of initiating treatment as substantiation of problematic drinking. Others attempted to avoid treatment and subsequent stigmatization by adjusting drinking behaviors to what they believed to be less maladaptive. Modifications included limiting excessive drinking to non-school or workdays, avoiding alcohol consumption before 5PM, or limiting use to weekends.[76][77] stigmatization of individuals who abuse alcohol has been linked to increased levels of depression, increased levels of anxiety, decreased levels of self-esteem, and poor sleeping habits.[78] While negative thoughts and views around the subject of alcohol abuse can keep those struggling with this issue from seeking the treatment they need, there have been several things that have been found to reduce this stigma. Social support can be an effective tool for counteracting the harmful effects of stigma and shame on those struggling with alcohol abuse.[78] Social support can help push those struggling with alcohol abuse to overcome the negative connotation associated with their struggle and finally seek the treatment that they need.
Prognosis[edit]
Alcohol abuse during adolescence, especially early adolescence (i.e. before age 15), may lead to long-term changes in the brain which leaves them at increased risk of alcoholism in later years; genetic factors also influence age of onset of alcohol abuse and risk of alcoholism.[87] For example, about 40 percent of those who begin drinking alcohol before age 15 develop alcohol dependence in later life, whereas only 10 percent of those who did not begin drinking until 20 years or older developed an alcohol problem in later life.[88] It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.[89]
Alcohol use disorders often cause a wide range of cognitive impairments that result in significant impairment of the affected individual. If alcohol-induced neurotoxicity has occurred a period of abstinence for on average a year is required for the cognitive deficits of alcohol abuse to reverse.[90]
College/university students who are heavy binge drinkers (three or more times in the past two weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times more likely to be diagnosed with alcohol abuse compared to non-heavy episodic drinkers, though the direction of causality remains unclear. Occasional binge drinkers (one or two times in the past two weeks), were found to be four times more likely to be diagnosed with alcohol abuse or dependence compared to non-heavy episodic drinkers.[21]
Epidemiology[edit]
Alcohol abuse is said to be most common in people aged between 15 and 24 years, according to Moreira 2009.[48] However, this particular study of 7275 college students in England collected no comparative data from other age groups or countries.
Causes of alcohol abuse are complex and are likely the combination of many factors, from coping with stress to childhood development. The US Department of Health & Human Services identifies several factors influencing adolescent alcohol use, such as risk-taking, expectancies, sensitivity and tolerance, personality and psychiatric comorbidity, hereditary factors, and environmental aspects.[91]
Studies show that child maltreatment such as neglect, physical, and/or sexual abuse,[92] as well as having parents with alcohol abuse problems,[93] increases the likelihood of that child developing alcohol use disorders later in life. According to Shin, Edwards, Heeren, & Amodeo (2009), underage drinking is more prevalent among teens that experienced multiple types of childhood maltreatment regardless of parental alcohol abuse, putting them at a greater risk for alcohol use disorders.[94] Genetic and environmental factors play a role in the development of alcohol use disorders, depending on age. The influence of genetic risk factors in developing alcohol use disorders increase with age[95] ranging from 28% in adolescence and 58% in adults.[96]