Problem Drinking, Alcohol Misuse & Alcohol Dependence
Problems related to alcohol consumption ranging from hazardous drinking, harmful drinking, alcohol misuse, and the most severe form of alcohol dependence. These terms have different definitions although used interchangeably in a non-medical society. Hazardous drinking refers to excessive consumption of alcohol, whereas Harmful drinking refers to levels of hazardous drinking in which damage to health is very likely. Alcohol Misuse refers to drinking that causes mental, physical, or social harm to the individual. Alcohol Dependence is the most severe form of alcohol abuse and is medically diagnosed when the DSM-IV and ICD-10 criteria for alcohol dependence are met. All these terms come under the wide umbrella of the term Problem Drinking.
How much alcohol is too much?
Alcohol has different effects on different individuals. The threshold of alcohol tolerance varies from individual to individual. Regardless, there are a set of guidelines and standards that have been put forward to categorise excessive alcohol intake for medical reasons and the purpose of law enforcement.
In the UK, the government advises men to drink no more than 3-4 units of alcohol per day, and 2-3 units per day for women. 1 unit of alcohol is equal to 10ml of pure alcohol, which is around the amount an adult can process in an hour. It is also recommended that everyone has at least 2 or 3 days off of alcohol a week.
Who are at a Risk of Alcohol Misuse
Excessive alcohol consumption leading to mental, physical, and social harm also known as alcohol misuse is not merely a bad habit that goes out of control. Several factors predispose an individual to the likelihood of alcohol misuse.
• Genetic factors - predisposition to alcohol misuse has been observed in sons of fathers who misuse alcohol, and in monozygotic twins. A mutation in the gene Aldehyde Dehydrogenase (ALDH2) which metabolizes alcohol is associated with a lower risk of developing alcohol misuse.
• Learning factors - religions, cultures, and households that do not encourage alcohol consumption have individuals with alcohol problems.
• Personality factors - alcohol misuse is observed in many people with chronic anxiety, a sense of inferiority, self-indulgent tendencies, and anti-social traits.
• Psychiatric disorders - Those with depressive disorder, panic disorder, and social phobia are at risk of alcohol misuse.
• Alcohol consumption in society - the risk of developing alcohol problems is directly proportional to the amount of alcohol consumption and alcohol problems prevailing in the society.
Alcohol dependence is a chronic disease in which the consumer has an uncontrollable addiction to alcohol. The consumer develops tolerance (requiring greater and greater amounts of alcohol to achieve the same effect and develops withdrawal symptoms upon cessation of alcohol use. This gravely affects the physical, mental, and social health of the person leading to problems at home and in the workplace. The diagnosis for alcohol dependence is done by a medical professional following the ICD and DSM-IV criteria.
• Hypertension, stroke, cancers of the mouth, pharynx, liver, breast, and esophagus.
• Fetal alcoholic syndrome if consumed during pregnancy leading to mental retardation and fetal abnormalities.
• Psychological damage
• Idiosyncratic alcohol intoxication leading to aggression during intoxication, memory blackouts, short term amnesia, and insomnia.
• Personality deterioration, mood and anxiety disorders, suicidal behavior, pathological jealousy, and alcoholic hallucinosis.
• Delirium tremens is a high mortality condition seen in chronic alcoholics who withdraw leading to a rapid chaining picture of disordered mental activity, clouding consciousness, disorientation, severe agitation which lasts for around 3-4 days.
• Social damage
• Family problems, divorce, abandoned children, battered wives, affected children.
• Difficulty in working, problems with coworkers.
• Risk of road accidents, crime.
• Brief intervention - this including education and awareness about alcohol misuse and its consequences.
• Motivational interviewing
• Support and advice
• Withdraw alcohol (controlled drinking)
• High-intensity psychological treatments
• Alcoholics anonymous
• Medication (disulfurum, acamprosate)
1. Harrison, P. Shorter Oxford textbook of psychiatry (6th ed., pp. 444-463)
"ASV exists to provide any person impacted by an addiction affordable access to evidenced based drug and alcohol rehab options across Victoria. Assembling an experienced team dedicated to supporting people who are seeking change the best available opportunity at recovery has been a pleasure". - Jase Bowman - ASV CEO - Rehab Victoria 2020.