Alcohol Abuse (305.00)

DSM-IV-TR criteria

A maladaptive pattern of substance 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 substance 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 substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication physical fights)

Or the symptoms have never met the criteria for Substance Dependence for this class of substance.

Associated features

  • Alcohol abuse has a high co-morbidity rate with the abuse of other substances. When substances that are normally abused are not available, alcohol may be used as an alternative. Alcohol abuse can also be associated with other psychological disorders such as conduct disorder and antisocial behavior in adolescents. Alcohol has the psychological effect of inhibition reduction making it seem as if it is a stimulant. Alcohol is in fact a depressant of the central nervous system (CNS). It is estimated that forty percent of all people in the United States will be involved in an accident related to alcohol at some point during their lives and that fifty five percent of all fatal driving accidents are in some way due to alcohol. A diagnosis of Alcohol Abuse can be applied when alcohol is causing problems in the individual’s life activities. Binge drinking is a serious problem and also a form of abuse that occurs in about fifty-percent of college men. The average age that one peaks at consumption and abuse is twenty one. Individuals who qualify for Alcohol Abuse typically consume alcohol in situations that are hazardous to one’s health. The most common of which is driving while intoxicated (DWI) from alcohol and is the number one cause of all automobile accidents in the United States.
  • Alcohol withdrawal occurs when one stops or reduces heavy or prolonged use. Some withdrawal symptoms are autonomic hyperactivity, increased hand tremor, psycho-motor agitation, insomnia, nausea or vomiting, and transient visual, auditory or tactile hallucinations or delusions. Also anxiety and grand Mal seizures may be present.

Child vs. adult presentation

According to recent studies, the prevalence of alcohol abuse among adolescents ranges between four and percent in males. This percentage has been found to increase with age. Children who start to use alcohol at an earlier age (before fifteen) have a higher tendency to abuse alcohol later on. The age at which adults abuse alcohol varies widely. Males tend to present with alcohol abuse at a younger age than females.

Gender and cultural differences in presentation

  • Men are diagnosed with alcohol abuse more often than women. The ratio has been as high as 5:1 with a variance between age groups. Men start drinking at a younger age than women, however, once alcohol use becomes abusive, the disorder progresses faster in females than in males. The rate is highest among men aged 18 to 25, most of which are in college. Throughout different cultures, the amount of alcohol abuse varies widely. There are many possible reasons for this variance; alcohol is more readily available in some cultures than in others and each culture has its own social beliefs and regulations about drinking. What is socially acceptable in one culture is not necessarily the same in others. Cultural attitudes about alcohol consumption are also affected by the religious beliefs of each culture. Alcohol abuse also has different physiological effects on people of different cultures because of the religious beliefs and what is expected when alcohol is consumed, such as hallucinations or delusions as a possibility.
  • Prevalence is high in western countries; Asian cultures have a low prevalence but male to female ratio is high. Caucasian males generally reach a peak, in terms of alcohol use, during early adulthood from ages 18-30. After age 30 alcohol use in this group tends to wane throughout the rest of life. African American males often display drinking patterns completely different from those of Caucasion males. African American males generally have low instances of alcohol abuse during their 20’s, and rising use during their 30’s and 40’s (Homila, 2004).
  • Women are affected differently than men. When consuming alcohol women become more impaired even when taking weight into account. The reason is that alcohol mixes with the water in your body and that dilutes it. Men generally have more water in their bodies than women, so alcohol is diluted more when men drink it versus women. A binge drinker is classified as a person that consumes 5 or more drinks in a one week period more than once a week in men, and only 4 or so for women in the same classification.

Epidemiology

It is estimated that between sixty-six and ninety percent of all adults have at some time in their lives consumed alcohol. Although alcohol abuse is not as severe as alcohol dependence, it is more common and can be seen a precursor to dependence. Alcohol is the second most used psychoactive substance, next to caffeine. Lifetime prevalence is 13.3% to 15% in the general population. The highest prevalence is in ages 26-34 with 77% prevalence. Alcohol abuse and dependence are co-morbid with Axis I and II, mood disorders, anxiety, Schizophrenia and Anti-Social Personality disorder. Depression may result from effects of intoxication or withdrawal. Concurrent and sequential treatments are questionable for other problems.

Etiology

Individuals who have a positive attitude about alcohol consumption tend to be more likely to abuse alcohol. There are many different types of and reasons for alcohol abuse. These reasons range from psychosocial to physiological and cultural. One type of alcohol abuse is getting drunk or binge drinking (which has a high prevalence in college men) at social events. Alcohol abuse can also be attributed to other substance abuse disorders and psychological disorders. Alcohol abuse can be used to deal with physiological problems or pain. There is also a possible genetic factor involved in alcohol abuse and dependence.

Empirically supported treatments

The first and most important step in treatment of alcohol abuse is to make the individual realize and admit that he abuses alcohol. The most effective way to prevent alcohol abuse is abstaining from its use. Clinical therapy can also be used to help the person learn to control the amount of alcohol consumption. Prescription medications can also be used to reduce the desire to consume alcohol. Alcoholics Anonymous is a self-help group that has been around for over seventy years. This program is structured around alcohol dependence but can be used by alcohol abusers that realize they may be on the road to dependence. Its method is called the “Twelve Step Program.”┬áMembers introduce themselves anonymously and progress through the twelve steps. Some studies show a greater recovery in those individuals who participate in non-emotion centered therapy. Other individuals involved in therapy centered on depression or other emotional problems have a tendancy to show lower recovery rates (Raitasalo, 2005).

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