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Alcohol Abuse and Dependence
In U.S. general population surveys, approximately 70% of men and 60% of women report drinking on at least one occasion during the previous year. The majority of drinkers consume light to moderate amounts of alcohol (typically defined as no more than one drink per day for a woman and two drinks per day for a man) and experience few, if any, negative health effects of drinking alcohol. Those negative effects that do occur, such as cognitive impairment and decreased motor skills/coordination, tend to be short term, usually resolving themselves as soon as alcohol is metabolized and removed from the body. Recent research suggests that moderate drinkers may even experience long-term cardiovascular benefits of alcohol.
Among those who have ever consumed alcohol (approximately 92% of the adult population), prevalence surveys suggest that up to 14% eventually develop alcohol dependence. At the higher levels of use that characterize alcohol abuse and dependence, alcohol consumption is related to negative health effects as well as increases in other high-risk behaviors such as smoking and violence. At these higher levels of intake, alcohol can have significant negative effects on health, either directly through the pharmacological and toxic effects of ingesting excessive amounts of ethanol or indirectly through their interaction with other problem and high-risk behaviors.
What is Alcohol Abuse?
Alcohol abuse involves alcohol intake that causes problems and is maladaptive. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association, alcohol abuse is said to occur when the individual experiences impairment or distress related to any one of the following symptoms within a 12-month period: excessive drinking that leads to repeated failures to fulfill responsibilities at work, school, or home; physically hazardous drinking (e.g., while driving); repeated legal problems; and continuing to drink despite alcohol-related social or interpersonal problems.
What is Alcohol Dependence?
The DSM-IV describes alcohol dependence as involving maladaptively high alcohol intake that produces impairment or distress. Persons diagnosed as alcohol dependent experience at least three of the following symptoms within a 12-month period: tolerance (e.g., the need to increase alcohol intake to achieve the desired effects); withdrawal symptoms (e.g., shakiness, seizures) when alcohol is not available; impairment in the ability to control alcohol intake (e.g., desire for alcohol and lack of success cutting down on alcohol intake); neglect of important activities such as work; large amounts of time spent on alcohol-related activities; and continuing to drink even though experiencing recurring alcohol-related physical and psychological problems.
Although the diagnostic criteria portray alcohol abuse and dependence as categorical phenomena, it is possible to view alcohol consumption and alcohol problems as involving a continuum from no use or problems to heavy drinking and severe problems. Along this continuum there is much heterogeneity in patterns of use and the nature and extent of alcohol problems. Moreover, patterns of use can change over time. Some individuals report a linear progression from social drinking to alcohol abuse followed by dependence. Others exhibit stable patterns of either problematic or nonproblematic alcohol use over time, or move back and forth among patterns (e.g., alternating between long periods of heavy and light drinking patterns).
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