Alcohol is the most used intoxicating substance in the United States. Drinking is legal for people age 21 and older, and most who drink do so without incident. However, there is a continuum of risks and problems associated with alcohol consumption.
Risky drinking involves heavy or excessive drinking, including binge drinking. Binge drinking is defined as four or more drinks on a single occasion for females and five or more drinks for males.
Risky drinking also refers to consuming alcohol in situations that involve an increased potential for harm, such as before or while driving, while pregnant, or while taking certain prescription medications (e.g., certain sedatives).
Identifying and addressing risky drinking behavior can help to prevent more severe problems of alcohol abuse and alcohol dependence.
Alcohol abuse is a recognized medical condition that refers to the regular use of alcohol despite recurrent adverse consequences. A diagnosis is made when an individual exhibits one or more of the following signs of alcohol abuse within a 12-month period:
Alcohol dependence, also referred to as alcoholism or alcohol addiction, is a chronic disease with definable symptoms. A diagnosis of alcohol dependence is made when an individual experiences three or more of the following in a 12-month period:
Alcohol withdrawal or the occurrence of physical symptoms when heavy alcohol use is reduced or stopped may include:
Alcohol dependence is influenced by both genetic and environmental factors. Persons with a family history of dependence have a higher chance of lifetime dependence than those without such a history. In addition, researchers have identified genes that influence people's susceptibility to alcohol dependence; however, hereditary influences alone do not predict a future of alcohol dependence and addiction.
Environmental factors also play a significant role. For example, the child of a parent who is dependent on alcohol may be genetically predisposed to alcohol dependence but may effectively thwart it through education, self-monitoring and social support. Conversely, neurochemical changes in the brain caused by repeated abuse of substances such as alcohol can lead to neurological substance dependence, even if the individual has no genetic vulnerability to addiction disorders.
Preventing drinking among youth and teens is important, not only because drinking alcohol is illegal for persons younger than age 21, but also because postponing the onset of alcohol use decreases the likelihood of developing dependence later in life.
About 40 percent of those who start drinking at age 15 or younger develop alcohol dependence at some point; for those who start drinking at age 21 or older, the figure is approximately 10 percent. Several factors may help discourage or at least postpone alcohol use. Parental support, communication and monitoring are significantly related to whether adolescents drink, the amount they drink and the frequency of their drinking. Teenage drinking behavior is also related to their friends' acceptance or rejection of drinking and whether their friends drink.
Problematic alcohol use of any degree or severity may disrupt family and social relationships and lead to psychological problems, violence and aggression and legal problems. Alcohol abuse is also linked to an increased risk of injuries, including those resulting from automobile crashes, falls and fires. Not only does the risk of injury increase with the amount of alcohol consumed, but this risk begins to rise at relatively low levels of consumption. Alcohol abuse may also contribute to unsafe sex practices leading to an increased incidence of HIV/AIDS, hepatitis and other sexually transmitted diseases.
Higher levels of alcohol consumption are associated with a greater risk of negative health effects, including:
Prevention of and early intervention in alcohol problems helps to reduce harmful consequences and related social and economic costs.
Screening—Alcohol screening attempts to identify both risky drinkers and drinkers who are experiencing symptoms of alcohol abuse or dependence. Screening tools range from brief self-administered questionnaires to clinician-administered interviews. Screening for co-occurring mental disorders is also essential for planning an effective intervention.
Assessment—A comprehensive assessment provides a detailed description of the type and level of an individual's alcohol problem. The individual's unique situation characteristics, strengths and weaknesses should be considered in order to develop the most effective solutions. In general, individuals identified as risky drinkers—those experiencing mild or moderate alcohol problems—may benefit most from brief interventions, which usually incorporate counseling and education sessions that provide practical advice and build skills. Typically used by a primary care provider, brief interventions are designed to reduce alcohol use and minimize the risk of developing alcohol-related problems.
Alcohol Addiction Treatment—Brief interventions are insufficient for persons diagnosed with alcohol dependence. These individuals benefit from more intensive addiction treatment, which can include psychological, pharmacological, social and medical services in an inpatient or outpatient basis, depending on the needs of the individual.
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