|Classification and external resources|
"The Drunkard’s Progress", 1846
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite its negative consequences. Alcohol abuse is sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse. There are two types of alcoholics: those who have anti social and pleasure-seeking tendencies, and those who are anxiety-ridden- people who are able to go without drinking for long periods of time but are unable to control themselves once they start. Binge drinking is another form of alcohol abuse. Frequent binge drinking or getting severely drunk more than twice is classed as alcohol misuse. According to research done through international surveys, the heaviest drinkers happen to be the United Kingdom's adolescent generation.
When differentiating between alcohol abuse and alcoholism, one should remember that alcohol abuse is when the abuser has faced critical consequences for their actions, recently. Where an alcoholic has experienced a sense of withdrawal in the same time period.
Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. According to Gelder, Mayou & Geddes (2005) alcohol abuse is linked with suicide. They state the risk of suicide is high in older men who have a history of drinking, as well as those suffering from depression. Certain manifestations of alcohol abuse include failure to fulfill responsibilities at work, school, or home; drinking in dangerous situations, including the operation of a motor vehicle; legal concerns associated with alcohol use; and continued drinking despite problems that are caused or worsened by drinking. Alcohol abuse can lead to alcohol dependence. Proposed changes to the DSM-IV to the DSM-5 are expected to combine alcohol abuse with alcohol dependence to create one unified disorder, alcohol use disorder (AUD), that would include graded clinical severity from moderate to severe with at least 2 criteria to make diagnoses. For adolescents, the DSM-5 proposes that diagnoses meeting 2 or 3 criteria would be similar to alcohol abuse while meeting over 4 criteria would be equivalent to alcohol dependence when compared to the DSM-IV.
Alcohol abuse has both short-term and long-term risks. If a person drives while drunk or regularly consuming binge drinks (more than five standard drinks in one drinking session), they are considered to have been involved in alcohol abuse. Short-term abuses of alcohol include, but are not limited to, violence, injuries, unprotected sexual activities and, additionally, social and financial problems.
The older adult population (over 65 years) is frequently overlooked when discussing alcohol abuse. A smaller volume of consumed alcohol has a greater impact on the older adult than it does on a younger individual. As a result the American Geriatrics Society recommends for an older adult with no known risk factors less than one drink a day or fewer than two drinks per occasion regardless of gender, this is less than current recommendations of maximum alcohol consumption per week, for adults noted to be nine drinks for a male and seven for a female.
In the USA, binge drinking is defined as consuming more than five units in men and four units in women. It increases chances for vandalism, fights, violent behaviours, injuries, drunk driving, trouble with police, negative health, social, economic, or legal consequences to occur. Binge drinking is also associated with neurocognitive deficits of frontal lobe processing and impaired working memory as well as delayed auditory and verbal memory deficits.
Binge drinking combined with the stress of returning to work is a contributing factor to Monday deaths from heart attacks. The chances of becoming dependent are increased greatly in men who have 15 or more drinks each week or women who have 12 or more drinks each week. This is known as alcohol dependency.
It is believed that one way to prevent binge drinking is to raise the legal drinking age.
Symptoms and signs
Individuals with an alcohol use disorder will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems; additionally patients do complain of irritability and insomnia. Alcohol abuse is also an important cause of chronic fatigue.
Signs of alcohol abuse are related to alcohol's effects on organ systems. However, while these findings are often present, they are not necessary to make a diagnosis of alcohol abuse. Signs of alcohol abuse shows its drastic effects on the central nervous system acutely include inebriation and poor judgment; chronic anxiety, irritability, and insomnia. Alcohol's effects on the liver include elevated liver function tests (classically AST is at least twice as high as ALT). Prolonged use leads to cirrhosis and failure of the liver. With cirrhosis, patients develop an inability to process hormones and toxins. The skin of a patient with alcoholic cirrhosis can feature cherry angiomas, palmar erythema and — in fulminent liver failure — jaundice and ascities. The derangements of the endocrine system lead to gynecomastia. Inability to process toxins leads to hepatic encephalopathy.
Binge drinking is associated with individuals reporting fair to poor health compared to non-binge drinking individuals and which may progressively worsen over time. Alcohol also causes impairment in a person's critical thinking. Person's ability to reason in stressful situation is compromised, and they seem very inattentive to what is going on around them. Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers. Patients who abuse alcohol are less likely to survive critical illness. Research conducted at Ohio State University Medical Center found that patients who suffer from alcoholism or alcohol withdrawal are at a much higher risk for having sepsis and were more likely to die during hospitalization.
Alcohol abuse causes neuroinflammation and leads to myelin disruptions and white matter loss; the developing adolescent brain is at increased risk of brain damage and other long lasting alterations to the brain. Adolescents with an alcohol use disorder damage the hippocampal, prefrontal cortex, and temporal lobes. Children aged 16 and under who consume alcohol heavily display symptoms of conduct disorder. Its symptoms include troublesome behaviour in school, constantly lying, learning disabilities and social impairments.
Association with violence
Alcohol abuse is significantly associated with suicide and violence. Alcohol is the most significant health concern in Native American communities because of very high rates of alcohol dependence and abuse; up to 80 percent of suicides and 60 percent of violent acts are a result of alcohol abuse in Native American communities.[not in citation given]
The reason of alcohol abuse is complex. It is related to economic and biological origins and is associated with adverse health consequences. Peer pressure influences individuals to abuse alcohol; however most of the influence of peers is due to inaccurate perceptions of the risks of alcohol abuse. According to Gelder, Mayou and Geddes (2005) easy accessibility of alcohol is one of the reasons people engage in alcohol abuse as this substance is easily obtained in shops. Another influencing factor among adolescents and college students are the perceptions of social norms for drinking; people will often drink more to keep up with their peers because they believe that their peers drink more than they actually do or that they expect to drink more given the context (e.g. sporting event, fraternity party, etc.). This perception of norms results in higher alcohol consumption than is normal. Alcohol abuse is also associated with acculturation, because social and cultural factors such as an ethnic group’s norms and attitudes can influence alcohol abuse. The instantaneous effect of drugs releases the neurotransmitter dopamine which acts as reinforcement for the behavior. Laboratory studies of ad-lib consumption of alcohol by alcoholics have often indicated that continued drinking is associated with self-reports of increased anxiety and depression
It is also possible that the person abusing alcohol is doing so because they find the pharmacological effects of the alcohol provides relief from a non-diagnosed psychological problem, such as anxiety or depression. In these patients, the abuse of the alcohol is not a disease in and of itself, but rather a treatment for disease (albeit a poor treatment). Therefore, treating the alcoholism without discovering and properly treating the underlying disorder that caused the alcoholism will necessarily increase the chances of relapse and various other stresses and harms to the patient's life.
The numbing effects of alcohol and narcotics can become a coping strategy for traumatized people who are unable to disassociate. However, the altered or intoxicated state of the abuser prevents the full consciousness necessary for healing.
Preventing or reducing the harm has been called for via increased taxation of alcohol, stricter regulation of alcohol advertising and the provision of brief Interventions. Brief Interventions for alcohol abuse reduce the incidence of unsafe sex, sexual violence, unplanned pregnancy and, likely, STD transmission. Information and education on social norms and the harms associated with alcohol abuse delivered either via the internet or face to face has been found to result in a decrease in harmful drinking behaviours in young people.
According to the European law, individuals who are suffering from alcohol abuse or other related problems cannot be given a license, or if present of a license cannot get it renewed. This is a way to prevent individuals driving under the influence of alcohol.
Withdrawal of alcohol leads to over activity of neural function because the use of alcohol leads to the depression of the central nervous system. This results in hallucinations and seizures (Schreiber, 2001).
An individual's need for alcohol can depend on their family's history status with the use of alcohol. For instance, if it is discovered that their family history with alcohol has a strong correlation, there might be a need for education to be set in place for the prevention of it so that it is less likely to occur in their family again (Powers, 2007).
However, it has been established within 10 studies that those suffering through alcohol abuse tend to have family members who try to provide help. In many of these occasions the family members would try to help the individual change or to help improve the individuals lifestyle.
Treatment and interventions among youth should focus on eliminating or reducing the effects of adverse childhood experiences, like childhood maltreatment, since these are common risk factors contributing to the development of alcohol abuse. Approaches like contingency management and motivational interviewing have shown to be effective means of treating substance abuse in impulsive adolescents by focusing on positive rewards and redirecting them towards healthier goals. Educating youth about what is considered heavy drinking along with helping them focus on their own drinking behaviors has been shown to effectively change their perceptions of drinking and could potentially help them to avoid alcohol abuse. Completely stopping the use of alcohol is the ideal goal of treatment. This is called abstinence. A strong social network and family support are important in achieving this.
Some people who abuse alcohol may be able to simply reduce the amount they drink. This is called drinking in moderation. If this method does not work, the person may need to try to quit drinking completely.
In the clinics when a patient comes in with a history of alcohol abuse the doctor must use the CAGE questionnaire approach to determine if the alcohol use is a problem for the patient.If two or more of the following questions are warranted then alcohol abuse is considered and further treatment options are explored. The CAGE questionnaire consists of four questions; Have you ever felt the need to cut down on drinking, Have you ever felt annoyed by criticism of drinking, Have you ever felt guilty about drinking, and Have you ever taken a drink first thing in the morning as an eye opener.
Alcohol abuse is said to be most common in people aged between 15 and 24 years: however this particular study of 7275 college students in England collected no data about other age groups or other 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. Studies show that child maltreatment such as neglect, physical, and/or sexual abuse, as well as having parents with alcohol abuse problems, 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. 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 ranging from 28% in adolescence and 58% in adults.
Alcohol abuse among pregnant women causes their fetus to develop Fetal Alcohol Syndrome. Fetal alcohol syndrome is the pattern of physical abnormalities and the impairment of mental development which is seen with increasing frequency amongst children with alcoholic mothers. Alcohol exposure in developing fetus can result in slowed development of the fetal brain resulting in severe retardation or death. Surviving infants may suffer severe abnormalities such as abnormal eyes, fissures, lips and incomplete cerebella. Some infants may develop lung disease. Experts suggest that pregnant women take no more than one unit of alcohol per day. However, other organizations advise complete abstinence from alcohol while pregnant. It is even possible that the baby throughout pregnancy will develop heart defects such as ventricular septal defect or atrial septal defect 
The brain goes through dynamic changes (puberty) during adolescence, and alcohol can damage long- and short-term growth processes in teenagers. Alcohol abuse during adolescence greatly increases the risk of developing an alcohol use disorder in adulthood due to changes to neurocircuitry that alcohol abuse causes in the vulnerable developing adolescent brain. Younger ages and the male gender in recent studies have shown to be associated with increased rates of alcohol abuse within the general population. In Australia over one third of underage drinkers, alcohol was supplied by the parents.
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. 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. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.
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 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.
Society and culture
The introduction of alcopops, which are flavoured alcoholic drinks, which have a sweet and pleasant taste, was responsible in Sweden for half of the increase in alcohol abuse in 15-16 year olds in a survey. In the case of girls the alcopops, which disguise the taste of alcohol, were responsible for two thirds of the increase. The introduction of alcopops to Sweden was a result of Sweden joining the European Union and adopting the entire European Union law. Alcohol abuse is highly associated with adolescent suicide. Adolescents who abuse alcohol are 17 times more likely to commit suicide than adolescents who don't drink.
Societal and economic costs
Alcohol abuse is associated with many accidents, fights, driving offenses and unprotected sex. Alcohol is responsible in the world for 1.8 million deaths and results in disability in approximately 58.3 million people. Approximately 40 percent of the 58.3 million people disabled through alcohol abuse are disabled due to alcohol-related neuropsychiatric disorders. In South Africa, where HIV infection is epidemic, alcohol abusers exposed themselves to double the risk of this infection. Additionally, alcohol abuse increases the risk of individuals either being the victim of sexual violence or perpetrating sexual violence.
In the United States, many people are arrested for drinking and driving. Also, people under the influence of alcohol commit a large portion of various violent crimes, including child abuse, homicide and suicide. In addition, people of minority groups are affected by alcohol-related problems disproportionately, with the exception of Asian Americans.
Also, according to studies of present and former alcoholic drinkers in Canada, 20% of them are aware that their drinking has negatively impacted their lives in various vital areas including finances, work and relationships.
Alcohol misuse costs the National Health Service (UK) three billion pounds sterling per year and the cost to employers is 6.4 billion pounds sterling per year. These figures do not include the crime and social problems associated with alcohol misuse. The number of women regularly drinking alcohol has almost caught up with men.
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