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==Symptoms and signs==
==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]].{{fact}} Alcohol abuse is also an important cause of [[chronic fatigue]].<ref name="Avellaneda Fernández-2009">{{Cite journal | last1 = Avellaneda Fernández | first1 = A. | last2 = Pérez Martín | first2 = A. | last3 = Izquierdo Martínez | first3 = M. | last4 = Arruti Bustillo | first4 = M. | last5 = Barbado Hernández | first5 = FJ. | last6 = de la Cruz Labrado | first6 = J. | last7 = Díaz-Delgado Peñas | first7 = R. | last8 = Gutiérrez Rivas | first8 = E. | last9 = Palacín Delgado | first9 = C. | title = Chronic fatigue syndrome: aetiology, diagnosis and treatment. | journal = BMC Psychiatry | volume = 9 Suppl 1 | issue = | pages = S1 | month = | year = 2009 | doi = 10.1186/1471-244X-9-S1-S1 | PMID = 19857242 }}</ref>
Symptoms are the defining characteristics of alcohol abuse and are reviewed above in Definitions. Patient will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems. Additionally patients do complain of irritability and [[insomnia]].


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's 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.
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's 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.<ref name="Courtney-2009"/> [[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.<ref name="pmid18412750">{{cite journal |author=Uekermann J, Daum I |title=Social cognition in alcoholism: a link to prefrontal cortex dysfunction? |journal=Addiction |volume=103 |issue=5 |pages=726–35 |year=2008 |month=May |pmid=18412750 |doi=10.1111/j.1360-0443.2008.02157.x |url=}}</ref>
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.<ref name="Courtney-2009"/> [[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.<ref name="pmid18412750">{{cite journal |author=Uekermann J, Daum I |title=Social cognition in alcoholism: a link to prefrontal cortex dysfunction? |journal=Addiction |volume=103 |issue=5 |pages=726–35 |year=2008 |month=May |pmid=18412750 |doi=10.1111/j.1360-0443.2008.02157.x |url=}}</ref>
Patients who abuse alcohol are less likely to survive critical illness and or death. Research conducted at Ohio State University Medical Center found that patients who suffer from alcoholism or alcohol withdrawal are are at a much higher risk for having ''sepsis'' and were more likely to die during hospitalization. <ref> http://bf4dv7zn3u.search.serialssolutions.com.myaccess.library.utoronto.ca/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ALCOHOL+ABUSE&rft.jtitle=Juvenile+Justice+Digest&rft.au=Anonymous&rft.date=2007-01-31&rft.issn=0094-2413&rft.volume=35&rft.issue=2&rft.spage=7&rft.externalDBID=JJDG&rft.externalDocID=1222013741 </ref>
Patients who abuse alcohol are less likely to survive critical illness and or death. Research conducted at Ohio State University Medical Center found that patients who suffer from alcoholism or alcohol withdrawal are are at a much higher risk for having ''sepsis'' and were more likely to die during hospitalization.<ref> http://bf4dv7zn3u.search.serialssolutions.com.myaccess.library.utoronto.ca/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ALCOHOL+ABUSE&rft.jtitle=Juvenile+Justice+Digest&rft.au=Anonymous&rft.date=2007-01-31&rft.issn=0094-2413&rft.volume=35&rft.issue=2&rft.spage=7&rft.externalDBID=JJDG&rft.externalDocID=1222013741 </ref>


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.<ref name="Alfonso-Loeches-">{{Cite journal | last1 = Alfonso-Loeches | first1 = S. | last2 = Guerri | first2 = C. | title = Molecular and behavioral aspects of the actions of alcohol on the adult and developing brain. | journal = Crit Rev Clin Lab Sci | volume = 48 | issue = 1 | pages = 19-47 | month = | year = | doi = 10.3109/10408363.2011.580567 | PMID = 21657944 }}</ref> Adolescents with an alcohol use disorder damage the [[hippocampal]], [[prefrontal cortex]] as well as the [[temporal lobe]]s.<ref name="Nixon-2010"/> 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.<ref>{{cite journal|last=McArdle|first=Paul|title=Alcohol abuse in adolescents|journal=Archives of Disease in Childhood|date=27|year=2008|month=February|volume=93|issue=6|pages=524–527|url=http://adc.bmj.com.myaccess.library.utoronto.ca/content/93/6/524|accessdate=27 November 2011}}</ref>
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.<ref name="Alfonso-Loeches-">{{Cite journal | last1 = Alfonso-Loeches | first1 = S. | last2 = Guerri | first2 = C. | title = Molecular and behavioral aspects of the actions of alcohol on the adult and developing brain. | journal = Crit Rev Clin Lab Sci | volume = 48 | issue = 1 | pages = 19-47 | month = | year = | doi = 10.3109/10408363.2011.580567 | PMID = 21657944 }}</ref> Adolescents with an alcohol use disorder damage the [[hippocampal]], [[prefrontal cortex]] as well as the [[temporal lobe]]s.<ref name="Nixon-2010"/> 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.<ref>{{cite journal|last=McArdle|first=Paul|title=Alcohol abuse in adolescents|journal=Archives of Disease in Childhood|date=27|year=2008|month=February|volume=93|issue=6|pages=524–527|url=http://adc.bmj.com.myaccess.library.utoronto.ca/content/93/6/524|accessdate=27 November 2011}}</ref>

Revision as of 06:57, 20 September 2012

Alcohol abuse
SpecialtyPsychiatry Edit this on Wikidata

Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences.[1] 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.[2] Binge drinking is another form of alcohol abuse. Frequent binge drinking or getting severely drunk more than twice is classed as alcohol misuse.[3] According to research done through international surveys, the heaviest drinkers happen to be the United Kingdom's adolescent generation.[4]

Definitions

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, also if a person is suffering from depression. Certain manifestations of alcohol abuse include failure to fulfill responsibilities at work, school or home; drinking in dangerous situations, such as while driving; legal problems associated with alcohol use; and continued drinking despite problems that are caused or worsened by drinking. Alcohol abuse can lead to alcohol dependence.[5] Proposed changes to the DSM-IV to the DSM-V 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.[6] For adolescents, the DSM-V 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.[3]

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,[7][8][9] this is less than current recommendations of alcohol consumption per week, for adults noted to be nine drinks for a male and seven for a female[10].

Binge drinking

Main article: Binge drinking

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.[11] 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.[11]

Binge drinking combined with the stress of returning to work is a contributing factor to Monday deaths from heart attacks.[12]

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.[citation needed] Alcohol abuse is also an important cause of chronic fatigue.[13]

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's 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.[11] 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.[14] Patients who abuse alcohol are less likely to survive critical illness and or death. Research conducted at Ohio State University Medical Center found that patients who suffer from alcoholism or alcohol withdrawal are are at a much higher risk for having sepsis and were more likely to die during hospitalization.[15]

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.[16] Adolescents with an alcohol use disorder damage the hippocampal, prefrontal cortex as well as the temporal lobes.[17] 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.[18]

Causes

The reason of Alcohol abuse is complex. It is related to economic and biological origins and is associated with adverse health consequences.[19] 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.[20] 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.).[21] 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.[22] The instantaneous effect of drugs releases the neurotransmitter dopamine which acts as reinforcement for the behavior.[2] 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 [23]

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.[17]

Prevention

The United States Navy provides informative, in-depth training on alcohol and drug abuse prevention to soldiers and supervisors.

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.[24] 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.[20]

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).[25]

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).[26]

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. [27]

Epidemiology

Alcohol abuse is said to be most common in people aged between 15 and 24 years:[20] 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.[28] Studies show that child maltreatment such as neglect, physical, and/or sexual abuse,[29] as well as having parents with alcohol abuse problems,[30] 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.[31] 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[32] ranging from 28% in adolescence and 58% in adults.[33]

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.[20] 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.[24]

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.[34]

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.[35]

Pregnancy

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.[36] 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.[37] It is even possible that the baby throughout pregnancy will develop heart defects such as ventricular septal defect or atrial septal defect [38]

Prognosis

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.[39] 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.[40] It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.[41]

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.[11]

Alcopops

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.[42] 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.[43]

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.[44] However, abuse of alcohol can have a variety of effects and because it's categorized as a depressant can create an individual angry. This is not to say that every angry individual will resort to violence.

The overuse of alcohol has led to 16% of intoxicated people that have abused children. Abusing children can also come in the form of verbal abuse while under the influence, as well as physical abuse. Alcohol can impair one's judgment and make emotions more easily emphasized, such as anger towards a minor topic, which can cause them[who?] to become extremely dangerous.

Treatment and interventions

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.[29] 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.[45] 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.[46] 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.

Completely stopping and avoiding alcohol is difficult for many people with alcoholism. There will be times when it is difficult. You should aim to avoid drinking for as long as possible.

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, you should try to quit drinking completely.

See also

References

  1. ^ National Institute on Alcohol Abuse and Alcoholism. "Diagnostic Criteria for Alcohol Abuse and Dependence" Alcohol Alert, No. 30 PH 359, October 1995.
  2. ^ a b Neil R.Carlson, C.Donald Heth. "Psychology: The Science of Behaviour". Pearson Canada Inc,2010, p.572.
  3. ^ a b Michaud, PA. (2007). "[Alcohol misuse in adolescents - a challenge for general practitioners]". Ther Umsch. 64 (2): 121–6. doi:10.1024/0040-5930.64.2.121. PMID 17245680. {{cite journal}}: Unknown parameter |month= ignored (help)
  4. ^ McArdle, Paul (27). "Alcohol abuse in adolescents". BMJ. 93 (6). {{cite journal}}: |access-date= requires |url= (help); Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |month= ignored (help)
  5. ^ Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
  6. ^ "Proposed Revision - APA DSM-V". American Psychological Association. Retrieved 19 February 2012.
  7. ^ Dufour, M. C, Archer, L., & Gordis, E. (1992). Alcohol and the elderly. Clinics in Geriatric Medicine, 8(1), 127-141.
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  9. ^ Wilson, S. R., Fink, A., Verghese, S., Beck, J. C., Nguyen, K., & Lavori, P. (2007). Adding an alcohol-related risk score to an existing categorical risk classification for older adults: Sensitivity to group differences. Journal of the American Geriatric Society, 55, 445-450.
  10. ^ Wallace, C., Black, D.J., & Fothergill, A. (2010). Integrated assessment of older adults who misuse alcohol. Nursing Standard, 24(33), 51-58.
  11. ^ a b c d Courtney, Kelly E; Polich, John (2009). "Binge drinking in young adults: Data, definitions, and determinants". Psychological Bulletin. 135 (1): 142–56. doi:10.1037/a0014414. PMC 2748736. PMID 19210057. {{cite journal}}: Unknown parameter |month= ignored (help)
  12. ^ Phil Barker (7 October 2003). Psychiatric and mental health nursing: the craft of caring. London: Arnold. ISBN 978-0-340-81026-2. Retrieved 17 December 2010.
  13. ^ Avellaneda Fernández, A.; Pérez Martín, A.; Izquierdo Martínez, M.; Arruti Bustillo, M.; Barbado Hernández, FJ.; de la Cruz Labrado, J.; Díaz-Delgado Peñas, R.; Gutiérrez Rivas, E.; Palacín Delgado, C. (2009). "Chronic fatigue syndrome: aetiology, diagnosis and treatment". BMC Psychiatry. 9 Suppl 1: S1. doi:10.1186/1471-244X-9-S1-S1. PMID 19857242. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: unflagged free DOI (link)
  14. ^ Uekermann J, Daum I (2008). "Social cognition in alcoholism: a link to prefrontal cortex dysfunction?". Addiction. 103 (5): 726–35. doi:10.1111/j.1360-0443.2008.02157.x. PMID 18412750. {{cite journal}}: Unknown parameter |month= ignored (help)
  15. ^ http://bf4dv7zn3u.search.serialssolutions.com.myaccess.library.utoronto.ca/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ALCOHOL+ABUSE&rft.jtitle=Juvenile+Justice+Digest&rft.au=Anonymous&rft.date=2007-01-31&rft.issn=0094-2413&rft.volume=35&rft.issue=2&rft.spage=7&rft.externalDBID=JJDG&rft.externalDocID=1222013741
  16. ^ Alfonso-Loeches, S.; Guerri, C. "Molecular and behavioral aspects of the actions of alcohol on the adult and developing brain". Crit Rev Clin Lab Sci. 48 (1): 19–47. doi:10.3109/10408363.2011.580567. PMID 21657944. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
  17. ^ a b Nixon, K.; McClain, JA. (2010). "Adolescence as a critical window for developing an alcohol use disorder: current findings in neuroscience". Curr Opin Psychiatry. 23 (3): 227–32. doi:10.1097/YCO.0b013e32833864fe. PMID 20224404. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ^ McArdle, Paul (27). "Alcohol abuse in adolescents". Archives of Disease in Childhood. 93 (6): 524–527. Retrieved 27 November 2011. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |month= ignored (help)
  19. ^ McArdle, Paul (27). "Alcohol abuse in adolescents". Retrieved 21 August 2012. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Cite journal requires |journal= (help); Unknown parameter |month= ignored (help)
  20. ^ a b c d Moreira, MT.; Smith, LA.; Foxcroft, D.; Moreira, Maria Teresa (2009). "Social norms interventions to reduce alcohol misuse in university or college students". Cochrane Database Syst Rev (3): CD006748. doi:10.1002/14651858.CD006748.pub2. PMID 19588402. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
  21. ^ Lewis, Melissa (2011). "They drink how much and where? Normative perceptions by drinking contexts and their association to college students' alcohol consumption". Journal of Studies on Alcohol and Drugs. 72 (5): 844–853. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  22. ^ Alcohol Abuse and Ethnicity. AAOHN Journal. Volume 53(4), April 2005, p 152–155
  23. ^ David B. Abrams and G. Terence Wilson (1979) Effects of Alcohol on Social Anxiety in Women:Cognitive Versus Physiological Processes. Journal of Abnormal Psychology. Vol. 88 No. 2 Pg 161-173
  24. ^ a b Chersich, MF.; Rees, HV. (2010). "Causal links between binge drinking patterns, unsafe sex and HIV in South Africa: its time to intervene". Int J STD AIDS. 21 (1): 2–7. doi:10.1258/ijsa.2000.009432. PMID 20029060. {{cite journal}}: Unknown parameter |month= ignored (help)
  25. ^ Schreiber, Andrea. "Alcoholism." AORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 92.2 (2001): 127. Print.
  26. ^ Powers A, Rebecca (2007). "Alcohol and Drug Abuse Prevention". A Journal of Continuing Psychiatric Education- Psychiatric Annals. 37 (5): 349–358. {{cite journal}}: Italic or bold markup not allowed in: |journal= (help)
  27. ^ http://journals2.scholarsportal.info.myaccess.library.utoronto.ca/tmp/13482721438326488881.pdf
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External links

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