Is alcohol a problem in your life or the life of a loved one? Below are some definitions and statistics that may help you answer this important question.

Excerpted from the U.S. Department of Health and Human Services publication, ‘Substance Abuse in Brief’, April 2003, Volume 2, Issue 1:

How Do We Define “Alcohol Problem”?
The term alcohol problem refers to any problem related to alcohol use that may require some type of intervention or treatment…People who drink may, on occasion, consume alcohol at levels that pose a risk for alcohol-related problems. Such risky drinkers typically experience mild or moderate intermittent alcohol problems. More severe chronic problems may be experienced by persons clinically diagnosed with alcohol abuse or alcohol dependence (Institute of Medicine, 1990).

Risky Drinking
A significant proportion of problems related to alcohol use occur in persons who are not alcohol dependent but who engage in risky drinking (Institute of Medicine 1990; National Institute on Alcohol Abuse and Alcoholism 2000). Risky drinking is typically defined as consuming alcohol in a way that may pose a risk of physical or emotional harm to the drinker or others but has not produced effects that would result in a diagnosis of alcohol abuse or dependence problems (Babor and Higgins-Biddle 2000). Risky drinking includes heavy or excessive drinking, such as binge drinking (drinking four or more drinks on a single occasion for females and five or more drinks for males) (National Institute on Alcohol Abuse and Alcoholism 2000).

Alcohol Abuse
A person who frequently engages in risky drinking may have a more severe alcohol problem – alcohol abuse. A recognized medical condition, alcohol abuse is the regular use of alcohol despite recurrent adverse consequences. A diagnosis of alcohol abuse is made when someone exhibits one or more of the following within a 12-month period:

• Recurrent alcohol use resulting in a failure to fulfill obligations at work, school or home
• Recurrent alcohol use in situations in which it is physically hazardous (e.g. driving an automobile when impaired by alcohol use
• Recurrent alcohol-related legal problems
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol use (American Psychiatric Association 1994).

Alcohol abuse, although problematic, usually does not progress to dependence. In fact, a recent study found that 5 years after being diagnosed with alcohol abuse, only 3.5 percent of abusers met the criteria for alcohol dependence (Schuckit et al. 2001).

Alcohol Dependence
The most severe problem is alcohol dependence, also referred to as alcoholism or alcohol addiction. In 2001 an estimated 5.4 million people age 12 and older were dependent on alcohol (Substance Abuse and Mental Health Services Administration 2002). Alcohol dependence is a chronic disease with discrete definable symptoms. An individual has become alcohol dependent when he or she experiences three or more of the following in a 12-month period:

• Tolerance: the need for increasing amounts of alcohol to reach intoxication.
• Withdrawal: the occurrence of physical symptoms when heavy alcohol use is reduced or stopped. Its symptoms may include tremors, sweating, high pulse rate, nausea or vomiting, insomnia, and anxiety. Severe withdrawal may induce transient hallucinations or grand mal seizures.
• Drinking larger amounts or drinking over a longer period than was intended.
• A persistent desire or unsuccessful efforts to cut down or control alcohol use.
• Spending a great deal of time obtaining, using, or recovering from the effects of alcohol use.
• Giving up or reducing social, occupational, or recreational activities because of alcohol use.
• Using despite having knowledge of persistent or recurring physical or psychological problems that were caused or exacerbated by alcohol use (American Psychiatric Association 1994).

Alcohol dependence is a persistent condition. Approximately two-thirds of persons who are alcohol dependent will still be dependent in 5 years (Shuckit et al. 2001).

Factors That May Contribute to Alcohol Dependence
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 (U.S. Department of Health and Human Services 2000). 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. Environmental factors also play a significant role.

Preventing drinking among youth is important ….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 …(Grant and Dawson 1997).

Consequences of Problem Alcohol Use
Problem alcohol use of any degree of severity may disrupt family and social relationships and lead to psychological problems, violence and aggression, and legal problems. Problem alcohol use is also linked to an increased risk of injuries, including those resulting from automobile crashes, falls and fires. Problem drinking may also contribute to unsafe sex practices leading to an increased incidence of HIV/AIDS, hepatitis, and other sexually transmitted diseases. Finally, higher levels of alcohol consumption may be associated with a greater risk of negative health effects, including a weakened immune system, tuberculosis, coronary heart disease, stroke, liver cirrhosis, and cancer (National Institute on Alcohol Abuse and Alcoholism 2000).

The most recent calculation of the overall economic costs of alcohol problems was estimated by the National Institute on Alcohol Abuse and Alcoholism at more than $184 billion in 1998…. More than 70 percent of these costs were attributed to productivity losses ($134.2 billion) caused by impaired workplace and household productivity related to alcohol use, worktime lost by incarcerated offenders and victims of alcohol-related crime, and alcohol-related premature death.

Detection and Treatment of Alcohol Use Problems
Prevention of and early intervention in alcohol problems are important to reduce their consequences and related social and economic costs. 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 lengthy clinician-administered interviews. Screening for co-occurring mental disorders is also essential for planning effective intervention.

Once an alcohol problem has been identified, it should be treated appropriately. A comprehensive and effective assessment should provide a detailed description of the kind of alcohol problem experienced by a particular individual at a specific time (Institute of Medicine 1990).

In general, persons 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 (Babor and Higgins-Biddle 2000; Institute of Medicine 1990).

Brief interventions are insufficient for persons diagnosed with alcohol dependence. These persons may benefit more from intensive treatment approaches, which can include psychological, pharmacological, social, and medical services. The primary goal of all treatment programs should be to eliminate alcohol use as a factor contributing to physical, emotional, and social problems (Institute of Medicine 1990).