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Aetiology of alcohol problems 

Aetiology of alcohol problems
Chapter:
Aetiology of alcohol problems
Author(s):

Juan C. Negrete

and Kathryn J. Gill

DOI:
10.1093/med/9780199696758.003.0056
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date: 25 August 2019

Approximately 8 out of every 10 persons living in Europe and the Americas would report consuming alcoholic beverages in their lifetime, and the norm is for drinking to start in adolescence: in 2003 the average age of first drink in the United States was 14 years old. Also in the year 2003, 79.3 per cent of persons aged 15 years or more in Canada reported to be current users of alcohol, and 22.6 per cent admitted to having exceeded the country's safe drinking guidelines (i.e. no more than 14 units/week for males and 12 units/week for females). The same survey elicited a rate of ‘hazardous drinkers’ of 13.6 per cent, defined as all respondents who scored 8+ on the AUDIT screening questionnaire.Epidemiological data in the United States indicates that roughly one in seven persons who start drinking will develop an alcohol dependence disorder in the course of their lives. The figure is higher among men when compared to women. Of course it is also higher if other clinical forms of alcohol misuse (i.e. alcohol abuse/harmful drinking) are included in the rates in addition to dependence. A moderate level of alcohol use appears to be relatively harmless; and there exist public health guidelines on ‘safe’ drinking practices. The recommendations vary considerably from country to country, but they all assume a greater vulnerability to alcohol effects in the female gender. In the United Kingdom, for instance, hazardous drinking is thought to start at 21 units/week for men and 16 units/week for women; and in the United States the equivalent guidelines are 14 and 7 drinks per week. It is among alcohol users who exceed such guidelines that the prevalence of dependence is the highest; up to 40 per cent of the more frequent violators. The expression ‘alcohol problems’ encompasses a wide range of untoward occurrences, from maladaptive, impaired, or harmful behaviour, to health complications and the condition of alcohol dependence. Alcohol problems are not incurred just by chronic excessive drinkers, but also by persons who drink heavily on isolated occasions (e.g. accidents, violence, poisoning, etc.). Given their high frequency and social costs, these consequences of acute inebriation represent the most significant public health burden of drinking. This section focuses rather on the causes of problems of a clinical nature, the ones presented by individuals who engage in patterns of repeated excessive drinking, i.e. ‘alcohol dependence’ and ‘alcohol abuse’ (DSM-IV nomenclature) or ‘harmful drinking’ (ICD-10 nomenclature).

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