Alcohol abuse

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Alcohol abuse encompasses a spectrum of alcohol-related substance abuse, ranging from the consumption of more than 2 drinks per day on average for men, or more than 1 drink per day on average for women, to binge drinking or alcohol use disorder.^[1]

Alcohol abuse was a psychiatric diagnosis in the

Globally, excessive alcohol consumption is the seventh leading risk factor for both death and the burden of disease and injury,^[4] representing 5.1% of the total global burden of disease and injury, measured in disability-adjusted life years (DALYs).^[5] After tobacco, alcohol accounts for a higher burden of disease than any other drug. Alcohol use is a major cause of preventable liver disease worldwide, and alcoholic liver disease is the main alcohol-related chronic medical illness.^[6] Millions of people of all ages, from adolescents to the elderly, engage in unhealthy drinking.^[7] In the United States, excessive alcohol use costs more than $249 billion annually.^[8] There are many factors that play a role in causing someone to have an alcohol use disorder: genetic vulnerabilities, neurobiological precursors, psychiatric conditions, trauma, social influence, environmental factors, and even parental drinking habits.^[9]

Definitions

Risky drinking (also called hazardous drinking) is defined by drinking above the recommended limits:

• greater than 14 standard drinks units per week or greater than 4 standard drinks on a single occasion in men^[10]
• greater than 7 standard drinks units per week or greater than 3 standard drinks on a single occasion in women^[10]
• any drinking in pregnant women or persons < 21 years old^[10]

Binge drinking is a pattern of alcohol consumption that brings blood alcohol concentration ≥ 0.08%, usually corresponding to:

• ≥ 5 standard drinks on a single occasion in men^[10]
• ≥ 4 standard drinks on a single occasion in women^[10]

In the

Alcohol misuse is a term used by United States Preventive Services Task Force to describe a spectrum of drinking behaviors that encompass risky drinking, alcohol abuse, and alcohol dependence (similar meaning to alcohol use disorder but not a term used in DSM).^[12]

Signs and symptoms

Individuals with an alcohol use disorder will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems. Additionally, people may complain of irritability and

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.[24]^{[25][26][27][28][19][29][30][31][excessive citations]}

Violence

Alcohol use disorder has a significant association with suicide and violence. Though many people with Alcohol use disorder may take alcohol to ease their mental suffering, and increased intake of alcohol may serve to further exacerbate psychological issues. This could lead to an increase in suicidal behavior. ^[32] Alcohol has been implicated in up to 80 percent of suicides and 60 percent of violent acts in Native American communities.^{[33][failed verification]}

Pregnancy

Alcohol consumption during pregnancy can pose significant risk facts, as it can harm the developing fetus. The umbilical cord is a direct pathway for the mother's blood alcohol to reach the infant, which can result in miscarriage, and a number of lasting physical and cognitive impairments that can persist throughout the child's life.

Among pregnant women, alcohol use disorder can result in a condition called

Adolescence and the onset of puberty invoke significant physical, social, emotional, and cognitive changes. Increases in risk-taking, impulsivity, reward sensitivity, and social behavior lead to the emergence of alcohol use.^[40][41] New research is shedding light on pre-existing neurobiological markers that are predictive for the initiation of drug and alcohol abuse in adolescents.^[42] Alcohol use in adolescence is consistently associated with loss of grey matter volume, aberrant white matter development, and poor white matter integrity. A dose-dependent relationship among adolescent alcohol users is also consistently found for declines in various areas of cognition including executive function, visuospatial learning, impulsivity, working memory, attention, and language abilities. In the US, about 38% of adolescents aged 15–19 drink with 19% being classified as binge drinkers.^[40] Adolescents who drink are more likely to display symptoms of conduct disorder including disruptive behavior in school, violating social norms or the rights of others, aggression, learning disabilities, and other social impairments.^[43]

The causes of alcohol abuse are complex and multi-faceted. Alcohol abuse is related to economic and biological origins and is associated with adverse health consequences.[43] 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.^[46] Easy accessibility, social influence, and positive and negative reinforcement contribute to continued use. 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, as they believe their peers drink more than they actually do. They might also expect to drink more given the context (e.g. sporting event, house party, etc.).^[47][48] 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.^[49]

Mental illness

Alcohol consumption is often used as a temporary reprieve from states of severe anxiety, stress, or depression. Among individuals with mood disorders and anxiety disorders, the prevalence of a comorbid alcohol use disorder was significant. One study suggests that the median lifetime prevalence of alcohol use disorder in individuals with major depressive disorder was 30% across 35 US epidemiological studies. Despite this evidence, debate exists among how the relationship exists between alcohol use disorder and mood and anxiety disorders. That is, the role of alcohol use disorder as casual in depression and anxiety and alcohol use disorder as resultant have been established within the literature.^[50]

The numbing effects afforded by alcohol and other substances can serve as a coping strategy for traumatized people otherwise are unable to dissociate themselves from trauma. However, the altered or intoxicated state of the abused person prevents the full consciousness necessary for healing.^[51] Often both the alcohol misuse and psychological problems need to be treated at the same time.^{[citation needed]}

Puberty

Gender differences may affect drinking patterns and the risk for developing alcohol use disorders.^[52] Sensation-seeking behaviors have been previously shown to be associated with advanced pubertal maturation, as well as the company of deviant peers.^[41] Early pubertal maturation, as indicated by advanced morphological and hormonal development, has been linked to increased alcohol usage in both male and female individuals.^[53] Additionally, when controlling for age, this association between advanced development and alcohol use still held true.^[54]

Until recently, the underlying mechanisms mediating the link between pubertal maturation and increased alcohol use in adolescence was poorly understood. Now research has suggested that sex steroid hormone levels may play a role in this interaction. When controlling for age, it was demonstrated that elevated estradiol and testosterone levels in male teenagers undergoing pubertal development was linked to increased alcohol consumption.^[55] It has been suggested that sex hormones promote alcohol consumption behaviors in teens by stimulating areas in the male adolescent brain associated with reward processing. The same associations with hormone levels were not demonstrated in females undergoing pubertal development. It is hypothesized that sex steroid hormones, such as testosterone and estradiol, are stimulating areas in the male brain that function to promote sensation-seeking and status-seeking behaviors and result in increased alcohol usage.^[55]

Additionally, the enzyme TTTAn aromatase, which functions in the male brain to convert testosterone to estradiols, has been linked to addictive and reward-seeking behaviors. Therefore, the increased activity of the enzyme may be influencing male adolescent alcohol-usage behaviors during pubertal development.^[56] The underlying mechanisms for female alcohol consumption and abuse is still under examination, but is believed to be largely influenced by morphological, rather than hormonal, changes during puberty as well as the presence of deviant peer groups.^[53]

Genetic Influences

Several research studies suggest significant genetic contributions to alcohol use disorder. According to some adoption research, biological influences were strongly related to outcomes of adoptees. Among adoptees, a stronger correlation was found between alcohol use disorder and their biological parents than their adoptive parents. Other research adds that while multiple genes may be potentially implicated, alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2; mitochondrial aldehyde dehydrogenase), have been chiefly associated with excess alcohol consumption.

Nevertheless, it is important to note that alcohol use disorder entails a biopsychosocial component and genetics alone may not necessarily be causal in alcohol use disorder. There are numerous contributing risk factors which add to the complexity of alcohol including age, environment, psychiatric comorbidities and other substance use.^[57]

Mechanisms

Excessive alcohol use causes neuroinflammation and leads to

The brain goes through dynamic changes during adolescence as a result of advancing pubertal maturation, and alcohol can damage long- and short-term growth processes in teenagers.[61] The rewarding effects of alcohol are attributed to dopamine, serotonin, GABA, endocannabinoids, serotonin and opioid peptides.^[8]

Alcohol is the most recreationally used drug internationally,^[62] throughout history it has played a variety of roles, from medicine to a mood enhancer. Alcoholism and alcohol abuse however have undergone rigorous examination as a disease which has pervasive physiological and biosocial implications. The genesis and maintenance of the disease involves the mind, body, society and culture. A common anthropological approach to understanding alcoholism is one which relates to a social factor, and this is cross-cultural studies. The description and analysis of the degree of possibilities in drinking and its results among various populations indeed constitutes one of anthropology's major contributions to the field of alcohol studies. Understanding interactions between factors and evaluating ideas regarding how alcohol usage correlates to other cultural elements requires a number of cross-cultural comparisons. Anthropologists have analyzed a large global sample of cultures examining the association between particular traits for each which relate to the cultural components of alcoholism, these include significant measures which emphasize the social system, reliance and anxiety and strength as physical and social measures. These are the primary drivers of consuming alcohol affecting individuals on a psychosocial level.^[63]

Cultural influences

Individualistic cultures such as the United States or Australia are amongst some of the highest consumers of alcohol in the whole world,^[4] however this rate of consumption does not necessarily coincide with the rate of abuse as countries like Russia which are highly collectivist see the highest rates of alcohol use disorder. Research suggests that people who score highly on individualism, a trait commonly fostered by the culture, report a lower rate of alcohol abuse and alcohol related disorders so much so that the association was negative, however a higher average consumption of alcohol per week. It is implied that individuals will drink more in a given setting, or on average because they are less receptive towards negative social attitudes surrounding excessive consumption. This however acts on another component, by where individualism protects from maladaptive consumption by lowering the need to drink socially. The final axis by which individualism protects from abusive consumption is that it promotes higher degrees of individualization and achievement values which promote personally suited rewards, this allow the individual to be more cognizant of potential alcohol abuse, and therefore protect from damaging mentalities in those who already identify as drinkers.^[64]

Alcohol use disorder also has a variety of biosocial implications, such as the physiologically effects of a detox, how the detox period interacts with ones social life and how these interactions can make overcoming addiction a complex, difficult process. Alcohol use disorder can lead to a number of physical issues and may even create a mental health condition, leading to a double classification for the alcoholic. The stress, the social perceptions of these issues may reinforce abusive drinking habits.

Diagnosis

DSM-IV

Alcohol abuse was defined in the

• Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home
• Recurrent alcohol use in situations in which it is physically hazardous
• Recurrent alcohol-related legal problems
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol ^[65][66]

DSM-5

The alcohol abuse diagnosis is no longer used in the