Alcohol Abuse

Definition and common characteristics of alcohol abuse

A simple and informal definition of alcohol abuse is that it is the periodic maladaptive consumption of alcohol, usually in large amounts, which results in a variety of problems in different areas of one’s life.

A more specific and formal definition of alcohol abuse can be formulated using the Diagnostic and Statistical Manual, 4th Edition, of the American Psychiatric Association, (DSM-IV, 1994).

Using the DSM-IV criteria for substance abuse, but applying it to the case where the substance is alcohol, the diagnosis of alcohol abuse is made when one or more of the following occurs over a one year period:

  • Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions or expulsions from school; or neglect of children or household)
  • Recurrent use in situations in which it is physically dangerous (e.g., driving a car or truck or train, operating machinery e.g. in a factory, while under the influence of alcohol)
  • Having alcohol-related legal problems (e.g., arrests for alcohol-related fights in which injury occur).
  • Continuing to use alcohol despite having persistent or recurrent social or interpersonal problems caused or worsened by the effects of alcohol (e.g. arguments with wife over consequences of being drunk possibly leading to divorce, interpersonal difficulties leading to career problems including loss of job.

Alcohol abuse differs from alcohol dependence

Research has shown important differences between alcohol abuse and alcohol dependence (Hartford and Muthen, 2001).

For example in alcohol abuse there is no significant psychological or physiological dependence on alcohol whereas dependence and associated symptoms are characteristic of alcohol dependence. Also because of these differences in the nature of alcohol abuse and alcohol dependence, there are critical differences between the treatments of these two distinct conditions.

Prevalence of Alcohol Abuse

The lifetime prevalence for alcohol abuse was found to be 13.2% in a large epidemiological study carried out recently in the United States making it, by far, the most prevalent of the substance use and abuse disorders (Kessler et al, 2005).

It was followed in decreasing lifetime prevalence by drug abuse at 7.9%, alcohol dependence at 5.4%, and drug dependence at 3.0%.

Indeed of the 19 psychiatric disorders included in the study by Kessler and his colleagues, alcohol abuse is outranked only by major depressive disorder with a lifetime prevalence of 16.6%. It is to be noted that for both alcohol and drugs, dependence is less than half as common as abuse in this same study.

Alcohol abuse and codependence (developmental trauma)

The presence of an addiction of some kind has long been held as a main secondary symptom of codependency. Other names for codependency are developmental trauma and complex Post Traumatic Stress Disorder (PTSD).

There is indeed a lot of evidence that many individuals who abuse or become dependent to any substance be it alcohol or illicit drugs, have often been exposed to previous trauma during their childhood or thereafter.

For example, a study of borderline personality disorder, a severe form of what many call codependence, in patients with recent deliberate self-harm in Hong Kong, found they were more likely to suffer from a current alcohol and substance use disorder Wong (2010).

Also, research by Boriskin (2008) found that 25 to 50 percent of clients with a substance use disorder also meet the conditions for a diagnosis of post traumatic stress disorder (PTSD).

Hence there is strong reason to conclude that a person who experienced repeated or prolonged trauma during their childhood (and hence is likely codependent) is at greater risk of developing drug/alcohol abuse or dependence in adulthood.

Treatments available for alcohol abuse

Fortunately there are a number of effective treatments for alcohol abuse as listed below:

  • Prevention is considered the best way to deal with alcohol abuse and psychoeducation, either at that individual or the public health level, is the most important prevention strategy.

    Since generally the introduction to alcohol consumption starts in teenage years, or unfortunately even earlier, it is best to start educating about alcohol use and abuse in school as soon as possible. Of course this has to be done in a culturally sensitive and also in an age-appropriate level.

    Because alcohol consumption in a non-problematic way, e.g. wine at meals, is common in many cultures, care must be taken not to alienate children from their parents but at the same time inform children of the potential for abuse.
  • Psychoeducation is also an important therapeutic intervention in the treatment of actual alcohol abuse.
  • Many psychotherapeutic modalities e.g. cognitive behavioural therapy are used to treat alcohol abuse with varying degrees of success but little is known about their relative efficacy.
  • As already discussed individuals who have been traumatized as children or adults have greater risk of developing a problem with alcohol/drug abuse or dependence.

    For these individuals, treatment should include a component aimed at the trauma because it has the advantage of working through the lingering effects of traumatization and therefore reducing or stopping completely alcohol/drug abuse or dependence (Boriskin, 2008).

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.) Washington, DC: Author.

Boriskin, J. A. (2008, March). Effective treatments of complex PTSD and addiction. Paper presented at the meeting of Addiction, Trauma, and Co-Occurring Disorders, San Diego.

Harford, T. C., & Muthen, B. O. (2001). The dimensionality of alcohol abuse and dependence: A multivariate analysis of DSM-IV symptom items in the National Longitudinal Survey of Youth. Journal of Studies on Alcohol, 62, 150–157.

Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merikangas, K. R., Walters, Ellen E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602.

Wong, Hiu-Mei; Leung, Henry Chi-Ming; Chow, Lai-Yin; Kam, Wai-Kwo & Tang, Alan Ka-Lam. (2010) Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm. Journal of Personality Disorders, 24(6), 800-811.


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