Alcohol abuse
Alcohol abuse encompasses a spectrum of alcohol-related substance abuse. This spectrum can range from being mild, moderate, or severe. This can look like 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.
Alcohol abuse was a psychiatric diagnosis in the DSM-IV, but it has been merged with alcohol dependence in the DSM-5 into alcohol use disorder.
Alcohol use disorder, also known as AUD, shares similar conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the most used term, alcoholism.
Globally, excessive alcohol consumption is the seventh leading risk factor for both death and the burden of disease and injury, representing 5.1% of the total global burden of disease and injury, measured in disability-adjusted life years. 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. Millions of people of all ages, from adolescents to the elderly, engage in unhealthy drinking. In the United States, excessive alcohol use costs more than $249 billion annually. 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. Data shows that those that began drinking at an earlier stage in life were more likely to report experiencing AUD than those that began later. For example, those who began at age 15 are more likely to report suffering from this disorder than those that waited until age 26 and older. The risk of females reporting this is higher than that of males.
Definitions
Risky 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
- greater than 7 standard drinks units per week or greater than 3 standard drinks on a single occasion in women
- any drinking in pregnant women or persons < 21 years old
- ≥ 5 standard drinks on a single occasion in men
- ≥ 4 standard drinks on a single occasion in women
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.
Signs and symptoms
Specific diagnostic criteria for Alcohol Use Disorder, according to the includes: alcohol taken in excessive amounts over a long duration of time, a recurring desire/craving for alcohol, trouble stopping/resisting alcohol, recurrent alcohol use resulting in failure to adhere to social, occupational and personal obligations, continued alcohol use after continual social and interpersonal complications, physically hazardous alcohol use, continued alcohol use knowing that it causes persistent physical and cognitive problems, high alcohol tolerance and withdrawal syndrome for alcohol.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 insomnia. Alcohol use disorder is also an important cause of chronic fatigue.
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. Alcohol use disorder causes acute central nervous system depression which leads to inebriation, euphoria, impulsivity, sedation and poor judgment. Chronic alcohol use may lead to dependence, reckless behavior, anxiety, irritability, and insomnia.
Alcohol is hepatotoxic and chronic use leads to elevated liver enzyme levels in the bloodstream, cirrhosis, and liver failure. Cirrhosis leads to an inability to process hormones and toxins and increased estrogen levels. The skin of a patient with alcoholic cirrhosis can feature spider angiomas, palmar erythema, and — in acute liver failure — jaundice and ascites. The derangements of the endocrine system may lead to the enlargement of the male breasts. The inability to process toxic metabolites such as ammonia in alcoholic cirrhosis may lead to hepatic encephalopathy.
Alcohol is also an established carcinogen and its excessive use causes an increased risk of various cancers, such as breast cancer and head and neck cancer. Using alcohol, especially together with tobacco, is a major risk factor for head and neck cancer. 72% of head and neck cancer cases are caused by using both alcohol and tobacco. This rises to 89% when looking specifically at laryngeal cancer.
Chronic alcohol use is also associated with malnutrition, Wernicke-Korsakoff syndrome, alcoholic cardiomyopathy, hypertension, stroke, arrhythmias, pancreatitis, depression, and dementia. Alcohol is also an established carcinogen with chronic use associated with increased risk of cancer.
Alcohol use disorder can result in brain damage which causes impairments in executive functioning such as impairments to working memory and visuospatial function. Alcohol abuse is also associated with incidence of personality disorders, affective disorders, and emotional dysregulation. 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 critical thinking, ability to handle stress, and attention. Alcoholism can cause significant impairment in social skills, due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The prefrontal cortex is responsible for cognitive functions such as working memory, impulse control, and decision making. This region of the brain is vulnerable to chronic alcohol-induced oxidative DNA damage. The social skills that can be impaired by alcohol abuse include impairments in perceiving facial emotions, difficulty with perceiving vocal emotions, theory of mind deficits, and ability to understand humor. Adolescent binge drinkers are most sensitive to damaging neurocognitive functions especially executive functions and memory. People who abuse alcohol are less likely to survive critical illness with a higher risk for having sepsis and increased risk of death during hospitalization. Cessation of alcohol use after dependence is formed may lead to alcohol withdrawal disorder and associated sequela including seizures, insomnia, anxiety, cravings, and delirium tremens.
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.
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, an increased intake of alcohol may serve to further exacerbate psychological issues. This could lead to an increase in suicidal behavior. Alcohol has been implicated in up to 80 percent of suicides and 60 percent of violent acts in Native American communities.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 fetal alcohol syndrome. Fetal alcohol syndrome is a pattern of physical abnormalities and impairments of mental development seen among children of alcoholic mothers. Fetal alcohol syndrome is the most common preventable cause of intellectual disability in the United States. Symptoms include a thin upper lip, short palpebral fissures, smooth philtrum, microcephaly, and other facial dysmorphic features. Surviving infants may also have structural heart defects, heart-lung fistulas, skeletal abnormalities, impaired renal development, short stature, and various cognitive disabilities. Prenatal alcohol exposure is associated with lasting deleterious effects on the endocrine, reproductive, and immune systems. Prenatal alcohol exposure is also associated with increased incidence of disease, cancer, and behavioral issues during adulthood There is no safe quantity or time period for alcohol use during pregnancy and complete abstinence is recommended. Therefore, the biological implications of alcohol abuse are also further reaching than just the physical issues experienced by the consumer.
Adolescence
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. New research is shedding light on pre-existing neurobiological markers that are predictive for the initiation of drug and alcohol abuse in adolescents. 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. 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.Alcohol abuse during adolescence greatly increases the risk of developing an alcohol use disorder in adulthood due to changes to neurocircuitry in the vulnerable adolescent brain. Younger ages of initial consumption among males in recent studies has shown to be associated with increased rates of alcohol abuse within the general population.