Alcohol addiction and abuse

Alcoholism, that is, the continued use of alcohol despite its repeated and verifiable adverse effects, is one of the biggest and most intractable public health problems worldwide, with high costs and serious social consequences. At the level of behaviour, it is a continuum with significant deviations between the drinking patterns of different individuals. This continuum has gradations which can be divided into habitual consumption, problematic use or abuse, and serious abuse with physical harm and dependence. What is certain is that as the quantity consumed and the frequency of abuse increases, so do the physical and psychological problems that accompany the pathological relationship with alcohol. When referring to the pathogenesis of alcoholism it is clear that we are talking about the group of people who have a pathological relationship with alcohol at the level of abuse and dependence, according to DSM-IV criteria, and this is the most distinct group with the most complications, including physical and psycho-social. Individuals who do not belong to this category and who have a type of consumption that creates concern, but require a different approach to diagnosis and treatment, are the focus of primary prevention at the community level. The causal pathogenesis of alcoholism continues to be the subject of research. The lack of a successful and generally-accepted causative model certainly has consequences for both diagnosis and treatment.
The disorders associated with alcohol are reported by the World Health Organization (WHO) as a major health problem which, according to the latest estimates, accounts for about 1.4% of the total global burden of disease.

Among the factors which have so far been implicated for the role they play not only in the pathogenesis, but also in relapses, and therefore in the perpetuation of alcohol abuse and dependence include the following:

  • Heredity
  • Family circumstances (emotional outlet)
  • Social functioning
  • Professional functioning
  • Personality
  • Pathological or psychiatric comorbidity
  • Stressful or traumatic life events

According to DSM-IV-TR classification criteria (APA, 2000), alcohol use disorders are divided into:

A. Alcohol dependency
This is a maladaptive pattern of alcohol use leading to clinically significant decline or subjective discomfort, as manifested by three (or more) of the following:

  1. reduced tolerance as defined by either of the following two:
    • a need for greatly increased amounts of alcohol to achieve intoxication or the desired effect;
    • a clearly limited effect with continued use of the same amount of alcohol;
  2. withdrawal syndrome or compulsive behaviour involving alcohol consumption by the individual to relieve or avoid withdrawal symptoms
  3. use of alcohol in larger quantities and/or for a longer period of time, compared against the original intentions of the person
  4. there is a persistent desire or failed attempts by the individual to reduce or control alcohol use
  5. the person is spending a lot of time on activities involving finding alcohol (e.g. travelling long distances), using alcohol (e.g. drinking all day), or recovering from its effects (alcohol intoxication)
  6. abandonment or reduction of participation in important social, occupational, or recreational activities due to alcohol use
  7. continued substance use despite awareness of permanent or recurrent physical or psychological problems that may be exacerbated or caused by alcohol.

B. Alcohol abuse
This involves pathological alcohol use leading to clinically significant decline or discomfort, as manifested by three or more of the following within a consecutive 12 month period:

  1. recurrent alcohol use which results in failure to fulfill basic roles at work, at school or at home (absences or expulsions from school, poor performance at work, neglect of children or the household)
  2. recurrent alcohol use in situations of risk to the physical integrity of the individual (e.g. driving a car or operating machinery under the influence of alcohol)
  3. recurrent problems with the law, which are due to alcohol (e.g. arrests for alcohol-associated disturbance of the peace)
  4. continued alcohol use despite the existence of permanent or recurrent social or interpersonal problems caused or exacerbated by the use of the substance (e.g. arguments with a spouse that are associated with intoxication, physical fights)

Early identification and diagnosis of alcoholism is crucial. The cost of treatment is shorter, the prognosis is more favourable, and there are fewer complications. Forced treatment without the consent of the patient treatment has little chance of success. Generally speaking, treatment of alcohol use disorders involves two therapeutic targets. The first focuses on abstinence from the substance. The second focus is the mental, psychiatric and psychosocial well-being of the patient.