Describing alcohol consumption and alcohol related
How can hazardous and harmful drinking and dependence on alcohol be described?
Hazardous alcohol consumption
Hazardous alcohol consumption has been defined as a level of consumption or pattern of drinking that is likely to result in harm should present drinking habits persist (Babor et al. 1994). There is no standardized agreement for the level of alcohol consumption that should be taken for hazardous drinking, and, as shown for many conditions in Chapter 4, any level of alcohol consumption can carry risk. A working definition of the World Health Organization describes it as a regular average consumption of 20g-40g of alcohol a day for women and 40g60g a day for men (Rehm et al. 2004).
Harmful drinking is defined as .a pattern of drinking that causes damage to health, either physical (such as liver cirrhosis) or mental (such as depression secondary to alcohol consumption). (World Health Organization 1992). Based on the epidemiological data relating alcohol consumption to harm (see Chapter 4), the World Health Organization has adopted a working definition of harmful alcohol consumption as a regular average consumption of more than 40g alcohol a day for women and more than 60g a day for men (Rehm et al 2004).
Intoxication can be defined as a more or less short-term state of functional impairment in psychological and psychomotor performance induced by the presence of alcohol in the body (World Health Organization 1992), even at very low consumption levels (Eckardt et al 1998). Intoxication is not synonymous with ‘binge drinking' or ‘episodic heavy drinking'.
Episodic heavy drinking
A drinking occasion that includes consumption of at least 60g of alcohol can be defined as episodic heavy drinking (World Health Organization 2004). In common terms this is frequently called ‘binge drinking'.
The World Health Organization.s International Classification of Mental and Behavioural Disorders (1992), ICD-10, defines alcohol dependence as a cluster of physiological, behavioural, and cognitive phenomena in which the use of alcohol takes on a much higher priority for a given individual than other behaviours that once had greater value. A central characteristic is the desire (often strong, sometimes perceived as overpowering) to drink alcohol. Return to drinking after a period of abstinence is often associated with rapid reappearance of the features of the syndrome. The features are described in Table 3.1.
Table 3.1 ICD 10Criteria for alcohol dependence
1. Evidence of tolerance to the effects of alcohol, such that there is a need for markedly increased amounts to achieve intoxication or desired effect, or that there is a markedly diminished effect with continued use of the same amount of alcohol.
2. Aphysiological withdrawal state when alcohol use is reduced or ceased, as evidence by the characteristic withdrawal syndrome for the substance, or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms.
3. Persisting with alcohol use despite clear evidence of harmful consequences as evidenced by continued use when the person was actually aware of, or could be expected to have been aware of, the nature and extent of harm.
4. Preoccupation with alcohol use, as manifested by: important alternative pleasures or interests being given up or reduced because of alcohol use; or a great deal of time being spent in activities necessary to obtain alcohol, consume it, or recover from its effects.
5. Impaired capacity to control drinking behavior in terms of its onset, termination or level of use, as evidenced by: alcohol being often taken in larger amounts or over a longer period than intended, or any unsuccessful effort or persistent desire to cut down or control alcohol use.
6. A strong desire or sense of compulsion to use alcohol.
Ill-defined terms not recommended for useThere are a number of ill defined terms that the report does not use, including:
moderate drinking The report has avoided the use of the word .moderate., since it is an inexact term for a pattern of drinking that is by implication contrasted with heavy drinking. Although it commonly denotes drinking that does not cause problems (and thus is not drinking to .excess.), it is difficult to define. A better description might be lower-risk drinking .
sensible drinking, responsible drinking and social drinking, all of which are impossible to define and depend on social, cultural and ethical values which can differ widely from country to country, from culture to culture, and from time to time.
excessive drinking is currently a non-preferred term for a pattern of drinking considered to exceed some standard of light drinking. Hazardous use is the preferred term in current use.
alcoholism is a term of long-standing use and variable meaning, generally taken to refer to chronic continual drinking or periodic consumption of alcohol which is characterized by impaired control over drinking, frequent episodes of intoxication, and preoccupation with alcohol and the use of alcohol despite adverse consequences. The inexactness of the term led a WHO Expert Committee to disfavour it, preferring the narrower formulation of alcohol dependence syndrome as one among a wide range of alcoholrelated problems (Edwards & Gross 1976; World Health Organization 1980), and it is not included as a diagnostic entity in ICD-I0. The preferred term is alcohol dependence .
alcohol abuse a term in wide use but of varying meaning. Although it is used in the DSM (Diagnostic and Statistical Manual of Mental Disorders) classification (American Psychiatric Association 1994), it should be regarded as a residual category, with dependence taking precedence when applicable. The term is sometimes used disapprovingly to refer to any use at all, particularly of illicit drugs. Because of its ambiguity, the term is not used in the ICD-I0 classification. Harmful use and hazardous use are the equivalent terms.
alcohol misuse is a term that describes the use of alcohol for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. Although misuse is preferred by some to abuse in the belief that it is less judgmental, it is also ambiguous. Hazardous use is the equivalent term.
Last modified: 03/05/2006 | Published on: 29/06/2005