The terms alcoholic and alcoholism have been subject to some controversy and have been used differently by various groups in the past. The World Health Organization no longer recommends the term alcoholism but prefers the term alcohol dependence syndrome—“a state, psychic and usually also physical, resulting from taking alcohol, characterized by behavioral and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence; tolerance may or may not be present” (1992, p. 4). However, because the terms alcoholic and alcoholism are still widely used in practice, in scientific journals, and in government agencies and publications, we will sometimes use them in this book.
People of many ancient cultures, including the Egyptians, Greeks, Romans, and Israelites, made extensive and often excessive use of alcohol. Beer was first made in Egypt around 3000 B.C. The oldest surviving wine-making formulas were recorded by Marcus Cato in Italy almost a century and a half before the birth of Christ. About A.D. 800, the process of distillation was developed by an Arabian alchemist, thus making possible an increase in both the range and the potency of alcoholic beverages. Problems with excessive use of alcohol were observed almost as early as its use began. Cambyses, King of Persia in the sixth century B.C., has the dubious distinction of being one of the early alcohol abusers on record.
The Prevalence, Comorbidity, and Demo Graphics of Alcohol Abuse and Dependence
Alcohol abuse and alcohol dependence are major problems in the United States and are among the most destructive of the psychiatric disorders because of the impact excessive alcohol use can have upon users’ lives and those of their families and friends. It is estimated that 50 percent of adults who are 18 or older are current regular drinkers and only 21 percent are lifetime abstainers (Pleis et al., 2009 ). In 2008, 23.3 percent of Americans aged 12 or older reported binge drinking, and 6.7 percent were found to be heavy drinkers (Substance Abuse and Mental Health Services Administration, 2010 ). An estimated 12.4 percent of persons 12 or older drove under the influence of alcohol at least once over the past year. An estimated 22.2 million persons (8.9 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on DSM diagnostic criteria. In this sample, 3.1 million people were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs (Substance Abuse and Mental Health Services Administration, 2009 ).
DSM-5 criteria for: Alcohol Use Disorder
· A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
· 1. Alcohol is often taken in larger amounts or over a longer period than was intended.
· 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
· 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
· 4. Craving, or a strong desire or urge to use alcohol.
· 5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
· 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
· 7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
· 8. Recurrent alcohol use in situations in which it is physically hazardous.
· 9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
· 10. Tolerance, as defined by either of the following:
· a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
· b. A markedly diminished effect with continued use of the same amount of alcohol.
· 11. Withdrawal, as manifested by either of the following:
· a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499–500).
· b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright © 2013). American Psychiatric Association.
The potentially detrimental effects of excessive alcohol use—for an individual, his or her loved ones, and society—are legion. Heavy drinking is associated with vulnerability to injury (Cherpitel 1997 ), marital discord (Hornish & Leonard, 2007 ), and becoming involved in intimate partner violence (Eckhardt, 2007 ). The life span of the average person with alcohol dependence is about 12 years shorter than that of the average person without this disorder. Alcohol significantly lowers performance on cognitive tasks such as problem solving—and the more complex the task, the more the impairment (Pickworth et al., 1997 ). Organic impairment, including brain shrinkage, occurs in a high proportion of people with alcohol dependence (Gazdzinski et al., 2005 ), especially among binge drinkers—people who abuse alcohol following periods of sobriety (Hunt, 1993 ).