• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Definition

In considering alcohol related problems, it is helpful to disentangle the confusing terminology that involves both lay and technical language. In particular, it can beWhen considering the problems surrounding alcohol use, it is helpful to clarify the difficult to distinguishdifference between the terms such as alcohol use, misuse, hazardous and harmful drinking, excessive drinking, binge drinking, and alcohol dependence.

Alcohol use

Alcohol use refers to any ingestion of alcohol. Low risk use of alcohol refers to drinking within legal and medical guidelines, which is not likely to result in alcohol related problems. ¹ See table 1 below.

Table 1. Categories of alcohol consumption in men and women

Alcohol misuse

Alcohol misuse is a general term for any level of risk, ranging from hazardous drinking to alcohol dependence. ¹

Hazardous drinking

Hazardous drinking is consumption at a level or in such a pattern that increases an individual’s risk of physical or psychological consequences. ² Physical consequences of hazardous drinking could include injuries caused by impaired judgment after drinking alcohol while psychological effects could relate to mood disturbance, which may affect personal or social interactions. Hazardous and heavy drinking are more or less synonymous terms and are often used interchangeably.

Hazardous drinking can be identified by short screening tools designed for use in primary care such as alcohol use disorders identification test or AUDIT questionnaire (see figure 1), which has 10 items. ³ A score of 8-15 on AUDIT (out of a possible total of 40) indicates hazardous drinking. ³

Because of the limited time available in primary care, it may be helpful to use one of the validated shorter versions of AUDIT, such as AUDIT-C, which contains the first three "consumption" questions from AUDIT. ⁴ A score of ≥5 on AUDIT-C indicates at least hazardous drinking. ⁴

Harmful drinking

Harmful drinking is defined by the presence of adverse consequences related to alcohol. ⁵ Adverse consequences can be physical (such as liver cirrhosis) or psychological (such as depression).

A score of 16-19 ⁶ on the alcohol use disorders identification test ³ indicates harmful drinking.

Excessive drinking

Hazardous and harmful drinking are referred together as "excessive drinking." Excessive drinking can also be classified by drinking limits recommended by medical authorities in various countries, beginning with the level of consumption identified by epidemiological evidence as the point where the risk of harm begins to increase.

In the UK, for example, a joint working group of the Royal Colleges of Physicians, Psychiatrists, and General Practitioners in 1995 ⁷ defined "low risk" through to "harmful" drinking in terms of standard drink units per week (one unit being equivalent to 8 g ethylalcohol, see table 1). At about the same time, a UK government report on sensible drinking advised that consistently drinking four or more units a day in men and three or more units a day in women carried progressive health risks. ⁸ These weekly and daily benchmarks provide the basis for current public health advice on alcohol consumption.

Binge drinking

Binge drinking refers to high intensity drinking during a single session. ⁹ It is strongly associated with intoxication or drunkenness. Binge drinking was defined in the 1995 UK government report as drinking twice the daily limit for alcohol consumption (that is, eight or more units for men or six or more units for women) in one day. ⁸

Alcohol dependence

Alcohol dependence (syndrome) is a psychobiological condition characterised by an inner drive to consume alcohol, continued drinking despite harm, and commonly a withdrawal state on stopping drinking. ¹⁰

There are two forms of diagnostic criteria for alcohol dependence: the World Health Organization ICD-10 (international classification of diseases, 10th revision) has six criteria, ⁵ and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), has seven criteria. ¹¹ Both systems are based on a description of the alcohol dependence syndrome by Edwards and Gross ¹² and many of their criteria are similar, despite some differences in wording or emphases. ¹³

People with alcohol dependence who are assessed by a health professional have usually had three or more of the following criteria in the previous year ¹ :

• A strong desire or compulsion to take alcohol
• Difficulty in controlling alcohol consumption in terms of onset, termination, or levels of use
• Physiological withdrawal when alcohol use has ceased or reduced, or the use of alcohol to relieve or avoid symptoms of withdrawal
• Evidence of tolerance, in which increased doses of alcohol are required to achieve effects originally produced by lower doses
• Progressive neglect of alternative pleasures or interests because of alcohol use
• Continued use despite clear evidence of harm, such as liver damage.

A narrowing of the personal repertoire of patterns of alcohol use has also been described as a characteristic feature of dependence (for example, a tendency to drink alcoholic drinks in the same way on weekdays and weekends, regardless of social constraints that determine appropriate drinking behaviour). ¹²

Alcohol use disorder

Alcohol use disorder has been defined as hazardous, harmful, or dependent drinking. ¹⁴