Alcohol problems definedAlcoholism, also known as alcohol dependence or addiction, is considered a disease that includes alcohol craving, along with continued drinking, despite repeated alcohol-related problems--family/relational problems (early), losing a job or having legal troubles (late). It is characterized by four symptoms: * Craving--A strong need or compulsion to drink that characterizes psychological dependence. * Impaired control--The inability to limit one's drinking on any given occasion. Those who are alcohol dependent are unable to not take the first drink; they can't predict when they will drink and when they won't, and they cannot predict how much they will drink. * Tolerance--The need for increasing amounts of alcohol in order to achieve a desired effect. * Physical dependence--Brain counteradaptations that develop with chronic alcohol abuse and produce withdrawal-associated changes such as nausea, sweating, anxiety, fluctuations of blood pressure, and shakiness or tremors when alcohol use is abruptly stopped. Persons who may fulfill some, but not all four, criteria may be said to show alcohol abuse. (This definition is modified from that of NIAAA.) The 'standard drink' To equate the absolute amount of ethanol across alcoholic beverages, various nations have adopted scales of standard drinks. As shown at the Web site http://www.icap.org/ icapreport5.html, these differ between countries. By U.S. definition, "one drink" contains 14 grams of ethanol. This is provided by standard servings of beer (12 oz.), wine (5 oz.), and spirits (1.5 oz.). These standards are subject to variation, as with the differing strengths of beers. Hazardous and harmful drinking According to Arch Intern Med 159 (15):1681-89 (1999), for utility in primary care, three levels of risky drinking have been defined as follows
Heavy drinking implies alcohol intake that exceeds a certain threshold level. NIAAA sets this threshold at [greater than] 14 drinks per week for men (or [greater than] four drinks per occasion), more than seven drinks per week for women (or [greater than] three drinks per occasion), and more than seven drinks per week for all adults 65 years and older. Persons who drink beyond the guidelines are said to be risking adverse health events. Hazardous drinking is defined as a quantity or pattern of alcohol intake that places a person at even greater risk for adverse health events. It is recognized by the World Health Organization as a distinct medical disorder. The quantity or pattern of alcohol consumption that defines this state is specified by set thresholds for an individual's average number of drinks per week or per occasion. Recently, a study to evaluate the Alcohol Use Disorders Identification Test (AUDIT), defined hazardous drinking as an average intake of 21 drinks or more per week in men (or seven or more drinks per occasion, at least three times a week), and 14 drinks or more per week for women (or five or more per occasion, at least three times per week). Harmful drinking, a level of alcohol intake that results in physical or psychological harm, is also a WHO-recognized disease entity. It is defined by criteria of International Classification of Diseases, 10th Revision (ICD-10), which include clear evidence that alcohol is causative for physical or psychological harm; the nature of the harm is identifiable; alcohol consumption persisted for at least a month, or occurred repeatedly over the previous 12-month period; the person does not meet the criteria for alcohol dependence. Binge drinking Binge was long defined as "a drunken spree or celebration." Going "on a binge" meant an episode of steady drinking over one to several days. In recent times, however, the phrase gained a new usage: an intense consumption of alcoholic drinks in a short period (four or more drinks consecutively for women, five or more for men, usually within 30-60 minutes). Binge drinking may now be equated with the behavior of one who intends to drink steadily until intoxicated (Table 1). This pattern of drinking is such that acute, severe CNS effects often ensue, even to the extent of the person's becoming comatose (passing out) and occasionally, especially in younger persons, being at risk of acute fatality. Other physical injuries may occur following a sustained comatose state: rhabdomyolysis--skeletal muscle injury with a potential for causing kidney failure--and acute pneumonia.
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