ALCOHOL USE AND ABUSE

Ethyl alcohol, or ethanol, is the most commonly used drug in the world. Pharmacologically, alcohol is classified as a central nervous system depressant. Like other depressants, in small doses alcohol slows heart rate and respiration, decreases muscular coordination and energy, dulls the senses, and lowers inhibitions—resulting in feelings of relaxation and greater sociability. Large amounts of alcohol can result in depression of the various body systems, resulting in coma or death. The immediate physical effects of alcohol depend on the amount and frequency of drinking, while the mental and emotional effects are influenced by the mood of the drinker and the setting in which drinking takes place.

Two physical effects resulting from prolonged, heavy alcohol use include tolerance and withdrawal. Alcohol tolerance refers to the need for increased amounts of alcohol to achieve the same level of intoxication. For example, five or six drinks may be needed to achieve the same effects produced by one or two drinks when the individual first began drinking. Alcohol withdrawal, on the other hand, refers to a number of physical and psychological reactions an individual experiences when significantly reducing or stopping prolonged heavy drinking. Symptoms of withdrawal include nausea, vomiting, anxiety, and hand tremors.

An interaction of biological, psychological, and environmental factors come into play in the development of drinking behaviors and problems. For example, some individuals may be genetically predisposed to alcohol problems, but whether or not they actually experience negative alcohol consequences will also depend upon their immediate social and physical surroundings, such as family drinking patterns and alcohol availability, as well as their drinking habits.

ALCOHOL USE AND MISUSE

Most people who drink alcohol do so without negative consequences. Others may actually obtain a health benefit from its use. Some, however, drink in ways that place themselves or others at risk for experiencing alcohol-related problems. While no pattern of alcohol use is without risk, certain drinking patterns may help reduce risk significantly.

The Dietary Guidelines for Americans, issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, define moderate drinking as no more than two standard drinks per day for men, and no more than one per day for women and people sixty-five years of age and older. A standard drink is 0.5 ounces of alcohol, equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. These guidelines suggest that moderate or low alcohol use is linked to a reduced risk for the occurrence of negative alcohol consequences. For others, however, abstaining from all alcohol consumption is the safest thing to do. Groups who should avoid all alcohol use include pregnant women, children and adolescents, those planning to drive or participate in other activities requiring alertness, people who cannot maintain moderate alcohol use, and those who are using over-the-counter or prescription medicines that interact with alcohol.

Another way to understand drinking problems is to examine definitions of alcohol misuse. The World Health Organization (WHO) defines alcohol misuse as alcohol use that places people at risk for problems, including "at-risk use," "clinical alcohol abuse," and "dependence." At-risk alcohol use is the consumption of alcohol in a way that is not consistent with legal or medical guidelines, and it is likely to present risks of acute or chronic health or social problems for the user or others. Examples include underage drinking; drinking by individuals with a family history of alcoholism or problem drinking; or drinking if one has a medical condition that could be worsened by drinking, such as a stomach ulcer or liver disease. Clinical alcohol abuse is a more serious type of misuse that results in one or more recurrent, adverse consequences, such as failure to fulfill important obligations or the repeated use of alcohol in physically dangerous situations. Alcohol dependence is the most severe type of alcohol misuse and involves a chronic disorder characterized by three or more symptoms within a twelve-month period. These symptoms include alcohol tolerance, withdrawal, loss of control, and continued use despite knowledge of having a physical or psychological problem.

Negative consequences resulting from alcohol use are estimated to affect more than 10 percent of the U.S. population, with many of these individuals going undetected. A number of brief screening tools are available to help detect possible alcohol problems. One of the most widely used among these is the four-item CAGE questionnaire, which derives its name from the following four self-administrated questions:

1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye-opener)?

Answering "yes" to as few as one or two items on the CAGE questionnaire may indicate a drinking problem.