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Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnostic entity, and the use of alcoholism terminology is discouraged due to its heavily stigmatized connotations. Predominant diagnostic classifications are alcohol use disorder (DSM-5) or alcohol dependence (ICD-11); these are defined in their respective sources.
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.
Alcohol abuse encompasses a spectrum of unhealthy alcohol drinking behaviors, ranging from binge drinking to alcohol dependence, in extreme cases resulting in health problems for individuals and large scale social problems such as alcohol-related crimes.
Alcohol dependence is a previous psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol.
Alcohol exclusion laws permit insurance companies to deny claims associated with the consumption of alcohol. They were passed in the 1940s in the United States to discourage people from drinking alcoholic beverages and to save insurance companies money from alcohol-related claims. It was believed that people would be less likely to drive while impaired or intoxicated if insurance companies could deny medical payments or other claims associated with any injuries associated with the consumption of alcoholic beverages. Thirty-six states currently allow alcohol exclusions in health care insurance policies via either explicit exclusions or implicit exclusions determines by legal precedence. A growing number of states are overturning their alcohol exclusion laws, currently 14 states plus the District of Columbia prohibit insurance companies from including exclusions for alcohol intoxication.
Brief intervention can often be referred to as screening and brief intervention (SBI) or, in England, identification and brief advice (IBA). Brief interventions are a technique used to initiate change for an unhealthy or risky behaviour such as smoking, lack of exercise or alcohol misuse. This page primarily describes brief interventions as applied to alcohol. As an alcohol intervention it is typically targeted to non-dependent drinkers, or drinkers who might be experiencing problems but are not seeking treatment. It is an approach which aims to prevent the acceleration or impact of alcohol problems, and/or to reduce alcohol consumption. It can be carried out in a range of settings such as in primary care, emergency or other hospital departments, criminal justice settings, workplaces, online, university/college settings, and other settings.
Alcohol has a number of effects on health. Short-term effects of alcohol consumption include intoxication and dehydration. Long-term effects of alcohol include changes in the metabolism of the liver and brain, several types of cancer and alcohol use disorder. Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. Alcohol consumption can cause hypoglycemia in diabetics on certain medications, such as insulin or sulfonylurea, by blocking gluconeogenesis. There is an increased risk of developing an alcohol use disorder for teenagers while their brain is still developing. Adolescents who drink have a higher probability of injury including death.
The Alcohol Use Disorders Identification Test (AUDIT) is a ten-item questionnaire approved by the World Health Organization to screen patients for hazardous (risky) and harmful alcohol consumption. It was developed from a WHO multi-country collaborative study, the items being selected for the AUDIT being the best performing of approximately 150 items including in the original survey. It is widely used as a summary measure of alcohol use and related problems. It has application in primary health care, medical clinics, and hospital units and performs well in these settings. Using different cut-off points, it can also screen for Alcohol Use Disorder (DSM-5) and Alcohol Dependence. Guidelines for the use of the AUDIT have been published by WHO and are available in several languages. It has become a widely used instrument and has been translated into approximately fifty languages.
The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used screening test for problem drinking and potential alcohol problems. The questionnaire takes less than one minute to administer, and is often used in primary care or other general settings as a quick screening tool rather than as an in-depth interview for those who have alcoholism. The CAGE questionnaire does not have a specific intended population, and is meant to find those who drink excessively and need treatment. The CAGE questionnaire is reliable and valid; however, it is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE questionnaire have been frequently implemented for such a purpose.
Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages with an intention of becoming intoxicated by heavy consumption of alcohol over a short period of time, but definitions vary considerably.
The Severity of Alcohol Dependence Questionnaire is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.
The CRAFFT is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents. CRAFFT stands for the key words of the 6 items in the second section of the assessment - Car, Relax, Alone, Forget, Friends, Trouble. As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and "CRAFFT 2.1+N" have been released.
The Michigan Alcoholism Screening Test (MAST) screening tool was developed in 1971, and is one of the oldest alcoholism-screening tests for identifying dependent drinkers. Its use is constructed for the general population. There are other versions of the MAST screening tool, all of which can be self-administered or via interview with someone who is trained in the tool being used. All MAST screening tools are scored on a point scale system.
A sobering center is a facility or setting providing short-term recovery and recuperation from the effects of acute alcohol or drug intoxication. Sobering centers are fully staffed facilities providing oversight and ongoing monitoring throughout the sobering process. Sobering centers may be alternatives to jail and emergency departments, as well as drop-in centers. There is a small number of sobering centers around the world. There are over 40 established sobering centers in the United States.
Alcohol is a liquid form substance which contains ethyl alcohol that can cause harm and even damage to a person's DNA. "Alcohol consumption is recognized worldwide as a leading risk factor for disease, disability, and death" and is rated as the most used substance by adolescences. Adolescence is a transitional stage of physical and psychological changes, usually a time in a person life in which they go through puberty. Combining these transitional stages and the intake of alcohol can leave a number of consequences for an adolescent.
Social Emergency Medicine is an emerging branch of Emergency Medicine that explores the interplay of social forces and the emergency care system, and how these act together to affect the health of individuals and their communities. Organized in 2009, the field has gained wider acceptance within the larger specialty of emergency medicine. Initiatives in social emergency medicine include research, direct service and advocacy aimed at addressing the social determinants of health.
Jonathan P Shepherd CBE is a Welsh surgeon, criminologist and professor at Cardiff University's Crime and Security Research Institute which he co-founded in 2015. He also founded the University's Violence Research Group. He has initiated UK public service reforms and other measures to strengthen the evidence foundations on which these services are based. These include new professional bodies for policing, probation and teaching; the UK What Works Centres and What Works Council; new university police research centres in England and Wales; and a new police research funding scheme.
Jalie A Tucker is a professor of Health Education and Behavior at the University of Florida. She is known for her research on impulsive and harmful behaviors, such as alcohol and substance use, the effect of the environment on addiction, and natural resolutions to risky behavior including alcohol misuse. She has received numerous awards for excellence in clinical psychology and addiction research, including the 2015 Award for Distinguished Scientific Contributions to Clinical Psychology from the Society of Clinical Psychology. She was honored by APA, Division 50 with the Presidential Award for Service to the Division in 2010 and 2012.
Alcoholism in Ireland is a significant public health problem. In Ireland, 70.0% of Irish men and 34.1% of Irish women aged 15+ are considered to be hazardous drinkers. In the same age group, there are over one hundred and fifty thousand Irish people who are classified as 'dependent drinkers'. According to Eurostat, 24% of Ireland's population engages in heavy episodic drinking at least once a month, compared to the European average of 19%.
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.
References
- ↑ Smith, SG; R Touquet; S Wright; N Das Gupta (Sep 1996). "Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)" (abstract page). Journal of Accident & Emergency Medicine. British Association for Accident and Emergency Medicine. 13 (5): 308–312. doi:10.1136/emj.13.5.308. PMC 1342761 . PMID 8894853.
- ↑ Patton, Robert; Catriona Hilton; Michael J. Crawford; Robin Touquet (2004). "The Paddington Alcohol Test: A Short Report". Alcohol and Alcoholism. Medical Council on Alcohol. 39 (3): 266–268. doi: 10.1093/alcalc/agh049 . ISSN 1464-3502. PMID 15082467.
- ↑ Screening and Intervention Programme for Sensible Drinking
- ↑ (also with annotated version) Archived 2011-07-07 at the Wayback Machine
- Patton R, Crawford M & Touquet R, 2005, "Hazardous drinkers in the AED – Who attends an appointment with an alcohol health worker?" Emergency Medicine Journal, 22:722–723
- Crawford M, Patton R & Touquet R et al., 2004, "Referral for brief intervention of patients misusing alcohol in an accident and emergency department: a pragmatic randomised controlled trial", The Lancet, 364:1334–1339
- Patton R, Crawford M & Touquet R, 2004, "Hazardous drinkers in the AED – Who accepts advice?", Emergency Medicine Journal, 21:491–492
