Alcoholism
 

This discussion of alcohol abuse is continued in the book

Alcohol Problems and Solutions

The regular abuse of alcoholic beverages (ABs) is called "alcoholism". A practical definition of alcoholism is the regular ingestion of ABs sufficient to produce dysfunction or damage at a physical and/or a social-economic level. The label "alcoholic" is resisted by most AB abusers. The stigma attached to the term "alcoholism" remains an obstacle  to understanding this common problem. There is a tendency to deny or to "normalize" excessive drinking. The use of alcoholic beverages is woven into the fabric of society and excessive use of alcohol is considered "normal"  in many social circles. You only have to go to medical conventions to be reminded that drinking is not only acceptable but, often, a necessary social attribute for social and career success.

Alcohol abuse is considered to be an addiction and some argue about calling alcoholism a “disease.” The term “addiction” refers both the compulsive aspect of drinking and also to the harm drinking causes. The drinker harms himself, his family and the community at large. A reasonable person will notice the harm he or she is causing and will seek to remedy the problem. An addict ignores the harm and remains devoted to ingesting alcoholic beverages no matter how much harm is caused.

The Dietary Guidelines for Americans, published by the US government, recommends no more than one drink a day for women and two for men. One drink is defined as 12 ounces (355 ml) of beer, 5 ounces (148 ml) of wine or 1.5 ounces (44 ml) of spirits. In the USA a national survey on drug use and health 2002, estimated that among the general population age 12 and older: 120 million Americans were current alcohol users, 75.1 million Americans were current tobacco users, and 19.5 million Americans were current illicit drug users.  An estimated 22 million Americans were classified with abuse or dependence on alcohol, illicit drugs or both.  The incidence of alcohol use increased steadily during the 1990s, from 3.3 million new users in 1990 to 5.6 million in 2000. Youths under 18 accounted for much of the increase, the number of adolescent initiates nearly doubling from 2.2 million in 1990 to 4.1 million in 2000. During this period, the increase was equally distributed among boys (1.1 million to 2.1 million) and girls (1.1 million to 2.0 million).
A "drink" was defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Estimates for the prevalence of alcohol use were reported at three levels defined for both males and females and for all ages as follows:

1. Current use - At least one drink in the past 30 days (includes binge and heavy use).
2. Binge use - Five or more drinks on the same occasion at least once in the past 30 days (includes heavy use).
3. Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past 30 days.

“The highest prevalence of both binge and heavy drinking in 2002 was for young adults aged 18 to 25, with the peak rate of both measures occurring at age 21  The rate of binge drinking was 40.9 percent for young adults and 50.2 percent at age 21. Heavy alcohol use was reported by 14.9 percent of persons aged 18 to 25 and by 20.1 percent of persons aged 21. Binge and heavy alcohol use rates decreased faster with increasing age than did rates of past month alcohol use. While 58.8 percent of the population aged 45 to 49 in 2002 were current drinkers, 22.5 percent of persons within this age range were binge drinkers and 7.7 percent drank heavily. Binge and heavy drinking were relatively rare among people aged 65 or older, with reported rates of 7.5 and 1.4 percent, respectively.”

The level of alcohol use was strongly associated with illicit drug use in 2002. Among the 15.9 million heavy drinkers aged 12 or older, 32.6 percent were current illicit drug users. For binge drinkers who were not heavy drinkers, 16.6 percent reported past month illicit drug use. Other drinkers (i.e., past month alcohol use but not binge drinking) had a rate of 5.8 percent for current illicit drug use, and persons who did not use alcohol in the past month were least likely to use illicit drugs (3.6 percent).  Among heavy alcohol users, 61.3 percent smoked cigarettes;  21.8 percent of non-binge current drinkers and 17.7 percent of nondrinkers were current smokers.

At the annual meeting of the American Public Health Association 2003, Jürgen Rehm, professor and chairman of addiction policy in at the University of Toronto stated: "Alcohol is the fifth largest cause of death and morbidity in terms of global burden of disease. That means overall for disease and disease-related deaths, alcohol is about as big a contributor to death as tobacco. The problem is getting worse because the most populous countries such as Russia, China and India, have increased their alcohol intake by an enormous amount.”

In North America 12% of men and 2.2% of women suffer from a disease that is alcohol-related or die prematurely due to alcohol intake.  In Canada,  alcohol is responsible for about 10% of the overall disease burden even though total alcohol consumption has decreasing  for the past 20 years: 50% of all alcohol-related deaths involve accidents or trauma and 20% of alcohol-related deaths are due to cancers in the mouth, esophagus, liver and the rest of the digestive tract.