Alcohol abuse

Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse is sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse. Binge drinking is another form of alcohol abuse. Frequent binge drinking or getting severely drunk more than twice is classed as alcohol misuse.

Definitions
Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. According to Gelder, Mayou & Geddes (2005) alcohol abuse is linked with suicide. They state the risk of suicide is high in older men who have a history of drinking, also if a person is suffering from depression. Certain manifestations of alcohol abuse include failure to fulfill responsibilities at work, school or home; drinking in dangerous situations, such as while driving; legal problems associated with alcohol use; and continued drinking despite problems that are caused or worsened by drinking. Alcohol abuse can lead to alcohol dependence.

Alcohol abuse has both short-term and long-term risks. If a person has driven while drunk or regularly binge drinks (more than 5 or 6 standard drinks in one drinking session), they are considered to have been involved in alcohol abuse. The short-term alcohol abuse include, but are not limited to, violence, injuries, unprotected sexual activities and additionally social and financial problems.

Binge Drinking
Binge drinking is characterized as consuming more than 5 drinks in men and 4 drinks in women. It increases vandalism, fights, injuries, drunk driving, trouble with police, and negative health, social, economic, or legal consequences. Binge drinking is also associated with neurocognitive deficits of frontal lobe processing and impaired working memory as well as delayed auditory and verbal memory deficits. Binge drinking combine with the stress of returning to work is a contributing factor to Monday deaths from heart attacks.

Symptoms & Signs
Symptoms are the defining characteristic of alcohol abuse and are reviewed above in Definitions. Patient will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems. Additionally patients do complain of irritability and insomnia.

Signs of alcohol abuse are related to alcohol's effects on organ systems. However, while these findings are often present, they are not necessary to make a diagnosis of alcohol abuse. Signs of alcohol's effects on the central nervous system acutely include inebriation and poor judgment; chronic anxiety, irritability, and insomnia often feature. Alcohol's effects on the liver include elevated liver function tests (classically AST is at least twice as high as ALT). Prolonged use leads to cirrhosis and failure of the liver. With cirrhosis patients develop an inability to process hormones and toxins. The skin of a patient with alcoholic cirrhosis can feature cherry angiomas, palmar erythema and - in fulminent liver failure - jaundice and ascities. The derrangements of the endocrine system lead to gynecomastia. Inability to process toxins leads to hepatic encephalopathy.

Binge drinking is associated with individuals reporting fair to poor health compared to non-binge drinking individuals and which may progressively worsen over time. Binge drinking is associated with alcohol poisoning, unintentional injuries, suicide, hypertension, pancreatitis, sexually transmitted diseases, and meningitis, among other disorders. Other negative consequences include social costs (including interpersonal violence), drunk driving, and lost economic productivity. Impairments in neurophysiological and neurocognitive function can result from binge drinking. A substantial proportion of alcohol-related deaths are due to binge drinking.

Causes
Peer pressure influences individuals to abuse alcohol; however most of the influence of peers is due to inaccurate perceptions of the risks of alcohol abuse. According to Gelder, Mayou and Geddes (2005)  easy accessibility of  alcohol  is one of the reasons people engage in  alcohol abuse as this substance  is  easily obtained in  shops.

Prevention
Preventing or reducing the harm has been called for via increased taxation of alcohol, stricter regulation of alcohol advertising and the provision of brief Interventions. Brief Interventions for alcohol abuse reduce the incidence of unsafe sex, sexual violence, unplanned pregnancy and, likely, HIV transmission. Information and education on social norms and the harms associated with alcohol abuse delivered either via the internet or face to face has been found to result in a decrease in harmful drinking behaviours in young people.

Epidemiology
Alcohol abuse is most common in people aged between 15 and 24 years.

Societal and economic costs
Alcohol abuse is associated with disabilities and death, accidents, fights, driving offenses and unprotected sex. Alcohol is responsible in the world for 1.8 million deaths and results in disability in approximately 58.3 million people. Approximately 40 percent of the 58.3 million people disabled through alcohol abuse are disabled due to alcohol related neuropsychiatric disorders. Due to increased unsafe sex associated with alcohol, there is a doubling of the risk of HIV infection in alcohol abusers. Additionally alcohol abuse increases the risk of individuals either being the victim of sexual violence or being the perpetrator of sexual violence.

Alcohol misuse costs the National Health Service (UK) 3 billion pounds sterling per year and the cost to employers is 6.4 billion pounds sterling per year. These figures do not include the crime and social problems associated with alcohol misuse. The number of women regularly drinking alcohol has almost caught up with men.

Prognosis
Alcohol abuse during adolescence, especially early adolescence (i.e. before age 15), may lead to long-term changes in the brain which leaves them at increased risk of alcoholism in later years; genetic factors also influence age of onset of alcohol abuse and risk of alcoholism. For example, about 40 percent of those who begin drinking alcohol before age 15 develop alcohol dependence in later life, whereas only 10 percent of those who did not begin drinking until 20 years or older developed an alcohol problem in later life. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.

College/university students who are heavy binge drinkers (3 or more times in the past 2 weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times more likely to be diagnosed with alcohol abuse compared to non-heavy episodic drinkers, though the direction of causality remains unclear. Occasional binge drinkers (one or two times in past 2 weeks), were found to be 4 times more likely to be diagnosed with alcohol abuse or dependence compared to non-heavy episodic drinkers.

Alcopops
The introduction of alcopops, which are flavoured alcoholic drinks which have a sweet and pleasant taste was responsible in Sweden for half of the increase in alcohol abuse in 15-16 year olds in a survey. In the case of girls the alcopops, which disguise the taste of alcohol, were responsible for two thirds of the increase. The introduction of alcopops to Sweden was a result of Sweden joining the European Union and adopting the entire European Union law. Alcohol abuse is highly associated with adolescent suicide. Adolescents who abuse alcohol are 17 times more likely to commit suicide than adolescents who don't drink.

Association with violence
Alcohol abuse is significantly associated with suicide and violence. Alcohol is the most significant health concern in Native American communities because of very high rates of alcohol dependence and abuse; up to 80 percent of suicides and 60 percent of violent acts are a result of alcohol abuse in Native American communities.

The overuse of alcohol has led to 16% of intoxicated people that have abused children. Abusing children can also come in the form of verbal abuse while under the influence, as well as physical abuse. Alcohol can increase one's judgement and make their emotions more easily emphasized, such as anger towards a minor topic, which can cause them to become dangerous.