Alcoholism Health Article

Definition

Alcoholism, or alcohol dependence, is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as "A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress."

That maladaptive pattern is manifested, according to the DSM-IV, by the following behaviors occurring any time within one 12-month period:

• tolerance for alcohol
• withdrawal from alcohol
• alcohol taken in larger amounts and over a longer period of time than was intended
• persistent desire or unsuccessful efforts to cut down or control alcohol use
• much time spent in activities necessary to obtaining alcohol
• various important activities, for example, in socializing or at work, are given up or reduced because of alcohol use
• alcohol use continued regardless of the pattern of physical or psychological problems that it causes or worsens

Alcohol abuse has the same definition but is manifested by one (or more) of the following behaviors occurring within the same 12-month period:

• repeated alcohol use leading to failure to fulfill major role obligations at work, school, or home
• repeated alcohol use in situations in which it is physically hazardous
• repeated alcohol-related legal problems
• persistent alcohol use despite its causing social and interpersonal problems or exacerbating them

This definition and the criteria established by DSMIV apply to both adults and children. The American Academy of Pediatrics (AAP) states that the pattern of use and abuse of alcohol in children and adolescents is not observably different from what is manifested in young people using marijuana or cocaine.

Description

The AAP divides the progression into childhood alcoholism into three stages:

• Stage 1: Experimentation with alcohol. Normally there is no change noted in physical status or behavior, and the drinking usually occurs only on weekends during social occasions with peers, making it the least detectable of the three. Peer pressure to use alcohol "just for fun."
• Stage 2: Actively trying to obtain alcohol. Alcohol use happens during the week to provide relief when stress is felt or to "feel good" when depressed.
• Stage 3: Preoccupation with alcohol. The child or adolescent has nearly lost the capacity for controlling alcohol use. Setting limits results in withdrawal symptoms, including depression, moodiness, or irritability. Severe withdrawal can result in serious medical problems, including delirium tremens.

Prevalence and severity of the problem

Based on findings mostly coming from the 1990s, the National Council on Alcohol and Drug Dependence (NCAAD) cites the following in its fact sheet Youth, Alcohol and Other Drugs:

• Approximately 10.4 million Americans ages 12 to 20 have at least one drink per month. One fifth of these (2.1 million) are heavy drinkers who have five or more drinks on a minimum of five different occasions. More than half of these (6.8 million) are considered binge drinkers who have five or more drinks on a single occasion.
• Eighty percent of all high school seniors have tried alcohol.
• Eight percent of eighth graders, 24 percent of tenth graders, and 32 percent of high school seniors have been intoxicated from alcohol in the past month.
• Children who begin smoking tobacco before the age of 13 are significantly more at risk for alcohol problems.
• Among high school seniors, alcohol use is more prevalent among Caucasian and Hispanic students than among African American students.
• Junior, middle, and senior high school students consume 35 percent of all wine coolers sold in the United States as well as 1.1 billion cans of beer.
• A Southern Illinois University study showed that students with overall grades of D or F drank on average three times as much alcohol as students with overall grades of A.
• A United States Department of Justice survey showed that nearly one third of children below the age of 18 incarcerated in juvenile institutions are under the influence of alcohol at the time of their arrest.
• More than half (56%) of children and teens in grades five through 12 report that alcohol advertising encourages them to drink.
• Thirty percent of children in grades four through six state that they have received pressure from peers to drink beer.
• Two thirds of teenagers who drink report that they are able to make their own alcohol purchases.
• The total cost of alcohol use by young people, including automobile crashes, violent crime, alcohol poisoning, burns, drowning, suicide attempts, and fetal alcohol syndrome is more than 58 billion dollars each year.
• Eighty percent of teenagers do not know that a 12-ounce can of beer has the same amount of alcohol as a shot of whiskey or a five-ounce glass of wine.