In This Article Alcohol Use Disorder

  • Introduction
  • General Overview
  • Screening and Assessment Issues
  • Families
  • Policy Issues

Social Work Alcohol Use Disorder
by
Shulamith Lala Ashenberg Straussner, Sarina Beth Straussner
  • LAST REVIEWED: 06 May 2015
  • LAST MODIFIED: 31 March 2016
  • DOI: 10.1093/obo/9780195389678-0025

Introduction

Millions of individuals use alcohol every day; however, not everyone experiences a problem due to such use. It is therefore helpful to conceptualize alcohol use as ranging on a continuum from nonproblematic social use (e.g., a glass of wine with dinner) to alcohol misuse (e.g., a one-time incident of binge drinking), to excessive use or abuse (e.g., frequent use of alcohol that results in a negative impact on the life of the individual and those around him or her, such as recurrent driving under the influence of alcohol), and finally, to physical dependence or addiction to alcohol (e.g., a chronic disorder that may require medical detoxification and/or formal treatment). While not used professionally, the commonly used term alcoholism has been used synonymously with alcohol addiction and refers to the compulsive use of alcoholic beverages. Both terms imply a progressive deterioration of the individual’s social, physical, and mental status combined with the inability to stop using alcohol even when wishing to do so. Although the professional literature on alcohol use problems is extensive and can be found in almost every country in the world, the inconsistent use of terminology is often confusing. There is a tremendous overlap with literature on topics such as alcohol-related problems, risky drinking, alcohol abuse and dependence, substance abuse, and alcohol addiction. The confusion has been compounded by the recent changes in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5; Washington, DC: American Psychiatric Association, 2013), which eliminated the previous diagnostic classifications of “alcohol abuse” and “alcohol dependence” and replace them with the overall category of “Alcohol Use Disorders” (AUD), which itself is part of the broader new DSM-5 category of “Substance-Related and Addictive Disorders.” A fuller discussion of the DSM changes can be seen in Straussner 2013. Research studies in the United States indicate a general decrease in the proportions of individuals with “pure” alcohol use diagnosis and an increase among those using multiple substances. Consequently, the topic of alcohol-use disorders needs to be considered within the context of the literature on problematic use of a variety of other chemical substances as well as other addictions, such as gambling and smoking. It also needs to take into account co-occurring mental disorders; age, gender, and sexual identity of users; socioeconomic and psychological issues; family dynamics; and ethnocultural factors. Finally, research and treatment focusing on AUD must be viewed within the context of governmental policies, which vary over time and in different locations.

  • Straussner, S. Lala A. 2013. The DSM–5 diagnostic criteria: What’s new? Journal of Social Work Practice in the Addictions 13.4: 448–453.

    DOI: 10.1080/1533256X.2013.840199E-mail Citation »

    This article provides background information on the overall changes in the DSM over the years, and an in-depth discussion of the revisions from DSM-IV to DSM-5 as they relate specifically to the new category of “Substance-Related and Addictive Disorders.” The article focuses on the elimination of the diagnostic classifications of “alcohol abuse” and “alcohol dependence” and their replacements with the term of “Alcohol Use Disorders” (AUD), which is then stratified by severity based on how many symptoms are met: mild disorder (two or three symptoms), moderate disorder (four or five symptoms), or severe disorder (six or more symptoms). The higher end of severity is equivalent to the DSM–IV “substance dependence” diagnosis.

General Overview

The literature in this section provides general background information on the nature of AUD and its prevalence in both the United States and other countries. The first reference is to the US government publication Alcohol Research: Current Reviews (ARCR), which is available on the National Institute of Alcohol Abuse and Alcoholism website and provides free, state-of-the-art publications on a variety of topics related to alcohol use disorders. Rehm, et al. 2009 quantifies the burden of mortality and disease attributable to alcohol, both globally and for ten large countries. The National Institute for Health and Clinical Excellence 2011; Grant, et al. 2006; and Kim, et al. 2008 are good sources for recent prevalence rates of alcohol problems in the United Kingdom, United States, and Hong Kong, respectively. Straussner 2014 offers an overview of the issues involved in understanding alcohol problems and the process for assessing and helping individuals impacted by such problems, while Willenbring 2010 summarizes the progress made in this field through well-known research studies over the past four decades. Vaillant 2003, a classic longitudinal study, documents the effects on alcoholic men over a sixty-year time span.

  • Alcohol Research: Current Reviews.

    E-mail Citation »

    A quarterly, peer-reviewed scientific journal (formerly known as Alcohol Research & Health), offering a wealth of rigorously researched studies focusing on alcohol and related topics.

  • Grant, Bridget F., Deborah A. Dawson, Frederick S. Stinson, S. Patricia Chou, Mary C. Dufour, and Roger P. Pickering. 2006. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Alcohol Research & Health 29.2: 79–91.

    E-mail Citation »

    Prevalence of alcohol abuse and dependence in the United States during 1991 to 1992 and 2001 to 2002 is compared; although alcohol abuse increased, dependence declined over time. Dependence is highest among males and younger respondents and varies by ethnicity: highest in whites, Native Americans, and Hispanics, and increasing among young black females and Asian males.

  • Kim, Jean H., Sing Lee, Julie Chow, et al. 2008. Prevalence and the factors associated with binge drinking, alcohol abuse, and alcohol dependence: A population-based study of Chinese adults in Hong Kong. Alcohol and Alcoholism 43.3: 360–370.

    DOI: 10.1093/alcalc/agm181E-mail Citation »

    The relationship among binge drinking, alcohol abuse, and dependence in Hong Kong Chinese is examined. Prevalence of alcohol dependence for men was 2.3 percent versus 0.7 percent for women. Younger age groups had the highest prevalence, and smoking was associated with alcohol dependence for both genders. Changing lifestyles point to increasing numbers of alcohol-related problems.

  • National Institute for Health and Clinical Excellence. 2011. Alcohol-use disorders: The NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical practice guidelines 115. Leicester, UK: British Psychological Society.

    E-mail Citation »

    About 4 percent of the United Kingdom population is alcohol dependent. This new guideline reviews the evidence for the assessment and diagnosis of alcohol use disorders, organization and delivery of care, assisted alcohol withdrawal, and psychological and pharmacological interventions.

  • Rehm, Jürgen, Colin Mathers, Svetlana Popova, Montarat Thavorncharoensap, Yot Teerawattananon, and Jayadeep Patra. 2009. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet 373.9682: 2223–2233.

    DOI: 10.1016/S0140-6736(09)60746-7E-mail Citation »

    This study quantified the burden of mortality and disease attributable to alcohol, both globally and for ten large countries, estimating that 3.8 percent of all global deaths and 4.6 percent of global disability-adjusted life-years are attributable to alcohol. Alcohol disease burden is highest among poor people and those who are marginalized from society. Overall, alcohol consumption is one of the major avoidable risk factors.

  • Straussner, Shulamith L. A.. 2014. Assessment and treatment of clients with alcohol and other drug abuse problems: An overview. In Clinical work with substance-abusing clients. 3d ed. Edited by Shulamith L. A. Straussner, 3–36. New York: Guilford.

    E-mail Citation »

    This chapter provides an overview of the issues related to the scope, diagnosis, assessment, and treatment of alcohol problems (and other drugs) as they relate to social work clinicians.

  • Vaillant, George E. 2003. A 60-year follow-up of alcoholic men. Addiction 98.8 (August): 1043–1051.

    DOI: 10.1046/j.1360-0443.2003.00422.xE-mail Citation »

    Describes the course of problems for male alcoholics from age twenty to age eighty of two community cohorts: Harvard students and inner-city adolescents. By age seventy, chronic alcohol dependence in each group was rare due either to death or stable abstinence. Alcoholics Anonymous attendance predicted sustained abstinence. Available online for purchase or by subscription.

  • Willenbring, Mark L. 2010. The past and future of research on treatment of alcohol dependence. Alcohol Research & Health 33.1–2: 55–63.

    E-mail Citation »

    Over the past forty years, alcoholism treatment research has moved from anecdotal findings to well-designed studies. The National Institute on Alcohol Abuse and Alcoholism’s Project MATCH and Project COMBINE, as well as data from the National Epidemiologic Survey on Alcohol and Related Conditions, provided the foundation for problem definitions and new treatment approaches.

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