Alcohol use disorders are categorized into mild, moderate, or severe based on the number of symptoms. The symptoms are referenced from The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria used nationwide by mental health professionals. Mild alcohol use disorder symptoms include; drinking more or for longer periods than intended and spending most of the time drinking or recovering from stupefaction. Moderate alcohol use disorder symptoms include; the persistent desire to quit or control alcohol use most of which are unsuccessful, strong desire to take alcohol, recurrent substance use leading to failure to meet responsibilities at home or work, and foregoing social interests in favor of alcohol consumption (Kiluk, Frankforter, Cusumano, Nich, and Carroll, 2018). Severe alcohol use disorder symptoms are manifested by continuing a pattern of drinking when aware of interpersonal and physical repercussions, increased alcohol tolerance, and lastly withdrawal symptoms.
According to the National Survey on Drug Use and Health (NSDUH) 2018 report, 14.1 million adults aged 18 and older had alcohol use disorder. The U.S economy loses $249 billion each year to alcohol-related services such as medical expenses and alcohol-related crimes such as drunk driving. Personally, alcohol addiction leads to absenteeism, low work productivity, and unemployment. Alcoholism is a major factor in divorces due to failure to meet obligations. Societal costs involve the alcohol-related deaths where there are an estimated 100,000 lives lost due to alcoholism in the U.S.
Several different models explain alcohol dependence such as the moral model, psychodynamic model, disease model, social learning model, public health model. The moral model considers addicted people as morally and spiritually weak. Individual choices are described as the main fault of alcohol dependence. The disease model views addiction as a medical disorder. The assumption is that the origin of the addiction lies within the individual and is either present or not. The disease model suggests addicted people cannot control their cravings for alcohol once they start consumption. The model implies the addiction is permanent and cannot be cured only treated through abstinence.
The psycho-dynamic model links childhood development with alcohol dependence as an unconscious response to childhood trauma (Rosenström, Torvik, Ystrom, Czajkowski, Gillespie, Aggen, and Reichborn‐Kjennerud, 2018). Social learning explains dependence based on behavior and the social nature of the drug. Dependence is influenced by the user’s view regarding alcohol and its effects. The model analyses operant conditioning that involves the association of behavior and consequences by focusing on either reinforcements or punishment. People who find alcohol pleasurable have a high risk of developing dependence. The social-cultural model focuses on the environmental factors that lead to dependency such as inequality. The model suggests socially disadvantaged people are more likely to develop addictions.
Biological, Psychological, Sociological, and Spiritual Manifestation of Alcohol Dependency.
The long-term effects of alcohol dependency include hypertension which occurs when blood pressure against the artery walls is too high, leading to heart diseases such as congestive heart failure. The liver organ metabolizes alcohol thus continued consumption leads to liver damage and blocking of bile ducts leading to hepatitis. Continued alcohol dependence also leads to brain damage as the chemicals block signals between neurons. The psychological effects of alcohol dependency include changes in moods such as anxiety and depression, cognitive abilities, level of consciousness, perception, behavior, and judgment. Alcohol slows down inhibition as it acts as a depressant to the central nervous system leading to impaired judgments. Alcohol dependency also leads to an alcohol-induced depressive disorder where one needs alcohol as a remedy for the mood disorder (Hogarth, Hardy, Mathew, and Hitsman, 2018). It also leads to personality disorders such as hallucinations and increased suicidal tendencies).
The manifestation of alcohol dependency in a society mostly affects the family unit. Alcohol dependent spouses have a high affinity for domestic violence which leads to marital breakups. Alcohol dependency also affects the performance of role as parents especially through lack of time for children and income generation for the family. Alcohol dependency also leads to work problems such as work accidents which affects productivity. There are also increased chances of risky behaviors such as drunk driving leading to fatal accidents.
Evaluation and Intervention Methods
One of the intervention techniques is Screening, Brief Intervention, and Referral to Treatment (SBRIT), a comprehensive public health approach for early identification and intervention. It is used on people with substance use disorder and whose patterns of alcohol use place them at higher risk levels of dependency (Toner, Böhnke, and McCambridge, 2017). The first step in SBRIT is to screen people to assess the level of drug use. The second step is a brief intervention which involves raising awareness with the individual regarding substance use such as behavioral change. The third step is a referral to treatment which refers to aftercare. Treatment consists of brief treatment such as education and coping mechanisms or special alcohol use disorder techniques.
The Alcohol Use Disorders Identification Test (AUDIT) tool screens individuals to pick up the early signs of mild dependence and hazardous drinking practices. The tool was developed by the World Health Organization and is one of the most accurate tests in detecting alcoholism preliminary signs with a 92% success rate across ethnic and gender groups. The test incorporates a 10-item questionnaire on drinking behavior, frequency, and quantity. A score of more than eight reflects an alcohol problem.
NIDA Quick Screen is used by primary care physicians to evaluate their patients for alcohol, tobacco, non-medical prescription, and illegal drug use. It entails a digital screening tool and reference guide and comprehensive resource for medical practitioners. The alcohol screening and brief intervention for youth is a tool used to screen children and adolescents between ages 9-18 years to identify risk levels for alcohol-related problems. The model uses a two-questionnaire test to predict current and future problems relating to alcohol use.
Evaluate How Issues Related to Alcohol Dependence Apply to Specific Populations
Alcohol dependence in women is more severe in women than men since they tend to absorb more alcohol content and metabolize it longer thus enhancing the negative effects. Women associated with alcohol use are more susceptible to developing breast cancer. Alcohol use during the prenatal stage increases the risk of stillbirths and fetal alcohol spectrum disorders (FASD) such as cognitive disabilities and physical birth defects. Alcohol is the drug of choice among the underage population and college students. Alcohol dependence among adolescents and college students is associated with violence, unsafe sex, educational failure, and suicide attempts. Unsafe sex leads to early pregnancies and the risk of contracting sexually transmitted infections. Elderly individuals are more prone to comorbidities than younger adults due to decreased metabolism rate and tolerance rate. Chronic alcohol use in older adults often results in aggravated medical conditions such as diabetes and hypertension. The elderly also suffer from hip fractures from falls due to distorted movements. The workplace environment requires attention whereas alcohol use distorts cognitive ability leading to reduced productivity and increased work injuries leading to dismissal. In the United Kingdom, 25 % of workplace accidents are attributed to alcohol use (Roche, Kostadinov, McEntee, Allan, Meumann, and McLaughlin, 2019). Military personnel often use alcohol to mask depression and post-combat stress leading to dependence. This leads to strained relationships with families, increased mood swings, and alcohol related injuries as they become violent while intoxicated.
Hogarth, L., Hardy, L., Mathew, A. R., & Hitsman, B. (2018). Negative mood-induced alcohol-seeking is greater in young adults who report depression symptoms, drinking to cope, and subjective reactivity. Experimental and clinical psychopharmacology, 26(2), 138.
Kiluk, B. D., Frankforter, T. L., Cusumano, M., Nich, C., & Carroll, K. M. (2018). Change in DSM‐5 alcohol use disorder criteria count and severity level as a treatment outcome indicator: results from a randomized trial. Alcoholism: Clinical and Experimental Research, 42(8), 1556-1563.
Le Berre, A. P. (2019). Emotional processing and social cognition in alcohol use disorder. Neuropsychology, 33(6), 808.
Roche, A., Kostadinov, V., McEntee, A., Allan, J., Meumann, N., & McLaughlin, L. (2019). Evaluation of a workshop to address drugs and alcohol in the workplace. International Journal of Workplace Health Management.
Rosenström, T., Torvik, F. A., Ystrom, E., Czajkowski, N. O., Gillespie, N. A., Aggen, S. H., … & Reichborn‐Kjennerud, T. (2018). Prediction of alcohol use disorder using personality disorder traits: a twin study. Addiction, 113(1), 15-24.
Toner, P., Böhnke, J. R., & McCambridge, J. (2017). A systematic review of alcohol screening and assessment measures for young people: a study protocol. BMJ Open, 7(5), e016406.