Alcoholism

             Alcoholism, chronic and usually progressive illness involving ingesting inappropriately high levels of ethyl alcohol, whether in the form of familiar alcoholic beverages or as a constituent of other substances. Alcoholics will drink to such an extent that that they exhibit an emotional and often physical dependence on alcohol classified by the World Health Organization (WHO) in 1977 as “alcohol dependence syndrome”. This term continues to be included in the International Classification of Diseases (10th revision). The transition between continued excessive alcohol consumption and alcoholism is an individual behaviour and the condition of degrees rather than absolutes: low risk or sensible; increasing risk or hazardous; high risk or harmful. It is thought to arise from a combination of a wide range of physiological, psychological, social, and genetic factors. Alcoholism frequently leads to brain damage or early death.

                  More men than women are directly affected by alcoholism. The heaviest drinkers have traditionally been men in their late teens or early twenties, but drinking among the young generally and among women is increasing. Peer pressure is likely to play an important role in encouraging the young to start drinking. In the developed world, male and female drinking patterns are converging. “Binge drinking” (heavy episodic drinking) among young women is a particular cause for concern. For various physiological reasons, besides smaller body-size, women are less able to tolerate alcohol. Consumption of alcohol is apparently on the rise in the United Kingdom and the United States, as is the total alcohol consumption and prevalence of alcohol-related problems in the former communist countries of Eastern Europe and the former Soviet Union (where alcohol is often produced at home). It is estimated that alcohol-use disorders reached 10 per cent of the adult male population in North America and Eastern Europe in 2000. This increase is paralleled in other countries, including developing nations, where home production is also common and therefore consumption is much more difficult to control through legislation.

                     The WHO calculates that alcohol-related problems account for about 4 per cent of the global disease and injury burden. For comparison, tobacco use accounts for 4.1 per cent and high blood pressure 4.4 per cent. In the developed world, 9.2 per cent of disability-adjusted life years (DALYs) lost are due to alcohol. In the developing world, the figure is 6.2 per cent, but as a contribution to disease, injury, disability, and premature death, it is the single greatest risk factor.

An excessive alcohol intake is frequently associated with other high-risk behaviours, for example, unsafe sex and the use of other psychoactive drugs. This pattern leads to co-morbidity with the ill health caused by other forms of drug dependence, sexually transmitted diseases, and, for women, unplanned pregnancy.

In addition to the self-inflicted harm caused by alcoholism, an alcoholic presents a danger to those living in close contact. Rates of domestic violence are higher where there is an alcoholic in the family, and the general standard of living is frequently compromised. The social costs of heavy drinking also include death and injury caused by drink driving and the added burden on healthcare providers of dealing with accidents and intentional harm.

                   The WHO estimated that in 2000, 1.8 million deaths (3.2 per cent) were due to the use of alcohol. In studies in the United Kingdom, United States, and Sweden it is estimated that the mortality rate among excessive drinkers is twice that otherwise expected. Among women aged between 15 and 39 years it may be as high as 17 times greater.