Alcohol and Alcohol Use Disorder _ _____________________________________________________________
prices. Other sources cite increased health awareness, national drunk-driving campaigns, and a less tolerant public attitude toward heavy drinking and youth intoxication [8]. This roller coaster of historical attitudes toward alcohol use results from conflicting sociologic and psychological factors. For centuries, alcohol has been part of our social fabric and part of holidays and traditions. Simultaneously, our society has either shunned or punished those who succumbed to alcohol abuse, treating dependence as a legal issue or a moral failing rather than as a mental health problem. On one hand, alcohol is readily and cheaply accessible, safe for most people, moderately beneficial to health, and an important sector of our economy. However, we also understand that some individuals are at a high risk of losing control over alcohol. CURRENT ESTIMATES OF ALCOHOL USE As many as 90% of adults in the United States have had some experience with alcohol [11]. People drink alcohol for a variety of reasons: • The pleasurable feeling that often accompanies drinking, including reduced tension and/or anxiety • Enjoyment of the taste
Use of alcohol is higher for college graduates compared to those with only a high school diploma (66.2% and 33.8%, respectively) [12]. However, binge and heavy use is slightly higher for young adults 18 years of age and older who have not completed college [12]. The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use among full-time college students, compared with rates for others 18 to 22 years of age, has remained consistent since 2002 [14]. In a 2002 study of alcohol use on college campuses, researchers at Harvard University reported that of the more than 14,000 students surveyed, 31% met the criteria for alcohol abuse and an additional 6% met the criteria for diagnosis of alcohol dependence [15]. In the study, alcohol abuse was defined as a positive response to any one of the four abuse criteria and the absence of dependence. Alcohol dependence was defined as a positive response to any three or more of seven dependence criteria. Percentages of students meeting specific alcohol abuse and dependence criteria are presented in Figure 1 [15]. Male students are at greater risk than female students. Almost 10% of male students and 5% of female college students younger than 24 years of age met the criteria for a 12-month diagnosis of alcohol dependence [15]. About 40% of people who drink have experienced an alcohol- related problem [11]. Between 3% and 8% of women and 10% to 15% of men will develop alcohol use disorder at some point in their lives. While alcohol use disorders can develop at any age, repeated intoxication at an early age increases the risk of developing an alcohol use disorder [11]. Usually, dependence develops in the mid-twenties through age forty. COSTS OF ALCOHOL USE DISORDERS The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimated that the annual economic cost of alcohol and drug abuse was $365.4 billion in 1998 [9]. This estimate represents roughly $1,350 each year for every man, woman, and child living in the United States. Alcohol use disorders generated about half of the estimated costs ($184.6 billion). This figure rose to $249 billion in 2010, representing approximately $807 for every man, woman, and child living in the United States [16]. Nearly three-fourths (72%) of the costs of alcohol abuse are related to lost workplace productivity ($179 billion); 11% are related to healthcare expenses for treating problems caused by excessive drinking ($28 billion); 10% are law enforcement and other criminal justice expenses ($25 billion); and 5% are losses from motor vehicle crashes related to excessive alcohol use ($13 billion) [16]. Binge drinking is responsible for the majority of the cost at $191 billion [16]. Alcohol use disorder generally reduces the lifespan by 15 years [11]. Approximately $99.6 billion of the total costs of alcohol abuse is paid by federal, state, and local governments [16]. When both direct and indirect costs are included, the estimated annual cost of alcohol-related problems alone may be much greater [16].
• Social inclusion • Self-medication • Peer pressure • Behavioral and physical addiction
Nearly one-half (47.4%) of all Americans older than 12 years of age reported being current consumers of alcohol in the 2022 National Survey on Drug Use and Health [12]. This translates to an estimated 137.5 million people, slightly less than the 2019 estimate of 139.7 million people [12]. An estimated 21.7% of Americans participated in binge drinking at least once in the 30 days prior to the survey. This represents approximately 61.1 million people. Heavy drinking was reported by 5.7% of the population 18 years of age and older (16.0 million people) [12]. The 2022 estimates for binge and heavy drinking are lower than the 2019 estimates [12]. There is some evidence that drinking and alcohol-related injuries increased during the COVID-19 pandemic [13]. National mortality data revealed a 25% increase in alcohol- related deaths from 2019 to 2020, outpacing the all-cause increase in mortality over the same period (16.6%). Binge drinking among various races is 10.9% for Asian Americans, 21.3% for Black Americans, 26.5% for persons reporting two or more races, 22.2% for White Americans, and 23.1% for Hispanic Americans [12].
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