Alcohol and Alcohol Use Disorder _ _____________________________________________________________
PROTECTIVE FACTORS An exciting area of research is focused on protective factors and poses the question, “What protects children from taking one of the risk pathways to alcohol use disorder?” In 1997, some good news came from the National Longitudinal Study on Adolescent Health, a survey in which nearly 12,000 students in grades 7 through 12 were given lengthy interviews timed one year apart. The researchers were trying to determine what kept children, over the course of that year, from taking health risks in four areas: substance abuse (cigarettes, alcohol, and marijuana), sexuality, violence, and emotional health [86]. The researchers found two factors that protected these children in all four areas. They named the factors: parent-family connectedness and school connectedness. Children identified as having parent-family connectedness said they felt close to their mother or father, felt that their mother or father cared about them, felt satisfied with their relationship with their mother or father, and felt loved by family members [86]. School connectedness was experienced as a feeling of being part of one’s school and a belief that students were treated fairly by the teachers. There is broad evidence of the protective role of parenting on adolescent health risks. Another well-established protective factor is adolescents’ perceived disapproval of alcohol use by their parents [87; 88; 89; 90; 91]. In 2022, the National Survey on Drug Use and Health asked children 12 to 17 years of age about their perceptions of the level of parental disapproval of substance use initiation, including alcohol [12]. Most adolescents (88.9%) reported that their parents would strongly disapprove of them having one or two alcoholic drinks nearly every day. This percentage was similar to percentages in most years since 2002, with rates ranging from 88.5% to 91.2% [12]. The number of past-year initiates 12 years of age or older for alcohol also remained stable between 2002 and 2022 [12]. ALCOHOL USE DISORDER Alcohol use disorder, also referred to as alcohol abuse and/ or alcohol dependence, is defined in the DSM-5-TR as a problematic pattern of use with two or more of the following criteria over a one-year period [17]: • Alcohol often taken in larger amounts or over a longer period than was intended • A persistent desire or unsuccessful efforts to cut down or control alcohol use • A great deal of time spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects • Craving, or a strong desire or urge to use alcohol • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
• Important social, occupational, or recreational activities given up or reduced because of alcohol use • Recurrent alcohol use in situations in which it is physically hazardousAlcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol • Tolerance • Withdrawal Alcohol use disorder is extremely amenable to brief intervention. Brief intervention usually includes giving patients information about problems associated with excessive drinking and advising them to cut down on their drinking or abstain. Without intervention, 10% will likely progress to dependence and 50% to 60% will continue to experience problems over the next five years [92; 93]. Alcohol use disorder is a primary and chronic disease that is progressive and often fatal; it is not a symptom of another physical or mental condition. It is a disease in itself, like cancer or heart disease, with a very recognizable set of symptoms that are shared by others with the same disorder. About 29.5 million people in the United States met DSM-5-TR criteria for alcohol use disorder in 2022, with an additional 5.3 million abusing or dependent on both alcohol and illicit drugs [12; 94]. Like cancer and many other chronic diseases, alcohol use disorder progresses over time. People with alcohol use disorder experience physical, emotional, and other changes in their lives and relationships. These changes may worsen if drinking continues and if treatment specifically targeted to alcohol use disorder is not initiated. Left untreated, alcohol use disorders may lead to premature death through overdose or through damage to the brain, liver, heart, and many other organs. Excessive alcohol consumption is highly associated with suicide, motor vehicle accidents, violence, and other traumatic events [94]. People with untreated alcohol use disorders often lose their jobs, their families, their relationships, and other freedoms that were once important to them. As noted, alcohol problems can often be prevented by early identification and brief intervention. A weak link in the early identification of problems is the lack of skill and competencies necessary to perform such an assessment and the experience to confidently move to more specific questions and suggestions for change. Alcohol dependence is included in the DSM-5-TR umbrella definition of alcohol use disorder [17]. The symptoms of withdrawal and tolerance have been the hallmarks of more severe disease, though alone they are neither necessary for nor sufficient to make the diagnosis. Healthcare professionals should understand the criteria and warning signs of alcohol use disorder. This enables confrontation and intervention earlier in the course of the illness rather than relying on toxic liver markers. Verifying the facts that show a person is at risk for alcohol use disorder and confronting the impaired individual with those facts
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