______________________________________________________________ Alcohol and Alcohol Use Disorder
abusive parent was abused themselves or witnessed a parent or sibling being abused. Although several studies report very high rates of alcoholism among the parents of incest victims, much additional research in this area is needed [194; 195]. VIOLENCE Among some individuals and subgroups, excess alcohol consumption is associated with the risk of violent behavior. Alcohol may encourage aggression or violence by disrupting normal brain function, especially in levels of serotonin [196]. There is considerable overlap among nerve cell pathways in the brain that regulate aspects of aggression, sexual behavior, and alcohol consumption. Alcohol may weaken brain mechanisms that normally restrain impulsive behaviors, including inappropriate aggression. Drinking and violence may occur together by chance. Also, violent criminals who drink heavily are more likely to be caught and consequently are over-represented in samples of people arrested for violent behavior. Antisocial personality disorder (ASPD) and early-onset alcoholism are common traits in many criminals. A person who intends to engage in a violent act may drink to bolster his or her courage or in hopes of evading punishment or censure. The motive of drinking to avoid censure is encouraged by the popular view of intoxication as a “time-out,” during which a person is not subject to the same rules of conduct as when sober. Such alcohol-violence interactions are not readily treated. However, ongoing research has identified medications that have the potential to reduce violent behavior in both alcoholic and nonalcoholic subjects. Young men who exhibit violent and antisocial behaviors often “burn out” with age [197]. By the time they reach 40 years of age, serotonin concentrations are increasing and testosterone concentrations are decreasing, both of which help to restrain violent behavior [198]. Research suggests that increasing the unit price of alcohol by raising alcohol taxes is an effective strategy for reducing excessive alcohol consumption and related harms, including violent behavior [199]. An examination of the impact of the price of alcoholic beverages on violence and other delinquent behavior among college students found that an increase in the price of beer could reduce the overall number of students involved in some sort of violent behavior by 4% [200]. In a study that used data from the National Household Survey on Drug Abuse, higher taxes on beer led to significant reductions in crime (e.g., property damage, use of force), with the largest impact among individuals younger than 21 years of age [201]. Another study that examined the impact of tax increases and advertising bans on reducing the prevalence of underage drinking and subsequent alcohol-related harms found both interventions to be effective [202]. A literature review of studies of underage populations found that increased taxes were significantly associated with reduced consumption and alcohol-related harms [203]. Public policies that affect the price of alcohol appear to have significant effects on alcohol-related
disease and injury rates. The results of one systematic review suggest that doubling the tax on alcoholic beverages could reduce alcohol-related violence by 2% and crime by 1.4% [204]. According to the National Council on Alcoholism and Drug Dependence, on college campuses each year an estimated 696,000 students 18 to 24 years of age are assaulted by another student who has been drinking, and 97,000 students report experiencing alcohol-related sexual assault or date rape [205]. Four out of every five juvenile and teen arrestees are under the influence of alcohol or drugs while committing their crimes, test positive for drugs, are arrested for committing an alcohol- or drug-related offense, admit having substance abuse problems, or share some combination of these characteristics [206]. TRAFFIC ACCIDENTS In 2022, 10,317 people died in alcohol-related traffic fatalities, accounting for 32% of all traffic-related deaths in the United States [207]. Of the 1,090 traffic-related fatalities in 2020 among children 0 to 14 years of age, 229 (21%) involved an alcohol-impaired driver [208]. Of the estimated 127 million episodes of alcohol-impaired driving among U.S. adults, 1 million drivers were arrested for driving under the influence [208]. The CDC estimates that 32 people in the United States die in alcohol-related crashes every day [208]. In a study of persons who have been convicted of driving while impaired, 85% of women and 91% of men reported a lifetime alcohol use disorder [209]. Psychiatric comorbidity may be a key element distinguishing driving under the influence (DUI) offenders from others and in distinguishing repeat offenders from first- time offenders [210]. A study found that although marijuana’s effects on driving performance were small or moderate when taken alone, the effects were severe when combined with even a low dose of alcohol. These findings are very serious considering the frequency with which these two substances are combined, especially in young inexperienced drivers [211; 212; 213; 214; 215]. One study conducted at seven trauma centers involving 4,243 drivers who were seriously injured in crashes found that 54% of these drivers tested positive for alcohol and/or drugs from September 2019 to July 2021. Of these, 22% of the drivers tested positive for alcohol, 25% tested positive for cannabis, 9% tested positive for opioids, 10% tested positive for stimulants, and 8% tested positive for sedatives [216].
OTHER PSYCHIATRIC DISORDERS ASSOCIATED WITH ALCOHOL USE DISORDERS
Persons with alcohol use disorder, like other addicts, generally have comorbid disorders, meaning they have alcohol problems as well as other illnesses or conditions [217]. These problems may include personality disorders (formerly Axis II disorders), other drug use (especially tobacco use disorders), or a number of
61
MDMI1826
Powered by FlippingBook