Alcohol Abuse Category Addition Proposed
> 6/24/2008 11:56:05 AM

For the millions who often drink a bit more than they should but don’t quite qualify as alcoholics, Finnish researchers call for a new classification preceding abuse and dependence. Officially termed “hazardous drinking,” this label could be applied to the many who, while not clinically addicted to alcohol, regularly drink to excess. The group's concerns are valid given the fact that many downplay their own drinking problems by insisting that, as diagnostic definitions go, they have no real problems at all.

There are differing opinions on what constitutes alcohol usage in need of clincal attention. Because one instantiation of this new condition has been defined as “drinking more than guidelines recommend,” it may present a bit of a problem.Millions drink more than 2-3 drinks at a sitting - at least on occasion. A slightly less inclusive definition of “drinking too much and being at risk but not alcohol dependent” was found by Finnish researchers to apply to nearly 6% of a subject pool consisting of nearly 4,500 Fins, aged 30 to 64, with near-equal gender representation.

Some already classify abuse as “any harmful use” of alcohol “despite negative consequences,” leading one to wonder how the proposed “hazardous” label differs from the previous category. The ceiling for the condition, however, was rather high, which explains why only 6% of the sample qualified, and why those who did should be concerned. Male subjects had to have averaged at least 24 drinks per week during the previous year, which is higher than other figures. The magic number for women was 16 drinks a week - still quite a hefty total. Since very few individuals drink every day, affected subjects likely drank to excess during each sitting. So why do they not qualify as dependent? The major factor seems to be the health problems that inevitably come with alcohol dependence. Most of the 6% had yet to experience the withdrawal, incredibly high tolerance, or cardiovascular problems that come with long-term heavy drinking. Over time, however, they almost certainly would develop these conditions. 

Researchers found problem drinking rates to be highest among men, subjects over the age of 40, the unmarried or divorced, and the unemployed. Classifying every degree of unhealthy drinking as a separate clinical condition may not be the most productive approach. Still, it can raise the issue that many who aren’t strictly dependent on or addicted to alcohol still use it in dangerous ways. And it might break the tendency of those who don’t quite qualify for later conditions to dismiss their troublesome habits. Researchers voice the concern that such drinkers, witnessing the behaviors of others who drink just about the same amount as they do (or more) can more easily justify their own behavior. This is especially true of those with heavier-drinking friends.

Will a new classification in any way curb the considerable public health issue posed by problem drinking? Probably not. But it will certainly draw out the conversation which may have been researchers’ primary goal. It could, if further established, lead some individuals to curb their worrying but not quite disordered drinking before it grows to justify a more extreme diagnosis. It may also provide doctors with a talking point through which to address concerns they have with their clients. We can certainly agree with researchers that “this is an issue that needs to be debated.” - Patrick Coffee



What purpose do the classifications serve? Aren't most people likely to feel "let off the hook"?
Posted by: Kathy 6/24/2008 1:15:56 PM

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