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PROBLEM
drinking comes in a range of severity and demographic
subtypes but is quite common and substantially
undertreated, according to several recent studies.
There
are two main disorders: alcohol abuse and alcohol
dependence. The former is less severe and is marked by
drinking that leads to at least one of four problems:
physically risky behavior (such as drinking and
driving); interpersonal difficulties; “role failures” at
home, school or work; and legal troubles. Dependence
requires numerous features from a longer list and is
characterized by preoccupation with drinking, inability
to cut back and symptoms of physical need and
withdrawal.
A
federal landmark study, the National Epidemiologic
Survey on Alcohol and Related Conditions, last year
reported findings from 43,000 face-to-face interviews
with a sample of Americans age 18 or older. It found
that 4.7 percent had suffered from alcohol abuse and 3.8
percent from dependence in the preceding year, and
17.8-percent alcohol abuse and 12.5-percent dependence
sometime in their lives. The average age of onset for
either disorder was about 22.
About 24
percent of people with dependence, the more severe
condition, had received treatment at some point in their
lives, about half in the previous year. For those with
alcohol abuse, the numbers were smaller: 7 percent and 3
percent.
The
statistics encompass heterogeneous groups of problem
drinkers, each with its own profile and natural history.
The researchers described five. The most common was the
“young adult subtype,” affecting men more than twice as
often as women, with most people in their 20s. They
don’t have a strong family history of alcoholism, and
they drink less frequently than people in the other
subtypes: about 140 days a year, with more than five
drinks most of those days. Once drinking, though, they
consume a lot, with an average maximum of 14 drinks.
The
other subtypes include people with various
constellations of symptoms and histories, including
various amounts of family and work stability, medical
problems from drinking and coexisting mental illness or
other substance abuse.
One
subtype that the new strategy for treatment seems to be
aimed at, however, is a high-functioning group of people
who are mostly in their 40s, with men predominating only
slightly. They work, are often married and have
seemingly stable lives, even though they have more than
five drinks about a hundred days a year. Only 17 percent
had sought treatment, the survey found.
“The
people not seeking help tend to have less severe
disorders and are more functional,” said Mark
Willenbring of the National Institute on Alcohol Abuse
and Alcoholism. “It doesn’t mean their drinking doesn’t
cause pain and unhappiness. But it may not mean they are
so dysfunctional that they lose their job, they drop out
of school, they get divorced.” |
