Alcohol

EDGAR P. NACE

Alcohol dependence continues to be one of the most costly health care problems in American society. The estimated social cost of alcoholism includes treatment costs, productivity costs associated with alcohol-related morbidity and mortality, and costs associated with alcohol-related crime and traffic crashes. The yearly dollar costs for alcoholism is projected to be more than $185 billion (Harwood, 2000). Violence is commonly associated with alcohol use, with an estimated 26% of offenders using alcohol at the time of their crime (Greenfield & Henneberg, 2001).

Epidemiology helps us understand the percentage of United States adults who experience either alcohol abuse or alcohol dependence. The National Comorbidity Study (Kessler et al., 1997) found that 2.5% of those interviewed could be classified as having abused alcohol during the past 12 months (see section on diagnosis for definitions of abuse and dependence). The same study determined that 7.2% could be diagnosed as alcohol-dependent during the previous 12 months. The Epidemiologic Catchment Area study (Regier et al., 1990) determined that 3.5% of Americans met criteria for alcohol abuse at some point in their lives, and an additional 7.9% met criteria for alcohol dependence at some point in their lifetime.

The age at which drinking is initiated has become earlier over the past decades. The earlier the age of onset, the greater the risk for dependence, as well as antisocial behavior.

Current dietary guidelines for Americans recommend that men consume no more than two drinks per day and women, no more than one drink per day

(Dufour, 2001). Consumption of more than five drinks per day is consistently associated with acute and chronic adverse consequences (Midanik, Tam, Greenfield, & Caetano, 1996) Cross-sectional surveys of drinking behavior in the United States have determined that at least 65% of Americans are current drinkers and average 88 drinking days per year. The average number of heavy drinking days per year is 13 (Greenfield, 2000).

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