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Problem Drinker? You're Not Alone.

Tuesday, June 17, 2008

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 (NESARC), 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 L. Willenbring of the NIAAA. "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."

-- David Brown

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