Alcohol Use and Misuse
Mark D. Wood
University of Rhode Island
Daniel C. Vinson
Kenneth J. Sher
University of Missouri-Columbia
Alcohol consumption is a complex, multifaceted phenomenon related to both objective drinking topographies such as quantity, frequency, and patterns of use, and to accompanying physiological, psychological, and social consequences. Adverse consequences from drinking may occur as a result of chronic misuse (e.g., pancreatitis, liver disease), or from single episodes of hazardous use (e.g., alcohol-related motor vehicle crashes). Although alcohol abuse and dependence often tend to be the focal points for discussion of alcohol- related problems, a burgeoning literature on the association between hazardous drinking (e.g., intoxication, heavy drinking) and various types of bodily trauma highlights the importance of recognizing that even “nonproblem” drinkers are placed at substantially increased risk as a function of alcohol consumption (Klatsky, Friedman, & Siegelaub, 1981; National Institute on Alcohol Abuse and Alcoholism, [NIAAA], 1997). In this chapter we use the term alcohol use to describe any alcohol consumption, and group hazardous drinking, alcohol abuse, and alcohol dependence under the label alcohol misuse.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association, APA, 1994) defines two major categories of alcohol use disorders: alcohol abuse and alcohol dependence. Alcohol abuse, or nondependent problem drinking, is characterized by one or more of the following as a result of alcohol use: (a) failure to fulfill major role obligations; (b) recurrent physically hazardous use; (c) recurrent alcohol-related legal problems; or (d) continued use despite persistent alcohol-related social or interpersonal problems. Alcohol dependence is characterized by three (or more) of the following symptoms occurring at any time in a 12. month period: (a) tolerance; (b) withdrawal; (c) alcohol consumption frequently in larger amounts or over a longer period than was intended; (d) persistent desire to reduce intake or unsuccessful attempts to control alcohol use; (e) a great deal of time engaging in activities to obtain alcohol or to recover from its effects; (f) limiting or suspending important social, occupational, or recreational activities because of alcohol use; and (g) continued use despite persistent alcohol- related physical or psychological problems. Alcohol dependence is further subtyped as occurring with or without physical dependence (i.e., tolerance and withdrawal).
There are two predominant methods for measuring alcohol consumption. Production and distribution statistics (e.g., tax records of total beverage sales) are analyzed to estimate Per capita consumption at the population level, and surveys are used to examine consumption patterns among both the general population and various targeted subpopulations. Apparent per capita consumption represents an estimate of consumption calculated to include all individuals age 14 and