ohol abuse 

encompasses a spectrum of unhealthy alcohol drinking behaviors, ranging from binge

drinking to alcohol dependence, in extreme cases resulting in health problems for individuals and
large scale social problems such as alcohol-related crimes.
Alcohol abuse was a psychiatric diagnosis in the DSM-IV, and has been merged with alcohol
dependence into alcohol use disorder in the DSM-5.[1][2]
Globally, excessive alcohol consumption is the seventh leading risk factor for both death and
the burden of disease and injury. In short, except for tobacco, alcohol accounts for a higher burden
of disease than any other drug. Alcohol use is a major cause of preventable liver disease worldwide,
and alcoholic liver disease is the main alcohol-related chronic medical illness.[3] Millions of people of
all ages, from adolescents to the elderly, engage in unhealthy drinking. Alcohol use disorder can
affect people from all walks of life. There are many factors that play a role in causing someone to
have an alcohol use disorder: genetics, psychiatric conditions, trauma, environmental issues, and
even parental drinking habits.[

 eater than 14 standard drinks units per week or greater than 4 standard drinks on a single
occasion in men
 greater than 7 standard drinks units per week or greater than 3 standard drinks on a single
occasion in women
 any drinking in pregnant women or persons < 21 years old
Binge drinking is a pattern of alcohol consumption that brings blood alcohol concentration ≥ 0.08%,
usually corresponding to

 ≥ 5 standard drinks on a single occasion in men

 ≥ 4 standard drinks on a single occasion in women
In the DSM-IV, alcohol abuse and alcohol dependence were defined as distinct disorders from 1994
to 2013. The DSM-5 combined those two disorders into alcohol use disorder with sub-classifications
of severity. The DSM-IV definition is no longer used. There is no "alcoholism" diagnosis in medical
care.
Alcohol misuse is a term used by United States Preventive Services Task Force to describe a
spectrum of drinking behaviors that encompass risky drinking, alcohol abuse, and alcohol
dependence (similar meaning to alcohol use disorder but not a term used in DSM).

Signs and symptoms[edit]

Main article: Long-term effects of alcohol consumption
Individuals with an alcohol use disorder will often complain of difficulty with interpersonal
relationships, problems at work or school, and legal problems. Additionally, people may complain of
irritability and insomnia.[5] Alcohol abuse is also an important cause of chronic fatigue.[6] Signs of
alcohol abuse are related to alcohol's effects on organ systems. However, while these findings are
often present, they are not necessary to make a diagnosis of alcohol abuse. Signs of alcohol abuse
show its drastic effects on the central nervous system, including inebriation and poor judgment;
chronic anxiety, irritability, and insomnia. Alcohol's effects on the liver include elevated liver function
tests (classically AST is at least twice as high as ALT). Prolonged use leads to cirrhosis and liver
failure. With cirrhosis, patients develop an inability to process hormones and toxins. The skin of a
patient with alcoholic cirrhosis can feature spider angiomas, palmar erythema and — in acute liver
failure — jaundice and ascites. The derangements of the endocrine system lead to the enlargement
of the male breasts. The inability to process toxins leads to liver disease, such as hepatic
encephalopathy.[citation needed]
Alcohol abuse can result in brain damage which causes impairments in executive functioning such
as impairments to working memory and visuospatial function, and can cause an abnormal
personality as well as affective disorders to develop.[7][8] Binge drinking is associated with individuals
reporting fair to poor health compared to non-binge drinking individuals and which may progressively
worsen over time. Alcohol also causes impairment in a person's critical thinking. A person's ability to
reason in stressful situations is compromised, and they seem very inattentive to what is going on
around them.[9] Social skills are significantly impaired in people who have alcoholism due to
the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain.
The prefrontal cortex is responsible for cognitive functions such as working memory, impulse
control and decision making. This region of the brain is vulnerable to chronic alcohol-
induced oxidative DNA damage.[10] The social skills that are impaired by alcohol abuse include
impairments in perceiving facial emotions, difficulty with perceiving vocal emotions and theory of
mind deficits; the ability to understand humour is also impaired in alcohol abusers.[11] Adolescent
binge drinkers are most sensitive to damaging neurocognitive functions especially executive
functions and memory.[12] People who abuse alcohol are less likely to survive critical illness with a
higher risk for having sepsis and were more likely to die during hospitalization.[13]
A smaller volume of consumed alcohol has a greater impact on the older adult than it does on a
younger individual. As a result, the American Geriatrics Society recommends for an older adult with
no known risk factors less than one drink a day or fewer than two drinks per occasion regardless of
gender.[14][15][16][17][18][9][19][20][21][excessive citations]

Violence[edit]
Alcohol abuse is significantly associated with suicide and violence. Alcohol is the most significant
health concern in Native American communities because of very high rates of alcohol
dependence and abuse; up to 80 percent of suicides and 60 percent of violent acts are a result
of alcohol abuse in Native American communities.[22][failed verification]
In the United States alcohol-related violence is related to more severe injuries and chronic cases.[23]
[citation needed]

Pregnancy[edit]

A label on alcoholic drinks promoting zero alcohol during pregnancy

Alcohol abuse among pregnant women causes their baby to develop fetal alcohol syndrome. Fetal
alcohol syndrome is the pattern of physical abnormalities and the impairment of mental development
which is seen with increasing frequency among children with alcoholic mothers.[24] Alcohol exposure
in a developing fetus can result in slowed development of the fetal brain, resulting in severe
retardation or death. Surviving infants may have severe abnormalities such as abnormal eyes,
fissures, lips and incomplete cerebella. Some infants may develop lung disease. It is even possible
that the baby throughout pregnancy will develop heart defects such as ventricular septal defect or
atrial septal defect.[25] Experts suggest that pregnant women take no more than one unit of alcohol
per day. However, other organizations advise complete abstinence from alcohol while pregnant.[26]

Adolescence[edit]
Adolescence and the onset of puberty have both a physiological and social impact on a developing
person. About half of grade 12 students have been drunk, and a third binge drink. About 3% drink
every day.[27] One of these social impacts is the increase in risk-taking behaviors, such as the
emergence of alcohol use.[28] Children aged 16 and under who consume alcohol heavily display
symptoms of conduct disorder. Its symptoms include troublesome behaviour in school, constantly
lying, learning disabilities and social impairments.[29]
Alcohol abuse during adolescence greatly increases the risk of developing an alcohol use disorder in
adulthood due to changes to neurocircuitry that alcohol abuse causes in the vulnerable adolescent
brain.[30] Younger ages of initial consumption among males in recent studies has shown to be
associated with increased rates of alcohol abuse within the general population.[31]
Societal inequalities (among other factors) have influenced an adolescents decision to consume
alcohol.[32][citation needed] One study suggests that girls were scrutinized for "drinking like men", whereas
magazines that target the male population sent underlying messages to boys and or men that
drinking alcohol was "masculine". (Bogren, 2010)[33]

Causes[edit]
The cause of alcohol abuse is complex. Alcohol abuse is related to economic and biological origins
and is associated with adverse health consequences.[29] Peer pressure influences individuals to
abuse alcohol; however, most of the influence of peers is due to inaccurate perceptions of the risks
of alcohol abuse.[34] According to Gelder, Mayou and Geddes (2005) easy accessibility of alcohol is
one of the reasons people engage in alcohol abuse as this substance is easily obtained in shops.
Another influencing factor among adolescents and college students are the perceptions of social
norms for drinking; people will often drink more to keep up with their peers, as they believe their
peers drink more than they actually do. They might also expect to drink more given the context (e.g.
sporting event, house party, etc.).[35][36] This perception of norms results in higher alcohol consumption
than is normal. Alcohol abuse is also associated with acculturation, because social and cultural
factors such as an ethnic group's norms and attitudes can influence alcohol abuse.[37]

Mental illness[edit]
A person misusing alcohol may be doing so because they find alcohol's effects provide relief from a
psychological problem, such as anxiety or depression. Often both the alcohol misuse and
psychological problems need to be treated at the same time.[citation needed]
The numbing effects of alcohol and narcotics can become a coping strategy for traumatized people
who are unable to dissociate themselves from the trauma. However, the altered or intoxicated state
of the abuser prevents the full consciousness necessary for healing.[38]

Puberty[edit]
Gender differences may affect drinking patterns and the risk for developing alcohol use disorders.
[39]
 Sensation-seeking behaviors have been previously shown to be associated with advanced
pubertal maturation, as well as the company of deviant peers.[28] Early pubertal maturation, as
indicated by advanced morphological and hormonal development, has been linked to increased
alcohol usage in both male and female individuals.[40] Additionally, when controlling for age, this
association between advanced development and alcohol use still held true.[41]
Mechanisms[edit]
Excessive alcohol use causes neuroinflammation and leads to myelin disruptions and white
matter loss. The developing adolescent brain is at increased risk of brain damage and other long-
lasting alterations to the brain.[42] Adolescents with an alcohol use disorder damage
the hippocampal, prefrontal cortex, and temporal lobes.[30] Chronic alcohol exposure can result in
increased DNA damage in the brain, as well as reduced DNA repair and increased neuronal cell
death.[43] Alcohol metabolism generates genotoxic acetaldehyde and reactive oxygen species.[44]
Until recently, the underlying mechanisms mediating the link between pubertal maturation and
increased alcohol use in adolescence was poorly understood. Now research has suggested that sex
steroid hormone levels may play a role in this interaction. When controlling for age, it was
demonstrated that elevated estradiol and testosterone levels in male teenagers undergoing pubertal
development was linked to increased alcohol consumption.[45] It has been suggested that sex
hormones promote alcohol consumption behaviors in teens by stimulating areas in the male
adolescent brain associated with reward processing. The same associations with hormone levels
were not demonstrated in females undergoing pubertal development. It is hypothesized that sex
steroid hormones, such as testosterone and estradiol, are stimulating areas in the male brain that
function to promote sensation-seeking and status-seeking behaviors and result in increased alcohol
usage.[45]
Additionally, the enzyme TTTan aromatase, which functions in the male brain to convert
testosterone to estradiols, has been linked to addictive and reward-seeking behaviors. Therefore,
the increased activity of the enzyme may be influencing male adolescent alcohol-usage behaviors
during pubertal development.[46] The underlying mechanisms for female alcohol consumption and
abuse is still under examination, but is believed to be largely influenced by morphological, rather
than hormonal, changes during puberty as well as the presence of deviant peer groups.[40]
The brain goes through dynamic changes during adolescence as a result of advancing pubertal
maturation, and alcohol can damage long- and short-term growth processes in teenagers.[47] The
rapid effect of drugs releases the neurotransmitter dopamine which acts as reinforcement for the
behavior.[48]
Alcohol is the most recreationally used drug internationally,[49] throughout history it has played a
variety of roles, from medicine to a mood enhancer. Alcoholism and alcohol abuse however have
undergone rigorous examination as a disease which has pervasive physiological and biosocial
implications. The genesis and maintenance of the disease involves the mind, body, society and
culture. A common anthropological approach to understanding alcoholism is one which relates to a
social factor, and this is cross-cultural studies. The description and analysis of the degree of
possibilities in drinking and its results among various populations indeed constitutes one of
anthropology's major contributions to the field of alcohol studies. Understanding interactions
between factors and evaluating ideas regarding how alcohol usage correlates to other cultural
elements requires a number of cross-cultural comparisons. Anthropologists have analyzed a large
global sample of cultures examining the association between particular traits for each which relate to
the cultural components of alcoholism, these include significant measures which emphasize the
social system, reliance and anxiety and strength as physical and social measures. These are the
primary drivers of consuming alcohol affecting individuals on a psychosocial level.[50]
Individualistic cultures such as the United States or Australia are amongst some of the highest
consumers of alcohol in the whole world,[51] however this rate of consumption does not necessarily
coincide with the rate of abuse as countries like Russia which are highly collectivist see the highest
rates of Alcoholism. Research suggests that people who score highly on individualism, a trait
commonly fostered by the culture, report a lower rate of alcohol abuse and alcohol related disorders
so much so that the association was negative, however a higher average consumption of alcohol per
week. It is implied that individuals will drink more in a given setting, or on average because they are
less receptive towards negative social attitudes surrounding excessive consumption. This however
acts on another component, by where individualism protects from maladaptive consumption by
lowering the need to drink socially. The final axis by which individualism protects from abusive
consumption is that it promotes higher degrees of individualization and achievement values which
promote personally suited rewards, this allow the individual to be more cognizant of potential alcohol
abuse, and therefore protect from damaging mentalities in those who already identify as drinkers.[52]
Alcohol abuse also has a variety of biosocial implications, such as the physiologically effects of a
detox, how the detox period interacts with ones social life and how these interactions can make
beating alcoholism a complex, difficult process. Alcohol abuse can lead to a number of physical
issues and may even create a mental health condition, leading to a double classification for the
alcoholic. The stress, the social perceptions of these issues may reinforce abusive drinking habits.
Alcoholism is the most severe form of alcohol dependence and abuse, it is often in fact a
complicated hereditary disease. While it can run it families this is only a correlation and does not
prove that the inherited factors play a role. Genetic influences on its genesis are suggested by
numerous different sources of evidence. Alcoholism among adopted people has a stronger
correlation with their biological parents than with their adopted parents, according to adoption
research. Alcohol especially has a large effect on young and developing brains and chances of
further abuse, the culture surrounding the acceptable age of drinking therefore can be a biosocial
factor. This however isn't always preventable, alcohol when consumed during pregnancy is
profoundly damaging. The umbilical cord allows the mother's blood alcohol to reach the infant.
Consumption of alcohol during pregnancy can result in miscarriage, and a number of physical and
cognitive that can last a lifetime to the child. Therefore the biological implications of alcohol abuse
are also further reaching than just the physical issues experienced by the consumer.[53]