Alcohol Use and Abuse

Many people use alcohol socially and moderately without any consequenses. Research actually shows that there may be some health benefits from moderate alcohol use. Some, however, abuse alcohol in ways that place themselves or others at risk for experiencing alcohol-related problems. This shapes the difference between alcohol use and abuse.

Moderate alcohol use is defined as drinking no more than two standard drinks per day for men, and no more than one per day for women and people sixty-five years of age and older. A standard drink is 0.5 ounces of alcohol, equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. These guidelines suggest that moderate or low alcohol use does not commonly result in negative alcohol consequences. For others, however, abstaining from all alcohol use is necessary to avoid negative consequenses. Groups who should avoid all alcohol use include pregnant women, children and adolescents, those planning to drive or participate in other activities requiring alertness, people who cannot maintain moderate alcohol use, and those who are using over-the-counter or prescription medicines that interact with alcohol.

Another way to understand drinking problems is to examine definitions of alcohol abuse. The World Health Organization (WHO) defines alcohol abuse as alcohol use that places people at risk for problems, including "at-risk use," "clinical alcohol abuse," and "dependence." At-risk alcohol use is the consumption of alcohol in a way that is not consistent with legal or medical guidelines, and it is likely to present risks of acute or chronic health or social problems for the user or others. Examples include underage drinking; drinking by individuals with a family history of alcoholism or problem drinking; or drinking if one has a medical condition that could be worsened by drinking, such as a stomach ulcer or liver disease. Clinical alcohol abuse results in one or more recurrent, adverse consequences, such as failure to fulfill important obligations or the repeated use of alcohol in physically dangerous situations. Alcohol dependence is the most severe type of alcohol abuse and involves a chronic disorder characterized by three or more symptoms within a twelve-month period. These symptoms include alcohol tolerance, withdrawal, loss of control, and continued use despite knowledge of having a physical or psychological problem.

Negative consequences resulting from alcohol use are estimated to affect more than 10 percent of the U.S. population, with many of these individuals going undetected. A number of brief screening tools are available to help detect possible alcohol problems. One of the most widely used among these is the four-item CAGE questionnaire, which derives its name from the following four self-administrated questions:

1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye-opener)?

Answering "yes" to as few as one or two items on the CAGE questionnaire may indicate a drinking problem.