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Adolescence and Alcohol: a review of the literature

Affiliation.

• 1 Department of Child- and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. [email protected]
• PMID: 23839238
• DOI: 10.1007/s40211-013-0066-6

Up to two thirds of adolescents consume alcohol and about a quarter engage in abusive behavior at some point. Many users begin alcohol use at young ages, and binge drinking is a dominant pattern for a proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of adolescent alcohol abuse include changes in brain development and impairment of neurocognitive performance. A variety of mental and psychosocial problems are also often witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and psychosocial factors, the chance of developing problematic alcohol consumption is increased by consumption in a binge drinking manner and by first contact with alcohol at a young age. Discrimination of alcohol consumption within the frames of normal adolescent behavior from problematic use is still a challenging issue. Different prevention programs provide treatment either directly to the adolescent, in the context of the school, or within the frame of the adolescent's family. Although some of these efforts have been shown to be effective in reducing alcohol misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term prospect. Successful prevention strategies would need to comprise treatment of current neuropsychological impairment as well as of comorbid mental health problems and concurrent other substance misuse.

Publication types

• Alcohol Drinking / adverse effects
• Alcohol Drinking / epidemiology*
• Alcohol Drinking / prevention & control
• Alcohol Drinking / psychology
• Alcohol-Induced Disorders, Nervous System / epidemiology
• Alcohol-Induced Disorders, Nervous System / prevention & control
• Alcohol-Induced Disorders, Nervous System / psychology
• Alcoholism / epidemiology*
• Alcoholism / prevention & control
• Alcoholism / psychology
• Binge Drinking / epidemiology*
• Binge Drinking / prevention & control
• Binge Drinking / psychology
• Cross-Sectional Studies
• Follow-Up Studies
• Outcome and Process Assessment, Health Care
• Prospective Studies
• Risk Factors
• Temperance / psychology
• Temperance / statistics & numerical data

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• Alcohol Health Res World
• v.20(3); 1996

The Natural History of Alcoholism

Over the past 55 years, two longitudinal studies have been monitoring the drinking behaviors and their consequences of several hundred men from adolescence and early adulthood to old age. The studies identified co-occurring sociopathy, cultural factors (e.g., ethnicity), and genetic factors (i.e., a family history of alcoholism) as risk factors for alcoholism. n most alcoholics, the disease had a progressive course, resulting in increasing alcohol abuse or stable abstinence. However, some alcoholics exhibited a nonprogressive disease course and either maintained a stable level of alcohol abuse or returned to asymptomatic drinking. Long-term return to controlled drinking, however, was a rare and unstable outcome. Formal treatment, with the exception of attending Alcoholics Anonymous, did not appear to affect the men’s long-term outcomes, whereas several non-treatment-related factors were important for achieving stable recovery.

In many ways, alcoholism differs from most other diseases. First, it generally develops slowly over a person’s life and can occur in people of all ages. Second, it has no single known cause: Heredity, culture, economics, and the environment all contribute to its development, and each alcoholic has his or her own personal drinking history. Third, both alcoholics and their alcohol-related disabilities can change over time. For example, alcohol can have long-term effects on the central nervous system that may alter an alcoholic’s personality and perception of the past. Finally, no known cure exists; although some patients recover either “spontaneously” or after treatment, many patients never recover. In an effort to increase our understanding of alcoholism and develop more effective prevention and treatment programs, alcohol researchers are studying the development and course of the disease in people of various ages.

Several different methodological approaches can be used for investigating alcoholism and its characteristics, including cross-sectional and longitudinal studies. Cross-sectional studies examine large numbers of subjects of various ages and social backgrounds representative of the general population. Longitudinal studies, in contrast, usually include smaller and less representative samples, but the subjects are followed over longer periods (e.g., up to 50 years) and reexamined repeatedly. Thus, although the overall sample may be biased, the disease progress in each person can be documented in more detail.

Alcohol studies also vary by whether the subjects are evaluated retrospectively or prospectively. In retrospective studies, researchers select subjects with a specific disorder (e.g., alcoholism) and, using interviews, medical records, and other sources of information, try to determine the factors that contributed to the disease’s development. Conversely, the subjects of prospective studies are disease free at the study’s outset; accordingly, some subjects will develop the disorder under investigation, whereas others will not. This approach allows researchers to analyze the premorbid characteristics of both groups of subjects.

Most analyses of the development and course of alcoholism have used a cross-sectional, retrospective design, with researchers recruiting alcoholics (e.g., from treatment facilities) and establishing their drinking histories. This approach may not always produce reliable results, however, because alcoholism is a chronic disease that changes in its severity and manifestations over time. Consequently, chronic alcohol consumption may gradually alter an alcoholic’s personality. Furthermore, guilt, misattribution, and the passage of time can cause unwitting misrepresentation of an alcoholic’s characteristics before disease onset. Longitudinal, prospective studies therefore are better suited for analyzing alcoholism’s development, determining the subjects’ premorbid states, and monitoring alcohol-induced changes.

This article summarizes findings from two longitudinal, prospective studies (now coordinated at Harvard Medical School) that have been following two groups of men from about 1940 to the present ( Vaillant 1995 ). By integrating these data with other research findings obtained over the years, this article attempts to provide some answers to the following questions:

• Is alcoholism an independent disease or the symptom of an underlying disorder?
• Do certain characteristics distinguish people who eventually become alcoholics from those who do not?
• Is alcoholism always a progressive disorder?
• How does alcoholism treatment or participation in self-help groups, such as Alcoholics Anonymous (AA), influence the disease process?
• Is abstinence the only reasonable treatment goal, or can alcoholics safely return to social drinking?

The Study Samples

Most findings discussed in this article were derived from two groups of men—referred to as the “College” sample and the “Core City” sample—who have been studied for more than 50 years by researchers at the Harvard University Health Services. (Unless otherwise noted, these findings are summarized in Vaillant 1995 .) Neither one of the two ongoing studies has focused solely on alcohol and other drug abuse. The initial goal of the College study was to investigate the development of “healthy” college students, whereas the Core City sample originally served as a control group in a study of juvenile delinquents. Because both studies have used a multidisciplinary and comprehensive approach, however, they also provide information about the development of alcoholism and related disorders. Moreover, although neither sample is representative of the general population (i.e., they include only Caucasian men and primarily represent two extremes on the socioeconomic scale), the combined data provide some insight into various factors contributing to the natural history of alcoholism.

The College Sample

The 268 participants in the College sample were recruited from the sophomore classes at Harvard University between 1939 and 1944 and represented about 7 percent of each class. Whereas 10 percent of the sample were randomly selected, the other 90 percent fulfilled the selection criterion of being “sound” students (i.e., academically successful and experiencing no medical or psychological problems). Because of this selection criterion, the College sample generally comprised socioeconomically privileged men who were likely to lead successful, “satisfactory” lives. They attained an average of 18 years of education.

At the beginning of the study, a psychiatrist extensively interviewed each participant to determine his family background, career plan, and values. A social worker then interviewed each subject to establish his social history. By visiting each subject’s parents, the social worker also obtained information about the subject’s childhood development and compiled the family’s history (comprising information on the grandparents, aunts, uncles, and first cousins) of mental and physical illnesses, including alcoholism. Finally, each study participant underwent a thorough physical examination, several physiological tests, and several psychological tests measuring intelligence.

After graduating from college, the men received extensive questionnaires annually until 1955 and every 2 years since then. These questionnaires addressed health, family situation, employment, habits (e.g., alcohol consumption, smoking, and sports activities), and political views. Each subject’s health also was assessed by complete physical examinations every 5 years from age 45 to age 70. All men were reinterviewed in 1951. In addition, 50 percent were reinterviewed at about age 47 and the other 50 percent at about age 55. Furthermore, all men with suspected alcohol problems were reinterviewed between 1971 and 1976.

The Core City Sample

The 456 men of the Core City sample were selected between 1940 and 1944, at ages 11 to 16, from Boston inner-city schools as a control group for a sample of juvenile delinquents (i.e., they were matched to the delinquents by age, intelligence, neighborhood crime rate, and ethnicity). The participants predominantly came from lower social classes and attained an average of only 11 years of education. In addition, the Core City subjects had a variety of ethnic backgrounds, and 61 percent of their parents were immigrants.

Similar to the College sample, the Core City subjects were studied by physicians, psychologists, psychiatrists, and social workers. The initial assessment included interviews with the boys, their families, and their schools as well as a review of information from public records (e.g., through the criminal justice system, social services, and mental health services). Based on this information, the investigators documented the subjects’ family histories of criminality, mental health, and alcoholism for three generations. The Core City participants were subsequently reinterviewed at ages 25, 31, and 47; again, concurrent searches were conducted of public records and of data from mental health agencies, hospitals, and law enforcement agencies. Beginning in 1974, the men were followed with questionnaires every 2 years and physical examinations every 5 years.

The Development of Alcoholism

Before examining how alcoholism develops, one must first define what alcoholism is. For the purpose of this article, the term “alcoholism” encompasses two diagnoses: alcohol abuse and alcohol dependence. These diagnoses were determined according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM–III) ( American Psychiatric Association 1980 ). Both definitions imply that alcoholism is not characterized by one specific feature but requires the clustering of several alcohol-related symptoms. For example, study participants who were diagnosed as alcohol dependent according to the DSM–III criteria generally also experienced at least 8 of the 16 alcohol-related problems listed in the Problem Drinking Scale (PDS), 1 another tool used to define alcoholism. Thus, alcoholism can be viewed as one end of a continuum of drinking behaviors ranging from social drinking to severe dependence.

The Etiology of and Risk Factors for Alcoholism

One important question addressed by alcohol researchers focuses on the mechanisms underlying alcoholism’s development (i.e., the etiology): Is alcoholism an independent disorder that can lead to psychiatric symptoms, or is it a symptom or consequence of an underlying psychiatric disorder (e.g., depression, sociopathy, or neurosis)? Prospective longitudinal studies are particularly well suited to address this question, because they begin following subjects before the onset of a disorder. Prospective studies thus enable researchers to establish the temporal order in which two diseases (e.g., alcoholism and depression) occur. Other lines of research examine risk factors for alcoholism that exist early in life and that might help identify people who are likely to become alcoholic. The Harvard University Health Services studies focused on four such potential influences: sociopathy (i.e., antisocial personality disorder), cultural factors (e.g., the subject’s ethnic background), genetic factors, and childhood environment.

The Role of Psychiatric Disorders

Most studies investigating associations of alcoholism with psychiatric disorders have focused on depression, because both alcoholism and depression tend to run in families and frequently occur together in the same person ( Merikangas and Gelernter 1990 ). For example, in the College sample, severe depression was five times more common among alcoholics than among nonalcoholics. The common comorbidity of alcoholism and depression has led to the hypothesis that people begin to drink to self-medicate, or alleviate, their depression (i.e., alcoholism is secondary to depression). Several lines of evidence, including the following, indicate, however, that in most cases depression is a consequence of alcoholism:

• The rate of alcoholism among manic-depressive patients, who according to the self-medication hypothesis should use alcohol frequently, is not higher than the rate among other psychiatric patients ( Woodruff et al. 1973 ; Morrison 1974 ).
• Biochemical tests that can distinguish between genetically determined (i.e., primary) and environmentally determined (i.e., secondary) depression found that depressed alcoholics more closely resembled patients with evidence of environmentally induced depression than did patients with genetically determined depression ( Schlesser et al. 1980 ).
• Data from the College sample indicated that subjects who later became alcoholic did not manifest, either as children or as adolescents, the personality or childhood characteristics that would have predisposed them to depression ( Vaillant 1980 ). Moreover, of the 14 College men with both alcoholism and depression, only 4 experienced depression before they became alcoholic, a proportion that can be attributed to chance alone ( Vaillant 1995 ).
• Although depression and alcoholism may run in the same families, multigenerational studies have documented that the predispositions for both disorders are genetically separate ( Weissman et al. 1984 ; Merikangas and Gelernter 1990 ).
• In clinical studies, the use of antidepressants to treat patients with both alcoholism and depression did not alter the course of alcoholism; however, abstinence from alcohol in such patients alleviated the depression ( Brown et al. 1988 ; Dorus et al. 1989 ; Mason et al. 1996 ).

Researchers reached similar conclusions when investigating the associations of alcoholism with other disorders (e.g., generalized anxiety disorder). Thus, in most patients, alcoholism appears to be an independent disorder that does not develop secondary to other psychiatric disorders, such as depression. The one psychiatric disorder that clearly contributes to the risk for alcoholism is sociopathy.

Several studies have indicated that sociopathy 2 is a predisposing factor for alcoholism (e.g., Cloninger et al. 1988 ). The Core City study’s prospective design allowed researchers to determine whether sociopathy could lead to alcoholism (i.e., whether alcoholism was a symptom of the underlying behavioral disorder) or whether sociopathic symptoms were a consequence of alcoholism. Although the Core City subjects were originally selected because they did not exhibit antisocial behavior, 25 subjects eventually met the minimal criteria for sociopathy. These subjects were four times more likely to become alcohol dependent than the subjects who did not develop antisocial behavior; the rates of alcohol abuse, however, did not differ between the two groups. Moreover, the age at onset of alcoholism was significantly lower for the sociopathic subjects than for those who were nonsociopathic. Because most sociopathic alcoholic subjects developed sociopathic symptoms before they abused alcohol, alcoholism can be considered a symptom of underlying sociopathy. The overall proportion of sociopathic subjects among the alcoholics, however, was small. Thus, although many sociopaths abuse alcohol as part of their antisocial behavior, most alcoholics are not sociopathic except as a result of their addiction.

Cultural Factors

The Core City sample was particularly useful for studying the influences of ethnic background on drinking behavior, because the parents of more than 60 percent of the subjects were born outside the United States. Thus, the Core City sample represented a variety of ethnic backgrounds, including Irish, Polish, Russian, English, Northern European, Italian and other Southern European, Anglo Canadian, and French Canadian.

When comparing the lifetime rates of abstinence, social (i.e., asymptomatic) drinking, alcohol abuse, and alcohol dependence among men with different ethnic backgrounds, the researchers found that the alcoholism rates varied among the ethnic groups, although a similar proportion of men in each group (about 20 percent) were abstinent. Most strikingly, alcohol abuse and dependence were five times less common in men of Italian and other Southern European descent compared with other ethnic groups (e.g., Irish).

These differences may be attributed, at least in part, to variations in the cultural attitudes toward alcohol consumption (e.g., Heath 1975 ; Greely and McReady 1980 ). For example, in the Italian culture, wine is consumed regularly with meals, and children usually are introduced to alcohol by their parents. Although alcohol consumption is sanctioned even among children, moderation is encouraged and intoxication is proscribed. Conversely, alcohol consumption in Ireland is illegal before age 21, and drinking mainly occurs in bars and not within the family or at meals. Moreover, in Ireland, drunkenness in men is socially sanctioned—“a good man’s failing.” Although these examples oversimplify the many factors determining ethnic variance in alcohol consumption patterns, they suggest that cultural practices contribute to the risk for alcoholism.

Genetic Factors

A genetic predisposition (i.e., a family history) to alcoholism is a well-known risk factor, and many prospective and retrospective studies have demonstrated that the children of alcoholic parents—particularly sons of alcoholic fathers—are at increased risk of becoming alcoholic compared with children whose parents are not alcoholic (e.g., Schuckit 1995 ). Both the College and Core City samples confirmed these observations. In the College sample, 26 percent of the men with alcoholic relatives, but only 9 percent of the men without alcoholic relatives, became alcoholics themselves. In the Core City sample, the corresponding numbers were 34 percent and 10 percent, respectively.

It is difficult, however, to separate genetic and environmental effects of alcoholic family members on the development of alcoholism in a study subject. Frances and colleagues (1980) observed that alcoholics with family histories of alcoholism were more likely than alcoholics without such family histories to come from severely disrupted families, to exhibit antisocial behavior, and to have performed less well in school. Thus, living in a household with an alcoholic family member can potentially cause an environmental disruption that may increase the risk for alcoholism. These environmental effects, however, do not account for the entire risk associated with a family history of alcoholism. For example, 29 percent of the Core City men with alcoholic ancestors (i.e., family members who were not part of the subject’s environment) became alcoholic, whereas only 14 percent of the men without alcoholic ancestors developed alcoholism. (For an extensive review of the genetics of alcoholism, see Alcohol Health & Research World vol. 19, no. 3.)

Childhood Environment

When examining factors that might predispose a person to alcoholism, researchers also have investigated subjects’ childhood environments. This approach includes evaluating both environmental strengths and weaknesses, such as family cohesiveness, degree of parental supervision, relationship of the child with the parents, and home atmosphere. Early studies found that unstable childhoods with broken homes and inconsistent upbringing seemed to predict future alcoholism ( McCord and McCord 1960 ; Robins 1966 ). Superficial analysis of the Core City sample appeared to confirm these findings. “Warm” and cohesive environments and close relationships were most characteristic of the men who did not become alcoholics. Further analysis showed, however, that these differences generally could be accounted for by the presence or absence of an alcoholic parent in the subject’s family. Men with few childhood environmental weaknesses but an alcoholic parent (who, in fact, they might not live with) were four times more likely to become alcoholic themselves than men with many childhood environmental weaknesses—and perhaps an alcoholic stepparent—but no alcoholic parent. Accordingly, if alcoholism in biological parents is controlled for, a troubled childhood environment per se does not appear to affect a person’s risk for alcoholism, a finding that was confirmed in the College sample.

In summary, the analyses of the College and Core City samples found that both cultural and genetic factors can predispose a person to alcoholism, whereas childhood environment per se plays a much less significant role. Furthermore, although alcoholism generally is not the consequence or symptom of an underlying psychiatric disorder, an antisocial personality may lead to alcoholism. Some of these findings contrast with previous retrospective studies that found associations between psychiatric disorders, such as depression, and alcoholism. These discrepancies may be explained by differences in the study design. The results of retrospective studies sometimes may be misleading, because prolonged alcohol abuse can impair or distort alcoholics’ recollections of their childhood and adolescence as well as their ability to distinguish cause from effect (i.e., the temporal sequence of the development of certain symptoms).

The Course of Alcoholism

As stated in the article’s introduction, alcoholism generally develops over long periods of time. Furthermore, although the disorder progresses continuously in some alcoholics, it remains stable or even regresses spontaneously in others. Because the disease course varies widely among individual alcoholics, longitudinal studies that repeatedly examine the same subjects are especially well suited for investigating patterns of alcohol consumption and the development of alcoholism over time.

Patterns of Alcohol Consumption

To determine changes in the patterns of alcoholism, the Core City subjects were categorized at ages 47 and 60 according to their DSM–III diagnoses for lifetime alcohol abuse and dependence. This comparison found that only 9 of the 260 men who were nonalcoholic at age 47 had developed alcohol abuse or dependence at age 60. Moreover, none of the 59 men who were classified as alcohol abusers at age 47 had progressed to alcohol dependence at age 60. Thus, alcoholism does not appear to be an inevitably progressive disease, and alcohol consumption tends to stabilize or decline during middle and older age. A similar trend was evident when the men’s lifetime drinking patterns were compared with their current patterns at age 47 ( figure 1 ): Although nearly one-half of the men evaluated had been heavy drinkers (i.e., consumed three or more drinks per day) at some point during their lifetime, only approximately one-third still drank that much at age 47. Conversely, more men consumed less than one drink per month at age 47 than had a lifetime pattern of this level of alcohol consumption. These observations suggest that some heavy drinkers and even some alcohol abusers will maintain their drinking patterns or reduce them with increasing age.

Selected current and lifetime drinking patterns of Core City subjects evaluated at age 47. The data suggest that alcohol consumption stabilizes or declines during middle age.

SOURCE: Vaillant 1995 .

The Evolution of Alcoholism Over Time

As previously indicated, alcoholism does not progress inexorably in all patients, and possible long-term outcomes of alcoholism include a return to abstinence; a return to controlled, or asymptomatic, drinking; and continued alcoholism. In part, outcome depends on the alcoholic’s personal characteristics, such as age. For example, an 8-year followup study of relatively young alcoholic prisoners (i.e., average age of 27) found that one-third of the subjects returned to asymptomatic drinking during the study ( Goodwin et al. 1971 ). The subjects most commonly cited marriage and/or an increase in family responsibilities as reasons for their change in drinking behavior. These findings, which also were confirmed in the Core City sample, suggest that in young alcohol abusers who have not yet developed alcohol dependence, changes in their social responsibilities and peer groups often can reverse their drinking patterns. Other studies also noted that drinking behavior can change considerably between adolescence and young adulthood but tends to become more stable during middle age ( Jessor 1987 ; Fillmore 1987 ).

Another common finding of longitudinal studies is that the prevalence of alcoholism declines as the subjects age. For example, an analysis of eight long-term studies demonstrated that out of 675 alcoholic subjects who were followed for an average of 15 years (until they were approximately 60 years old), only 25 percent were still alcoholic at the end of the studies ( Vaillant 1995 ). Several factors appear to contribute to this decline. For example, several studies indicate that about 2 percent of all alcoholics return to stable abstinence each year, with or without receiving treatment. Furthermore, after age 40, roughly 2 percent of all alcoholics die each year.

The Core City participants included 116 men who met the diagnosis for alcohol abuse and/or dependence at some points in their lives and whose life courses of alcoholism could be charted ( figure 2 ). As previously mentioned, these men were interviewed at ages 25, 31, and 47 and received biennial questionnaires thereafter. The analyses found that the number of alcoholics increased steadily until age 40 but subsequently declined. At age 60, only 27 percent of the alcoholics were still actively abusing alcohol. Almost one-third of the alcoholic men had died before their 60th birthday, most of them as active alcoholics. Another one-third of the men were stably abstinent, and only about 10 percent had returned to asymptomatic drinking.

Life course of alcohol abuse of the 116 Core City men who met the DSM–III criteria for alcohol abuse at some point during the Harvard study and who remained active in the study. The proportion of men who died while active alcohol abusers is labeled “ALC”; the proportion of men who died while stably abstinent is labeled “ABS.” At age 20, nearly one-third of the men had been diagnosed as alcohol abusers; the remainder were still classified as social drinkers. By age 60, all 116 men had received their diagnoses of alcohol abuse; no social drinkers remained. Those who drank were either abusing alcohol or had returned to controlled drinking (i.e., they were able to limit their alcohol intake to the point where they no longer met the DSM-III criteria for active alcohol abuse.)

SOURCE: Adapted from Vaillant 1995 .

In most Core City subjects, the progression from social drinking to alcohol abuse and alcohol dependence occurred gradually, generally over a period of 3 to 15 years. This rate of progression can vary significantly, however, depending on the subjects studied. For example, in the College sample, progression to alcoholism often occurred even more slowly, with some subjects drinking asymptomatically for as long as 20 years before becoming alcoholic. Conversely, sociopathic alcoholics in the Core City sample exhibited a much more rapid onset of alcoholism.

When the evolution of alcoholism in individual alcoholics was studied in more detail, the subjects fell into two main categories—those with a progressive disease course and those with a nonprogressive, atypical disease course. Each category comprised two subgroups. The alcoholics with a progressive course either continued to drink, despite a worsening of their alcohol-related problems, or became stably abstinent in response to the consequences of their drinking. In contrast, atypical alcoholics either maintained a relatively stable pattern of alcohol abuse or returned to controlled drinking. When comparing the outcomes of the four groups at ages 47 and 60 (or at the time of their deaths if they had died before their 60th birthdays), the researchers obtained the following results:

• Of the 35 men with progressive alcoholism at age 47, approximately two-thirds continued to abuse alcohol at age 60. The other subjects at age 60 either became stably abstinent or returned to controlled drinking for more than 3 years.
• Of the 38 men who had been stably abstinent at age 47, the vast majority remained abstinent at age 60; only 4 men relapsed and 1 man returned to controlled drinking.
• Of the 19 men classified as atypical, nonprogressive alcohol abusers at age 47, approximately 40 percent remained alcohol abusers at age 60. Two men were abstinent at age 60, and 4 men had returned to controlled drinking.
• Of the 18 men who had returned to asymptomatic drinking at age 47, equal numbers relapsed to alcohol abuse or maintained a controlled drinking pattern at age 60. Four men became stably abstinent.

In general, the atypical alcoholics exhibited less severe alcoholism (e.g., had fewer alcohol-related problems on the PDS and were classified as alcohol abusers but not alcohol dependent by DSM–III criteria). They also had fewer risk factors for alcoholism (e.g., alcoholic relatives or behavioral problems in school) than alcoholics with a progressive disease course. Moreover, atypical alcoholics were less likely to die before their 60th birthday than progressive alcoholics. Surprisingly, among the progressive alcoholics, no significant differences either in alcoholism severity or in risk factors distinguished the men who continued to abuse alcohol and those who achieved stable abstinence.

In most Core City subjects, alcoholism was a progressive disease that either led to chronic, progressive alcohol abuse and dependence or required stable abstinence. In contrast, the College sample presented a very different picture of alcoholism’s evolution. As a group, the College subjects were characterized by a social environment different from that of the Core City subjects, a factor which appeared to influence their life courses of alcoholism ( figure 3 ). For example, alcoholism developed later in life among the College subjects than among the Core City subjects: The age of onset (i.e., the age when the subjects first met the DSM–III criteria for alcohol abuse) for most of the College men was between 40 and 50 years, whereas most Core City men became alcoholic before age 30. Also, significantly fewer College alcoholics than Core City alcoholics became abstinent after age 40. Finally, alcohol abuse in most College alcoholics became neither worse nor better between the ages of 45 and 70, although many men died before their 70th birthday.

Life course of alcohol abuse of the 46 College men who met the DSM–III criteria for alcohol abuse at some point during the Harvard study and who remained active in the study. The proportion of men who died while active alcohol abusers is labeled “ALC”; the proportion of men who died while stably abstinent is labeled “ABS.” At age 20, only about 10 percent of the men had been diagnosed as alcohol abusers; the remainder were still classified as social drinkers. By age 60, all 46 men had received their diagnoses of alcohol abuse; no social drinkers remained. Those who drank were either abusing alcohol or had returned to controlled drinking (i.e., they were able to limit their alcohol intake to the point where they no longer met the DSM-III criteria for active alcohol abuse.)

Clinically Treated Alcoholics

Researchers also analyzed the disease course of 100 subjects with severe alcoholism who required detoxification and therefore had entered the treatment system ( Vaillant 1995 ). After 8 years’ followup, 34 percent of the subjects had achieved stable abstinence, 29 percent had died, and 26 percent still were abusing alcohol. Subjects who had a stable social environment (i.e., employment or a functional marriage) or who frequently went to AA meetings had the highest rates of abstinence. Thus, subjects with stable social adjustment apparently could recover on their own after receiving initial treatment, whereas subjects with social instability appeared to require frequent AA attendance to achieve abstinence. Overall, however, treatment other than AA did not significantly improve the subjects’ outcomes (i.e., the achievement of stable abstinence) compared with the untreated Core City or College subjects. In all subject groups, the rate of stable remission was between 2 and 3 percent per year.

Recovery From Alcoholism

Recovery from alcoholism can have two possible outcomes: stable abstinence or a less stable return to controlled drinking. For both the Core City and College samples, stable abstinence was defined as the consuming of alcohol less than once per month for at least the past 3 years while living in the community (i.e., not institutionalized or imprisoned). According to these criteria, 47 of 110 Core City men (i.e., 42 percent) who had ever been classified as alcoholic and for whom sufficient data were available had achieved stable abstinence by age 60. In contrast, the number of stably abstinent alcoholics among the College men was significantly lower (10 of the 52 subjects, or 19 percent, by age 70).

To identify characteristics that could distinguish men who achieved stable abstinence from those who did not, researchers compared childhood and other risk factors, alcoholism symptoms, and other characteristics (e.g., treatment experiences) of the abstinent and nonabstinent men. These analyses found that men who did not achieve stable abstinence, compared with securely abstinent men, were more likely to have fulfilled alcohol dependence criteria and to have been binge drinkers. They were also more likely to attend AA meetings frequently. No other distinguishing characteristics existed. Moreover, with the exception of AA attendance, the subjects’ treatment experiences (e.g., treatment in a clinic, with psychotherapy, or with disulfiram) did not appear to affect long-term outcomes. These findings are consistent with other studies that found no differences in outcome whether the patients received inpatient or outpatient treatment or brief interventions ( Lindström 1992 ; Chapman and Huygens 1988 ). Researchers continue to debate, however, whether AA attendance is the cause or consequence of abstinence. Finally, almost one-half of the Core City men analyzed retrospectively credited “willpower” as an integral factor in their ability to achieve abstinence. Prospective studies suggest, however, that the prospectively identified personality trait of willpower failed to predict outcome ( Vaillant 1995 ).

Non-Treatment-Related Factors Associated With Abstinence

To determine the possible factors underlying the retrospective attribution of willpower as an important component in achieving abstinence, the researchers examined non-treatment-related influences and processes that coincided with the alcoholics’ development of abstinence. From these analyses, which were primarily based on self-reports by the study participants and therefore may contain some bias, the researchers identified four factors associated with stable abstinence.

First, approximately two-thirds of the stably abstinent alcoholics developed some form of substitute dependency. These substitute dependencies had many different forms, ranging from overeating, chain smoking, or using tranquilizers to compulsively working, depending excessively on one’s parents, or becoming strongly involved in either AA or a religious group.

Second, abstinence was reinforced by events contingent on alcohol use that systematically altered the consequences of alcohol consumption (i.e., behavior modification) and thus constantly reminded the alcoholic that alcohol was an “enemy.” These behavior modifications took the form of medical consequences (e.g., painful stomach problems after alcohol consumption), legal consequences (e.g., probation requirements), or social supervision and sanctions (e.g., employers who threatened job loss or spouses who threatened divorce in cases of relapse).

Third, enhanced hope, self-esteem, or both assisted the alcoholic in maintaining abstinence. Both evangelical religious involvement and AA participation served as sources of hope and self-esteem. Such intense involvement may have provided group forgiveness and relieved the feelings of shame over past relapses and over the negative impact on others caused by these relapses.

Fourth, abstinence often was associated with the development of new love relationships (e.g., with a new spouse or mentor). In contrast, renewal of existing relationships—for example, through marriage therapy—was less effective ( Orford and Edwards 1977 ), possibly because the emotional wounds inflicted by the alcoholic on his family members and on himself were too deep to be overcome permanently.

Self-help organizations, such as AA, can provide all four of the non-treatment-related factors associated with abstinence. However, by employing these four factors themselves, alcoholics also can achieve abstinence outside of AA. Thus, most of the stably abstinent Core City alcoholics used either AA or at least two of the four factors outside of AA. In general, AA membership was more commonly used as a means of achieving abstinence when the severity of the men’s alcohol-related problems increased.

The four non-treatment-related factors also form the basis of some relapse prevention programs that use cognitive-behavioral techniques (e.g., providing positive feedback for successful abstinence, recalling alcohol-related negative experiences, and avoiding relapse-provoking situations) to sustain abstinence (e.g., Marlatt and Gordon 1985 ). Components of these programs include changing the alcoholic’s perception of alcohol from positive to negative, developing a plan to stop drinking that enlists the help of others, developing ways of recognizing an imminent relapse and coping with the situation, developing social supports that help reinforce sobriety, and providing substitutes for drinking.

Stability of Abstinence

An important question in alcoholism treatment is how long abstinence must last before recovery can be considered secure. Many treatment outcome studies follow their subjects for only 6 to 12 months. Longterm followup of both the Core City and College samples demonstrated, however, that relapse rates were still high (41 percent) after 2 years of abstinence but fell dramatically after additional years of abstinence. For example, only 7 percent of the men who had achieved 6 years of abstinence eventually relapsed; the documented abstinence duration of men with at least 6 years of abstinence who never relapsed ranged from 9 to 33 years (with a mean of 20 years). These findings indicate that a 6- to 12-month followup probably is not sufficient to evaluate the efficacy of a specific treatment in inducing long-term recovery.

Consequences of Abstinence

AA and most other treatment programs generally consider abstinence the only desirable treatment outcome. The effects of abstinence on the alcoholic’s physical and psychological well-being, however, rarely have been examined. A comparison of the progressive alcoholics, stably abstinent alcoholics, and nonalcoholics in the Core City and College samples demonstrated that abstinence does not automatically restore an alcoholic’s physical and psychological health. For example, the short-term death rate among the abstinent alcoholics in the College sample was similar to that among the progressive alcoholics. In addition, compared with nonalcoholics, the stably abstinent Core City men still manifested an increased death rate. Nevertheless, long-term followup of the Core City men demonstrated that physical health steadily improved among the stably abstinent men compared with the chronic alcoholics.

Similarly, abstinence improved the psychological health and quality of life of the securely abstinent Core City alcoholics. For example, the stably abstinent men exhibited significantly lower levels of psychiatric disabilities than the progressive alcoholics and more closely resembled the nonalcoholic men in the sample. Similarly, the stably abstinent men were comparable with the nonalcoholics in their enjoyment of their marriages and family lives and in their occupational success.

Nonetheless, the beneficial effects of abstinence may take several years to develop. For example, Kurtines and colleagues (1978) found that newly abstinent alcoholics were “less normal” on several measures of psychological functioning than alcoholics who had been abstinent for more than 4 years. Similarly, Core City subjects who had been abstinent for less than 3 years had higher levels of psychopathology and more closely resembled active alcoholics than did subjects who had been abstinent for more than 3 years (at an average of 10 years). Divorce and depression are common during the early recovery stages: Newly abstinent alcoholics must readjust to their familial responsibilities and occupational roles. These adjustments can be stressful and time consuming, especially in patients with more severe and prolonged alcoholism. Accordingly, abstinence should not be considered a goal in itself but a means to achieve overall social rehabilitation.

Return to Asymptomatic Drinking

Several researchers have suggested that successful treatment outcomes for alcoholics include not only abstinence but also a return to asymptomatic drinking ( Edwards and Grant 1980 ; Sobell and Sobell 1978 ). Among the 111 alcoholic Core City subjects, 42 had returned to asymptomatic drinking (i.e., drinking more than once a month for at least 2 years without experiencing any problems) at age 47. Twenty-two of these men had been asymptomatic for more than 3 years. Compared with the men who remained alcoholic or who became abstinent, the asymptomatic drinkers had experienced significantly fewer alcoholism symptoms, were less likely to have been alcohol dependent, and had fewer alcohol-related job or medical problems. In this sense, they resembled people with high blood pressure or diabetes, who can control their illness by life changes and diet.

Further followup demonstrated, however, that even in these subjects, a return to controlled drinking only rarely was a stable outcome. At age 60, only 6 of the 42 men could still be considered stable asymptomatic drinkers; the others had either relapsed, become stably abstinent, left the study, or had been reclassified as not meeting the criteria for alcohol abuse. In contrast, the long-term outcome was more stable for Core City subjects who at age 47 had been abstinent for more than 3 years. At followup 15 years later, almost all of these men were still abstinent, and only one man had relapsed.

These findings indicate that although a short- to midterm return to controlled drinking is possible for many alcoholics, a long-term return to controlled drinking is a rare and unstable outcome. Similarly, Helzer and colleagues (1985) found that among 1,289 clinically treated alcoholics, only 1 to 2 percent returned to asymptomatic drinking for more than 1 or 2 years. Consequently, abstinence may be a more useful therapeutic focus for the vast majority of alcoholics than an effort to return to asymptomatic drinking. The exception to this generalization is that people in the early stages of alcohol abuse might be offered a monitored trial of controlled drinking ( Sanchez-Craig and Lei 1986 ) in the same way that a trial of weight reduction might be offered to someone with borderline hypertension or diabetes before prescribing medication.

The prospective, longitudinal studies of both the Core City and College samples described in this article have helped researchers and clinicians to begin finding answers to the five questions listed earlier. Analyses of the temporal order in which alcoholism and other psychiatric disorders, such as depression and anxiety, developed in the study subjects strongly suggest that these disorders developed as consequences of alcoholism and that alcoholism in most patients was not secondary to other psychiatric disorders. The only exception to this rule appeared to be sociopathy, which constitutes a risk factor for the later development of alcoholism. Other risk factors for alcoholism identified in these studies included cultural factors (i.e., a person’s ethnic background) and genetic factors (i.e., a family history of alcoholism). These characteristics may help distinguish people who eventually become alcoholic from those who do not. Conversely, the childhood environment—beyond the influences of an alcoholic parent—did not appear to contribute to the risk of alcoholism.

The longitudinal evaluation of the study subjects demonstrated that the development and prognosis of alcoholism can vary significantly among individual drinkers. For example, while some people (e.g., sociopaths) developed the symptoms of alcoholism after only several months of heavy drinking, other “late onset” alcoholics drank heavily for many years before becoming alcoholic. Similarly, alcoholism did not always progress inexorably; in some subjects it remained chronic for decades without either progressing or improving. The subjects’ long-term prognoses did not appear to depend on whether they received treatment or what the treatment entailed. Rather, recovery rates of 2 to 3 percent per year were observed in both treated and untreated subjects. AA appeared to be at least as effective as clinic treatment in helping alcoholics to begin stable abstinence; however, it was more important for maintaining stable recovery, partly because, like treatment for other chronic disorders, AA is used daily or weekly for years. Finally, long-term followup of the Core City and College samples demonstrated that (1) for most alcoholics, abstinence was the most effective treatment goal and (2) a return to controlled drinking, although feasible in some alcoholics (especially those at early stages of alcohol abuse), generally resulted in an unstable outcome.

1 Alcohol-related problems contained in the Problem Drinking Scale include complaints by friends and family members about a person’s drinking behavior, marital problems, multiple job loss, alcohol-related arrests, and visits to either clinics or Alcoholics Anonymous for alcoholism treatment.

2 In children and adolescents, sociopathy is characterized by behaviors such as juvenile delinquency, truancy, and school behavioral problems.

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Alcoholism research paper: writing guide & topics.

Writing a research paper on alcoholism might seem like pushing a cart downhill; nevertheless, most students end up feeling frustrated. The need to bring out a new and captivating piece, in the end, remains a dream to many. But luckily, there’s a way out!

Read the sections that follow and forget about alcoholism research paper hangovers and blackouts.

How To Write an Alcoholism Research Paper Thesis

As earlier introduced, knowing the secret behind any successful paper puts you in the winning team. We need to note that such an article will majorly serve two essential purposes:

• To fight alcoholism
• To raise awareness among the people

The alcoholism outline for the research paper is as follows:

Alcoholism Research Paper Intro

An exciting introduction will hook the reader to your research paper. He/she will want to read more to feed his curiosity. Since the intro is the first paragraph that meets the reader’s eye, it should be outstanding as much as possible.

You can spice up your introduction in the following ways:

Present unexpected statistics and facts on alcoholism, Brief definitions of technical terms in your topic, if any Give the context of your research through background information Add a clear and precise thesis statement

The thesis statement serves as an anchor for your paper, determining your stance on the subject. Therefore, keep it short and sweet yet communicating the main point coherently.

It consists of all the arguments in support of your thesis statement. For a strong defense, ensure that you line up your undisputed and important ideas first as you move to the least. Some of the alcoholism research paper points to include in your body can be:

• Social effects of alcoholism on students
• How to help people struggling with alcoholism
• Symptoms of alcoholism in teenagers

Arrange the points in an orderly way so that your reader can follow through quickly. Each body paragraph should have a well-stated topic sentence, followed by an elaborate explanation and relevant examples.

Conclusion For Alcoholism Research Paper

After presenting your case on alcoholism and defending it with supporting arguments, it’s time, to sum up, your paper. The conclusion for alcoholism research paper summarizes the discussion in short, clear, and precise sentences.

You should also restate the thesis statement to emphasize your main idea of the paper. In conclusion, the general rule of thumb applies, do not add any new information. Strife to make it as short as possible yet not devoid of meaning.

When writing papers on alcoholism, be sure to use factual arguments, especially for the symptoms, effects, and other related statistics. Remember to be sensitive to the choice of words not to end up stigmatizing your reader.

Whether it’s a paper on addiction or withdrawal symptoms, do not vocabularies that may blur the reader from the article’s full picture.

Below are professionally handpicked alcoholism research paper topics for your inspiration:

Teenage Alcoholism Research Paper Topics

• Why do most teens think drinking alcohol is cool?
• Reasons why most students in college’ want to fit in.’
• Do parents who drink influence the teens also to start the habit?
• Does alcohol make teens feel more comfortable around their friends?
• Can alcohol raise the self-esteem of teens?
• Why many teens opt for alcohol when they feel pressured
• What are the withdrawal symptoms for teens addicted to alcohol?
• How teens can battle anxiety and depression without taking alcohol

Topics For Research Paper on Alcoholism and Family

• How alcohol makes parents neglect their essential duties
• Why forgetfulness as a result of alcoholism may disrupt family relationships
• Domestic violence as a result of excessive alcohol drinking
• Financial instability in families with alcohol addicts
• Can parents who drink alcohol help their children with homework?
• Why do children from families where parents drink alcohol suffer depression?
• Difficulty with intimate relationships among adults who drink alcohol
• Mental and physical health issues as a result of alcoholism in the family

Topics on Risks of Alcoholism

• Motor vehicle accidents arising from drinking and driving
• Why cases of homicide are on the rise among those who drink
• What causes alcohol poisoning?
• Risky sexual behaviors as a result of irresponsible drinking
• How mothers can experience miscarriage if they take excessive alcohol consumption
• Why do alcohol drinking people develop high blood pressure?
• Learning and memory difficulties as a result of alcoholism
• Why you risk losing your job if you continue drinking

Topics on Alcoholism as a Disease

• Can we classify alcoholism as a curable disease?
• The pre-alcoholic phase of alcoholism as a disease
• What is the relationship between increased heart rate and alcoholism?
• How effective is the Intensive Outpatient alcoholism treatment Program?
• Causes of relapse among patients recovering from alcoholism
• Aftercare support programs for patients dealing with alcoholism
• How scary is a diagnosis of alcoholism?
• Medical treatment options for people struggling with alcohol addiction

Alcohol Abuse Research Paper Topics

• The impact of alcohol abuse on relationships
• How alcohol abuse can cause harm or injury
• How alcohol abuse can harm the quality of your life
• Sexual dysfunction complications as a result of alcohol abuse
• Recommended ways of controlling alcohol abuse
• Medications to reduce the symptoms of withdrawal among addicts
• The role of support groups in reducing alcohol abuse
• Warning signs that you are abusing alcohol

Addiction Research Paper Topics

• Why is the youthful population the most affected with alcohol addiction?
• Best approaches to dealing with alcohol addiction among adults
• How drug addiction has led to increased crime rates in society
• Does counseling help to deal with the problem of drug addiction?
• Compare and contrast drug addiction between first and third world countries
• What measures can the government institute curb drug addiction?
• How drug addictions contribute to marriage breakups
• Why most drug addicts cannot have gainful employment opportunities
• How alcohol addiction impacts human health
• Why are the majority of street children drug and substance addicts?
• What are the policies legislating against drug addiction?
• Why are more men drug addicts than women?
• Rehabilitation systems of helping drug addicts
• Sociological perspectives of drug addiction
• A step by step approach to helping adolescents in drug addiction

In case the topics are not enough for you, we have professional research paper writing help for college students. Using our services will ensure that you attain that much-coveted A+.

Give it a try now!

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Alcohol Abuse, Research Paper Example

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It is a well-known fact that alcohol abuse is a serious disease associated with intense drinking of alcoholic beverages and neglecting its negative consequences. Very often alcohol abuse is described as something like an alcoholic dependence, but there is a definite difference between these two forms of addiction. The difference is that alcohol abuse doesn’t have such symptoms as withdrawal (getting physical symptoms after not drinking for a short period of time) and tolerance (having to drink increasing amounts to achieve previous effect). Although it is much easier to treat alcohol abuse than alcohol dependence, it is still a huge problem. In this paper I want to argue that the seriousness of alcohol abuse and its consequences mustn’t be overlooked in any case. Many people may claim that alcohol can have a lot of positive effects on one’s health and mental well-being, but what I want to underline is that there is a very thin crossing border between drinking to one’s good and over consuming alcohol. National Institute on Alcohol Abuse and Alcoholism Analysis states that each year more than 100,000 deaths in the United States of America are caused by the excessive alcohol consumption. Alcohol is also a cause of thousands of innocent deaths each years, it is one of the major reasons for domestic violence and violent crimes.

There are a lot of different causes of alcohol abuse, but the most common among them are: 1) peers pressure – it is considered to be somewhat fashionable and common to drink alcohol, especially among teenagers and college students; 2) biological predisposition – those people who had alcoholics in their families are at the higher risk for abusing alcohol than those who don’t have a family history of such an addiction; 3) stressful situations or great life challenges – many people start drinking alcohol in excess in order to cope with all the problems and to get through all the challenges that they’re facing in their lives.  As Saisan reports very often people start drinking to mask their depression, grief, anxiety or loneliness, or drinking may become the only way for them to feel comfortable and relaxed, and to feel themselves connected to other people.  Another negative aspect of drinking alcohol is that many societies and cultures dictate it in one way or another. For example, in many countries it is natural to drink beer or wine during meals, different kinds of celebrations can’t be seen without alcohol beverages and cocktails, and in many businesses entertaining clients with alcohol after a working day is considered to be a norm.

The most dangerous thing is that people continue to consume alcohol in excess despite knowing all the social, personal and legal problems that alcohol abuse is causing them. Many people argue that a flute of champagne or glass of a red wine can make one’s heart stronger and may boost one’s memory, so there is nothing wrong in drinking alcohol time after time. But the problem is that such ‘time after time’ may turn into every night or everyday alcohol consumption. Another for-alcohol aspect is that some experts and doctors state that alcohol consumption may help to burn calories. Whatever food items a person eats alcohol will break it down. Moderate drinking also raises HDL (good) cholesterol and lowers LDL (bad) cholesterol, decreases blood pressure, improves body’s sensitivity to insulin, which cuts the risk of type 2 diabetes. However, what people should remember is such a case is that drinking must be moderate in order to have positive effects on one’s health. Moderate drinking is defined as one or two drinks a day for men and one drink a day for women and those over 65. A drink is a 12-ounce bottle or can of beer, a 5-ounce glass of wine, or 1.5 ounces of 80-proof liquor.

But what people do forget is that eventually untreated alcohol abuse leads to alcohol dependence which is much more difficult to cure. According to the Institute of Alcohol Studies, a person is considered to be dependent on alcohol when one have experienced three or more of the following symptoms during a year.

• A strong urge to drink, difficulty controlling how much they drink, or difficulty stopping.
• Physical withdrawal symptoms, such as sweating, shaking, agitation and nausea when they try to reduce drinking.
• A growing tolerance to alcohol – needing larger quantities to get the same effect.
• Gradual neglect of other activities.
• Persistent drinking even though it is obviously causing harm.

During different periods of their lifecycles all people can be in the risk zone of starting abusing alcohol, but still there are several groups of people who are more likely than others to have problems with alcohol. 1) Teenagers and young adults – approximately one-half of all high school seniors in the USA admit to having used alcohol. 2) Adults older than 65 – many people of this age use alcohol as a way of self-medication in order to cope with sleep problems and depression. 3) Low-income population – alcohol abuse is a problem for many minorities, homeless and disabled adults.  According to the National Institute on Alcohol Abuse and Alcoholism one in three people will become hooked on alcohol at some point in their lives, and only one-quarter of people with a problem will get treated. So what’s the point to get yourself in the risk of abusing alcohol by saying to oneself that it will happen to somebody else, but not me?

Another point that people, especially women, like to use in order to justify their sometimes excessive consumption of alcohol is that it lowers cancer risks. For example, it is stated by doctors that women who don’t drink at all have higher risks for certain diseases, for example breast cancer. But Rimm (2007) says that if one wants to lower risks of getting cancer one should better ditch cigarettes, eat more fruits and vegetables, avoid too much sun exposure, keep weight under control, get regular exercises, than simply add an extra bottle of wine to one’s everyday menu.

Alcohol abuse has negative consequences for single individuals as well as for the society in general. The main negative aspect of alcohol abuse is first of all health problems that it causes. There is a number of both long-term and short-term effects of alcohol on the organism of a person. Short-term problems are easier to treat, but eventually they may turn into much more serious diseases. As alcohol is a depressant of the central nervous system its excessive consumption may lead to a loss of inhibition. It also results in the loss of balance, blurred vision, vomiting, slurred speech and nausea. National Institute of Alcohol Abuse and Alcoholism also provides information that drinking too much alcohol at one time may result in unconsciousness, coma and even death. Long-term effects include:

• high blood pressure that can lead to stroke;
• hepatitis and cirrhosis of the liver;
• heart failure;
• damage to the brain;
• neurological problems such as epilepsy;
• other neurological problems, such as confusion, numbness and problems with memory;
• birth defects;
• gastritis (inflammation to the stomach lining) and pancreatitis (inflammation to the pancreas);
• different types of cancer, including mouth, lung and throat.

Alcohol abuse can also cause muscle disease, infertility, sexual and skin problems; erectile dysfunction. Excessive drinking also leads to a number of psychological problems. Although in short-term alcohol may help people to relax, in a long run it can lead to increase of anxiety and eventually to depression. It also causes sleeping problems, mood-swings and may lead to suicides.

But even more disastrous are the ways in which alcohol abuse affects families and family lives. It is stated by psychologists and sociologists that very often alcohol abuse results in the child abuse and neglect. “The abuser may neglect a child’s basic needs due to drinking.  Lack of impulse control can lead to increased physical and emotional abuse” (Saisan). Alcohol abuse of one of the family members causes huge emotional and psychological stress to other members of the family. Especially sensitive in this case are children, who may not understand what is happening with their parents, or who may come to the conclusion that drinking too much is a norm of living. Drinking in excess also leads to the increased domestic violence, greater number of injuries and deaths at homes.  Another major issue is alcohol and pregnancy. Women who drink heavily during pregnancy are at risk of having babies with a condition called fetal alcohol syndrome. This can result in growth deficiencies, nervous system problems, lowered intelligence, and facial abnormalities in the child (National Institute on Alcohol Abuse and Alcoholism).

Another important aspect of alcohol abuse is that it can eventually lead to the loss of one’s job. Person who suffers from alcohol addiction may not only have problems with meeting job requirements and deadlines, but one may cause serious hazards for others, especially if one’s job is connected with servicing people. For example, Leigh found in his research that heavy beer use is strongly correlated with the fatality rates within occupations and industries (20). But drinking among workers not only threatens public safety, it also results in costly medical, social and other problems both for the employees and for the employers. Problems with jobs cause even greater stress for the family. Other family members may find themselves in the situation when they have to work more in order to make financial ends meet.

The most frightening thing is that alcohol abuse doesn’t only affect single individuals and families, but it is a major threat for the American nation and society as a whole. Problems with alcohol in the USA start from drinking alcohol as a way of entertainment among teenagers and college students, it leads to the increase of deaths from the impaired drivers, and the ultimate result is the general degradation of the American nation. Studies showed that many male college students drink in order to feel themselves “macho” and female college students drink in order to feel equal to men. The consequences of drinking among college students include missing classes, not studying for the test, failing courses, altercations with other people. But the most serious issue in this case is that many college students drive cars while being under the influence of alcohol.  It was found that alcohol kills 6 ½ times more youth than all other illicit drugs combined. National Highway Traffic Safety Administration states that about 45% of all the traffic crashes are due to the excess alcohol consumption. And all this leads to the general degradation of our population. For many people (especially for youth) to go to the party or club and get drunk is more interesting and exiting than to go to some kind of a gallery, performance, or simply to watch a movie or read a book. Eventually alcohol abuse leads to the increased dropout rates, to the inability of students to find a job after college or school graduation, or to poor job performance if they will manage to obtain a job. Another aspect is that students who abuse alcohol are in the great risk of being involved in all sorts of crimes and high risk sexual behaviors. In such a way the amount of single mothers and abandoned children increases as well.

Many people in the USA and all over the world fight for the general prohibition of alcohol consumption but I don’t think that it is a good solution to the problem of alcohol abuse. First of all, because many people do drink reasonably and good alcohol adds certain level of pleasure to their lives, and therefore it is not right to punish the majority for the actions of minority. And secondly, total prohibition of alcohol consumption will lead to the increased desire to drink as it was observed in the USA in the 1920s – 1930s. Plus alcohol prohibition may encourage people to experiment with other drugs that may be much more dangerous than alcohol. The solution that I can propose in such a situation is to increase the awareness of the population not only about the negative consequences of alcoholism, but of alcohol abuse as well. People should come to the understanding of the true meaning of moderate drinking. Another way to decrease alcohol consumption rates is to punish people more severely for all the illegal actions done under the influence of alcohol.

So once again the point that I wanted to make in this argumentative essay is that alcohol abuse is indeed a serious problem and it mustn’t be underestimated in any case, because it can lead to even a greater problem – alcohol dependence. Many people find a lot of for-drinking arguments, covering excessive alcohol consumption by such reasons as improving health, relaxing and lowering risks of getting certain types of diseases, but in any case people should remember that eventually alcohol abuse may turn into an alcoholism, which is a chronic and progressive disease, and it may become fatal in not treated in time. The main issue of excessive drinking is that in doesn’t only cause problems to individuals, but it as well affects their families, friends, colleagues, employers, and it threatens the well-being of those people who simply surround them. Eventually alcohol abuse affects the American nation as a whole, making it weaker, less productive and culturally degraded.

Leigh, Paul J. “Alcohol Abuse and Job Hazards.” Journal of Safety Research 27.1 (1996): 17-32.

Saisan, Joanna, & Cutter, Deborah, & Segal, Jeanne. “Alcohol Abuse and Alcoholism.” Helpguide. Jan. 2009. 5 Apr. 2009.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Alcohol Alert: Underage Drinking – A Major Public Health Challenge”, Alcohol Alert #59. Apr. 2003.

Heath, Dwight B., and Hanson, David J. “The misguided prohibition that governs U.S. colleges.” The Chronicle of Higher Education 47.48 (2001): B14.

Formichelli, L. “The Health Pros and Cons of Drinking”. CNN Health. 4 Dec. 2007. 18 Apr. 2009. http://edition.cnn.com/2007/HEALTH/12/04/healthmag.alcohol/index.html

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• Alcohol Abuse Research Paper

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Alcohol abuse represents several ways in which alcohol has a negative impact on an individual’s life. Some alcohol problems are severe and involve substantial consumption of alcohol, which results in multiple physical and psychosocial problems. Other alcohol problems are less severe—an individual experiences some negative consequences as a result of his or her drinking, but these difficulties have not impacted the individual’s overall functioning.

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Academic writing, editing, proofreading, and problem solving services, alcoholism research paper outline.

I. What Is Alcohol Health?

II. Normal Development and Epidemiology of Alcohol Abuse

III. Etiology of Alcohol Problems

A. Biological Factors

B. environmental factors, c. cognitive factors.

IV. The Changing Nature of Alcohol Abuse over Time

V. Risk and Protective Factors

Vi. continuum of intervention for alcohol abuse, vii. conclusion, i. what is alcohol health.

In order to understand the problematic use of alcohol, it is helpful first to consider what constitutes a state of health with regard to its use. Alcohol has held a common, even honored, place in the daily life of many cultures for thousands of years. It has been an element central to religious observances in Judeo- Christian and other faiths, and has often been part of important social and cultural events as well. Wine has long been recommended to promote physical health, and indeed recent scientific evidence indicates a consistent association between moderate drinking and longevity, although the reasons for this link are still poorly understood.

At the same time, it is abundantly clear that heavier drinking is often associated with devastating consequences to the individual and to society. Alcohol is involved in about half of all traffic fatalities, and a substantial proportion of fatal falls, drownings, deaths by fire, homicides, and suicides. Excessive drinking is also closely linked to violence, crime, injuries, and a plethora of chronic diseases.

The relationship of alcohol to health can thus be understood as a continuum. At one end of the continuum are abstainers, those who do not drink alcohol at all, who constitute more than one-third of adults in the United States. Such people obviously have no negative consequences related to their own drinking. Next are moderate problem-free (“normal”) drinkers. The average consumption for this large group is about three or four drinks per week. They fall largely within the limits for safe drinking recommended by the National Institute on Alcohol Abuse and Alcoholism: not more than two drinks per day for men, and not more than one drink per day for women, with some alcohol- free days each week. Because alcoholic beverages differ in content, it is important here to define what constitutes “one drink.” A useful definition is that one standard drink contains one-half ounce of ethyl alcohol.

When moderation is exceeded, or when one drinks at all in dangerous situations, one enters the realm of risky drinking, which includes both acute and chronic risk. Acute risk has to do with the immediate effects of intoxication. Even low levels of alcohol in the bloodstream, for example, can significantly impair driving ability. The only safe blood alcohol level behind the wheel is zero. A small amount of impairment from intoxication can also be lethal when combined with activities such as water sports, skiing, hunting, climbing, or using power tools, where minor misjudgments can have major consequences. There is no known safe level of drinking during pregnancy. Perhaps one of the most dangerous aspects of intoxication is that above very moderate doses, perception and judgment are among the first abilities to be impaired. This can and does result in errors of perception regarding one’s ability or (lack of) impairment, and in decisions and judgments that themselves lead to risky consequences.

Chronic risk, on the other hand, has to do with the long-term effects of drinking. Heavy drinking is closely linked to a wide range of health problems, at least doubling the risk for heart disease, cancers of many types, and hypertension. Risks for liver disease and for cancers of the mouth and gastrointestinal system are greatly increased by drinking above moderate levels.

Harmful drinking is when negative consequences from drinking actually occur. In addition to adverse effects on physical health and appearance, common types include legal problems, social consequences, damage to relationships, financial problems, and emotional disturbance. Because alcohol is a depressant drug, depression is often caused or exacerbated by heavy drinking. In college students, drinking level has a strong and negative relationship to grade point average. Memory problems are common in heavy drinkers, and the occurrence of memory blackouts is associated with brain impairment from alcohol. A majority of crimes resulting in imprisonment are committed under the influence of alcohol, which is also associated with domestic violence.

Alcohol dependence occurs as a person develops a pattern of alcohol use that results in substantial impairment in functioning. The person’s life becomes more and more entangled with drinking. Typically, alcohol dependent people are quite able to “hold their liquor,” showing less apparent intoxication from drinking than might be expected in the average person. Such tolerance is misleading, however, because while it appears that the person is unaffected, in fact he or she has a sufficiently high blood alcohol level to cause serious acute and chronic risk. Drinking occupies more of the person’s time, and becomes increasingly important so that it is unpleasant to be away from alcohol. Gradually, the body adjusts to the presence of alcohol, so that sobering up results in unpleasant experiences such as hangovers, insomnia, agitation, or nervousness, sweating, and trembling. In the extreme, alcohol can produce a withdrawal syndrome stronger and considerably more life-threatening than that associated with heroin addiction. Other features of alcohol dependence include drinking more or for a longer time than intended, failed attempts to reduce or stop drinking, and foregoing other important activities in favor of drinking.

II. Normal Development and Epidemiology of Alcoholism

What is the normal course of human development with regard to alcohol? The answer to this question is quite specific to culture. In some cultures, the normal course is lifelong abstention from alcohol. In France, on the other hand, heavy drinking is common among adults, resulting in one of the world’s highest levels of alcohol-related health problems. In Mexico, binge drinking is common among males, whereas women are usually abstainers.

Large general population surveys reveal that a majority of Americans drink alcohol. In 1992, researchers conducting the National Health Interview Survey interviewed more than 40,000 people about their alcohol consumption. At one end of the continuum, about one-third of men and one-half of women were classified as abstainers—individuals who drink less than once per year or not at all. Most individuals were classified as either light drinkers, consuming I to 13 drinks per month, or moderate drinkers, consuming 4 to 13 drinks per week. Fewer individuals were classified as heavier drinkers (14 or more drinks per week), although men were more likely to report heavier drinking than women (19% versus 7%, respectively).

Although most Americans drink without negative consequences, a significant minority of individuals are found at the harmful end of the use continuum. Recent surveys estimate that 15.3 million individuals meet criteria for alcohol abuse (“harmful drinking”), dependence, or both. Drinking at these levels becomes increasingly dominated by men, who drink more often, in greater quantities, and report more frequent episodes of intoxication than women. In fact, studies find that men are more than three times more likely to be diagnosed with alcohol abuse or dependence at any age than are women.

In addition to gender, drinking patterns are affected by age. After little or no drinking during childhood, alcohol use increases sharply during adolescence and peaks in young adulthood. Young adults drink in greater quantities, show the highest rates of binge drinking and problems related to alcohol use, and show the highest rates of alcohol abuse and dependence of any age group. With adulthood, drinking tends to decrease, with most young adults “maturing out” of problem drinking in their later twenties. The percentage of abstainers increases with age, although it is thought that heavier drinkers may be more likely to show stability of heavy drinking over time. This decrease in the number of people who use and abuse alcohol continues into older adulthood. Adults over age 65 have the lowest rates of alcohol abuse, dependence, and alcohol-related negative consequences of any age group. Some longitudinal research suggests that drinking patterns remain fairly stable over time, with the decreased rates of use and problems in older adulthood being attributable to increased mortality of heavy drinkers.

Along with gender and age, a growing literature documents differences in alcohol use and problems across racial/ethnic groups. Although studies of general population samples indicate that consumption and problems are greatest during the young adult years, studies have found that minority groups do not always follow this pattern. For example, Blacks have been found to show low rates of heavy drinking in young adulthood, followed by increased rates of heavy drinking and problems in their adult years. Importantly, rates of abstinence are higher among Blacks of all ages, especially among Black females. Research has also found variations by age from general population samples in patterns of drinking among Hispanics. In a way that is similar to non-Hispanic Whites, heavy drinking and associated problems increase during the young adult years among Hispanics. Hispanic men, however, show a smaller decrease in heavy drinking and problems from young adulthood to adulthood than that found among general population samples. For Hispanic men, heavy drinking and negative consequences remain high into middle adulthood, and Hispanic men show higher rates of alcohol abuse and dependence than other racial/ethnic groups over this time as well. In addition, Hispanic women show higher rates of abstention at all ages than non-Hispanic White women. Importantly, research with Hispanic samples is complicated by the practice of studying individuals of Mexican, Cuban, and Puerto Rican descent together, ignoring the substantial cultural and geographic differences among these groups as well as their different rates of drinking and attitudes toward alcohol use.

American Indians tend to show higher rates of alcohol problems than the general population, with a death rate from alcohol dependence that is more than five times higher than the rate for other races. Patterns vary widely by tribal affiliation, however, with some tribes drinking more than the general population average and others drinking less. Alcohol use among American Indians is highest and is associated with the greatest number of negative consequences through young and middle adulthood, with a decline in consumption in the forties.

III. Etiology of Alcoholism

Whatever the population, it is clear that a significant minority of individuals drink in an excessive or harmful way. What causes alcohol problems? Historically, this question too often has been answered by pointing to a single cause. In the nineteenth century, drunkenness was the mark of a sinful person who lacked morals or will power. More recently, alcohol problems have been attributed to genetics, an alcoholic personality, or a “dysfunctional” family. It is clear, however, that there are many causes of alcohol problems, which develop out of interacting biological, environmental, and cognitive factors that begin early in life and continue over the course of development. At various points in development, different factors have more or less of an influence on drinking behavior.

Much research has shown that genetics play a role in the development of alcohol problems. This research studies individuals with varying degrees of genetic relatedness to individuals with alcohol problems, and observes the rates at which these different relatives develop alcohol problems themselves. For example, family pedigree studies look at biological relatives of alcohol dependent adults; twin studies examine the rates at which identical and fraternal twins both develop alcohol problems; adoption studies follow children of alcohol dependent individuals who have been adopted by individuals without alcohol problems. The results of contemporary genetic studies strongly support a role for genetics in the development of alcohol problems, particularly among sons of alcohol dependent parents, who are three to four times more likely to develop alcohol problems than sons of nonalcohol dependent parents.

Knowing that genetics plays a part in the development of alcohol problems, researchers have now turned their attention to identifying those processes or deficits that might be genetically transmitted and contribute to alcohol problems. Alcohol problems are often conceptualized as stemming from biologically based difficulties in temperament and self-regulation, defined by Diaz and Fruhauf in 1991 as the ability to “plan, guide, and monitor one’s own behavior flexibly according to changing circumstances.” Self-regulation becomes more sophisticated over the course of development. As children are required to function more independently, they learn skills to help them evaluate situations and change behavior such as self-monitoring of functioning, evaluating functioning in comparison to a standard, and designing and implementing behavior change if needed. Some children make this transition readily, while others fail to become competent self-regulators. Temperamentally difficult children- those showing poor behavioral control, hyperactivity, and impulsivity–are thought to have poor self-regulation. Such children can be difficult to parent. Their heightened activity interferes in the development of self-control skills, as well as in the formation of strong relationships with others such as parents who would help them develop these skills. As individuals develop and are required to behave more autonomously, individuals who are poor self-regulators may be less able to change their behaviors to meet new challenges. As a result, they rely on external sources of regulation such as alcohol and drugs, which in turn tend to impair self-regulation still further. A large body of research has shown that temperamentally difficult children show a greater likelihood of developing alcohol problems as adults.

Although genetic and biological processes contribute to the development of alcohol problems, environmental factors are also strongly involved. Difficulties in temperament and self-regulation can be thought of as risk factors that interact with personal and environmental factors to lead to the development of alcohol problems. Social learning models of alcohol use and problems emphasize the importance of social reinforcers—reactions from others in the social world that either reward or punish particular behaviors. Positive reactions serve to reinforce drinking behavior, while negative reactions punish such behavior. Also important to such a model are personal, internal events that guide an individual’s perception of the external world, such as attitudes and expectations about drinking.

What environmental factors might be important to drinking behavior? There are multiple levels of environmental influence–more immediate influences include family members and peers, while farther removed factors include aspects of society, culture, and religion. Family and peers strongly influence drinking behaviors by setting examples, altering availability of alcohol, and by encouraging or discouraging alcohol use. Much evidence suggests that adolescents and young adults tend to hold attitudes toward alcohol and show drinking behaviors that are like those of their parents and peers: young individuals who drink tend to have parents and peers who drink. Through these links with drinking others, young people observe the positive features of drinking, learn how to drink, and receive positive feedback for their drinking. Similarly, peer influence appears to have a particularly strong impact on drinking in adolescence and young adulthood. Heavy-drinking youth typically are involved with similarly heavy-drinking peers. Such drinking networks may serve to teach adolescents and young adults how to drink, model appropriate (or inappropriate) drinking behavior, and reward such behavior with attention, movement into a higher social status, and an identity as a drinker.

Along these lines, Jessor describes a problem-behavior theory in which proneness both to problem drinking and to other problem behaviors in youth results from an interaction of personality, environmental, and behavioral systems. Personality proneness to problem behavior includes a low value on academic achievement, a high value on independence, and greater tolerance for deviance coupled with lower expectations of attaining goals and lower self-esteem. Environmental stressors include low parental support and control along with high peer engagement in and approval for deviance. Together these factors have been described as a style of unconventionality. This unconventionality makes for problematic behaviors and stressful interactions with others.

Importantly, environment includes more than just an individual’s home and peer experiences. Characteristics of the person and the immediate environment occur within a larger social context. Cultural ideas about alcohol use, societal attitudes toward intoxication, and laws about the purchase and consumption of alcohol all interact with an individual’s biological, environmental, and cognitive makeup. For example, during Prohibition in the United States, when attitudes were distinctly anti-alcohol and purchasing liquor was illegal, people drank less and experienced fewer alcohol problems. Patterns of alcohol use and problems vary by religious group affiliation. Jews tend to report a high prevalence of drinking but very low rates of alcohol problems, while Catholics tend to report higher rates of both drinking and heavy drinking. An especially important societal influence in modern society is the media. Both visual and print media provide a variety of models of and reinforcers for alcohol consumption. Messages about the positive effects of alcohol (it’s fun and everyone is doing it) are delivered via television, movies, radio, billboards, and magazines. Drinkers are shown as attractive, socially adept, and healthy. In contrast, messages regarding the potentially harmful effects of alcohol on physical and psychological functioning are rarely shown.

Recently, the alcohol field has become interested in a third set of factors that influence and are influenced by an individual’s biology and environment. Cognitive factors m beliefs about alcohol and its use, one’s ability to cope with stress, and ideas about what sorts of things might help a person with their problems become increasingly important in decisions to engage in risky or harmful drinking. The young adult who has difficulty with self-regulation, is engaging in multiple problem behaviors, and experiences poor interactions with others is then faced with the more adult task of coping, a skill that has been found to be lacking in adolescents and young adults who drink heavily. In explaining differences between normal and problem-drinking adolescents, some researchers describe a stress-coping perspective in which adolescents who drink the most are using alcohol to cope with high levels of stress and few external rewards. Studies in this area have shown that teens who drink heavily report more life stressors along with poorer coping skills than teens who drink moderately.

In making a decision about how to cope with a stressor or a problem, beliefs about the effects of alcohol appear to be another important cognitive factor. Alcohol expectancies are beliefs that alcohol use will have positive outcomes, such as increased feelings of relaxation, assertion, or general well-being. Alcohol expectancies have been found to be related to differences in drinking behavior in adolescents and adults—individuals who drink more report more positive expectations or beliefs about alcohol and its effects. Moreover, individuals who develop alcohol problems report stronger alcohol expectancies than normal drinking adults. Positive experiences have been found to exist before a child’s direct experience with alcohol, suggesting a role for expectancies in developmental models of alcohol problems. Importantly, alcohol expectancies may connect coping and stress: problem drinking develops from using alcohol to cope with stress by those individuals who lack other means of coping and who perceive alcohol as being able to help resolve bad feelings. Research has shown some support for this view, finding that poor coping is linked to problem drinking in individuals with strong, positive alcohol expectancies. Thus at highest risk for problem drinking is the individual who, when faced with stress, shows low coping self-efficacy (I can’t cope) and has strong positive expectancies about the effects of alcohol (Alcohol will help me cope).

Rogers’ protection-motivation theory emphasizes a person’s perception of risk as crucial to the decision to engage in harmful behavior such as problem drinking. According to this view, health behaviors are guided by perceptions of threat and coping. First, a person must evaluate the likelihood of threat (Will drinking cause bad things to happen to me?) and the severity of the threat (If drinking causes bad things to happen to me, how bad will these things be?). Engaging in the maladaptive response, in this case harmful or risky drinking, is influenced by the interaction of rewards (feeling good, having fun, social approval) and consequences. Second, the individual makes a coping appraisal, a judgment about what alternatives are available and one’s ability to engage in alternative behavior (Are there things to do besides drinking and can I do them effectively?). Rogers stresses the importance of self-efficacy, an individual’s appraisal that he/she is capable of implementing and carrying out the behavior change. Problem-drinking individuals tend to evaluate the threat of problem drinking as low, the severity of potential consequences as low, the alternatives to drinking as unpleasant, and their ability to implement change as minimal.

Thus multiple influences over the course of development interact to produce threats to alcohol health. Alcohol problems can evolve out of inherited difficulties in temperament and self-regulation that lead an individual to engage in problem behaviors and poor interactions with others. With this foundation, a developing person is ill-equipped to cope with the stressors and problems that accompany the transition to adulthood. The balance of rewards that accompanies drinking and the perception of minimal threat contribute to an individual’s maintaining problem alcohol use.

Recently, researchers have become interested not only in the question of who is going to show alcohol problems at one point in time, but also in who is going to continue to have alcohol problems at many points in time. Remember that although young adults experience the highest rates of alcohol use and related problems, these rates decrease substantially in adulthood. These trends suggest that most young adults “mature out” of problem drinking upon entering adulthood. Different reasons for this “maturing out” have been suggested, most prominently that the assumption of adult roles such as work and marriage, along with a decrease in problem drinking among peers, leads young adults to moderate their use into patterns of typical social drinking. Individuals with alcohol problems, however, tend to report that they began drinking and experiencing negative consequences at a young age, so that rather than maturing out, some individuals will continue problem-drinking patterns from youth into adulthood. Some researchers have suggested that these patterns represent different problem- drinking typologies. According to this view, individuals who continue problem drinking over time are likely to be at the greatest risk for developing severe problems in adulthood; thus it is important to identify which young adults will be the ones to continue problem drinking into adulthood. Recent research suggests some qualities that may characterize individuals who will continue problem drinking from youth to adulthood, including having a higher degree of behavioral undercontrol, engaging in other problem behaviors in addition to problem drinking, and using alcohol to relieve negative feelings.

IV. The Changing Nature of Alcohol Abuse Over Time

The above discussion highlights some of the many factors that influence the development and continuation of alcohol problems over time. It is important to remember that alcohol problems vary widely: some individuals develop risky, harmful, or dependent patterns, and some cycle in and out of these various use patterns. Rather than being stable, alcohol problems change and develop over time and show a range of outcomes. Vaillant has provided the clearest illustration of this variability in his research on the natural history of alcohol problems. He has followed a large sample of men for more than 50 years, 110 of whom had experienced alcohol abuse at some point in their lives. These men drifted in and out of alcohol problems: some were abstinent for long periods of time, others relapsed to heavy or risky drinking, and others returned to dependent patterns of drinking. In his most recent follow-up of these men, now in their 70s, Vaillant stressed that alcohol abuse can have different paths for different people, sometimes progressing to more severe drinking, sometimes remitting, and most often varying in severity over time. Vaillant’s data illustrate that within an individual problem-drinking path there are many twists and turns, with periods of harmful and risky drinking interspersed with periods of moderate problem-free drinking or abstinence.

What factors put individuals at increased risk for alcohol problems? A public health model offers a useful framework for describing different types of risk factors and illustrating how they interact to influence outcomes. As with other complex disease processes, this approach highlights three kinds of risk factors– agent, host, and environment–to be considered in understanding the development of alcohol problems. The agent in infectious diseases is a bacterium or virus, but in this case the agent is alcohol. Alcohol has its own destructive properties, much like a particular virus can cause specific symptoms and damage. Yet in most diseases, only some individuals who are exposed to the agent actually come down with the disease. Similarly, only some individuals who are exposed to alcohol develop problems, highlighting the importance of host factors–individual characteristics that increase or decrease risk of alcohol problems. There are many such factors that are involved, including biological and psychological influences. One of the most important is gender. Men are more often drinkers and show a greater likelihood of drinking at a risky or harmful level at all ages. A family history of alcohol problems also is a significant risk factor. Evidence from family, twin, and adoption studies suggests that a genetic vulnerability contributes to alcohol problems in some individuals, especially in sons of alcoholic fathers. Yet even identical twins may differ in whether or not they develop alcohol problems, indicating the role of environmental factors in addition to agent and host factors. Age also constitutes a significant risk factor for problem drinking young adults show the greatest use and greatest number of alcohol-related problems of any age group. In his study of the natural history of alcohol problems, Vaillant found that more than half of the individuals who would meet diagnostic criteria for alcohol abuse did so by age 31.

Other host characteristics include temperament, coping skills, expectancies, and other psychopathology. As described earlier, temperamentally difficult children show a greater likelihood of developing alcohol problems as adults. Relatedly, individuals with alcohol problems tend to show poorer coping skills and to use alcohol to cope with the pressures and stresses that face them. As discussed earlier, individuals with strong, positive expectancies for alcohol (expecting alcohol will help relieve bad feelings) are more likely to drink and to develop alcohol problems. Finally, research shows that experiencing a psychological problem such as depression or anxiety, greatly increases risk for developing an alcohol problem.

A third relevant domain is the environment. As discussed earlier, environment can be defined in a number of ways. Immediate environmental risk factors for alcohol problems include heavy or other problem-drinking family members who not only contribute possible genetic influences but also serve as role models for alcohol use and create a stressful home environment that may contribute to alcohol use. For adolescents and young adults, peer influences are among the most important– being part of an alcohol-using peer group increases risk for alcohol problems in these populations. Aspects of the larger environment are also relevant. Heavy-drinking communities show greater rates of alcohol- related problems. Cultures that sanction liberal use of alcohol likewise show higher rates of risky and harmful drinking. Stress may also be an important environmental risk factor: research suggests that severe and prolonged stress appears to be an important factor in problem drinkers returning to drinking after a period of abstinence.

While there are characteristics that put people at increased risk for alcohol problems, there are also factors that protect individuals in the face of these risks. Protective factors are not merely the opposite or lack of risk factors. Rather, they are influences that moderate the links between risk factors and alcohol outcomes such that an individual may be exposed to risk but show resiliency and avoid problem alcohol use. Several protective factors have been identified in adolescents and young adults, including close and positive relationships with parents, adolescent conventionality, parental adjustment, and success in school. Religious affiliation and involvement appears to be a strong protective factor. Individuals who report strong religious beliefs or high levels of religious commitment consistently show lower levels of alcohol use and fewer alcohol- related problems. In contrast, individuals with alcohol problems are less likely to report firm religious beliefs or involvement. In addition, social support has been found to play an important protective role: individuals engaged in supportive relationships with others appear less likely to develop alcohol problems, and social resources are thought to offset other potentially harmful stressors and risks. It also makes a difference whether one’s social group supports abstinence, moderation, or risky and heavy drinking.

From the previous discussion, it is clear that alcohol problems encompass a range of risk factors and difficulties that vary along a continuum of severity. All individuals are exposed to some risk factors; many individuals experience multiple risk factors that make them increasingly vulnerable. Some individuals are just beginning to develop problems with alcohol; others already have well-developed dependence. Such diversity necessitates a variety of intervention strategies. Any single type of prevention program is not likely to reach all who are at-risk, and one brand of treatment will not be effective for all problem drinkers.

At one end of the continuum are universal prevention strategies, designed to target a large population with the goal of reducing the incidence of alcohol problems; for example, by increasing awareness of risks and promoting alternatives to alcohol use. A target population might be all individuals in a particular city, school district, or university campus. An example of a universal prevention strategy is instituting an excise tax on alcoholic beverages that makes alcohol more expensive, with the result that people purchase less. Print and electronic media campaigns are also designed to reach large groups of people with their alcohol- related messages. Universal prevention strategies target everyone in a population, regardless of their level of risk for developing problems.

Other interventions focus on individuals who are at high risk for developing problems. Termed targeted prevention strategies, such interventions are aimed at particular groups who have not yet developed a problem but are at increased risk due to their exposure to particular or multiple risk factors. Examples of such high-risk groups are children of parents with alcohol problems, adolescent boys with behavior problems, and college students with poor grades. The goal of targeted prevention is to stop a problem before it starts, or at least early in its development, by intervening with those at highest risk. For example, programs in college dormitories, fraternities, and sororities are aimed at providing information to individuals at high risk for drinking and related problems.

Prevention is aimed at individuals who have not yet developed problems. Once an individual is identified as having an alcohol problem, the focus of intervention shifts toward treatment. Individuals identified as already having an alcohol problem may be referred for some sort of intervention or treatment. However, only a small percentage of individuals with alcohol problems ever receive formal treatment. A critical bridge between developing problems and receiving treatment is the person’s motivation for change. Strengthening the commitment to change constitutes an important first step, and may need to be addressed before treatment takes place. Effective methods are available for enhancing motivation for change. Among the important elements of such interventions are providing personal feedback about drinking, empathic listening, acknowledging a range of alternatives for working toward behavior change, and emphasizing personal responsibility and ability to make change happen. Such motivational interventions are designed to help an individual become more aware of the impact of his/her drinking and to instill a commitment to change.

This discussion has emphasized the diversity of alcohol problems along a continuum of severity. The implication of this diversity is that what is helpful or appropriate for a drinker just beginning to develop an alcohol problem will differ from the most effective treatments for more severe, dependent drinkers. Individuals who are just beginning to show signs of problem alcohol use might fit the description of “risky’ or “harmful” drinkers who are drinking heavily or in potentially dangerous situations. Intervention with these individuals is aimed at recognizing a problem early and preventing it from reaching diagnostic levels. For example, businesses have employee assistance programs where personnel are trained to recognize the early signs of alcohol problems in their employees. Other early identification strategies include urine drug-screening programs, justice system referrals, screening during routine health care, and programs for impaired drivers. Individuals at the beginning stages of problem development are often helped by brief interventions– motivational strategies that help individuals see their increasing involvement with alcohol and the negative consequences they may experience as a result. These interventions are usually one or two sessions of alcohol-related counseling and advice to reduce drinking. Some brief interventions involve providing clients with reading and other educational materials that review drinking patterns and ways to reduce drinking. Studies have consistently found that such brief interventions help problem drinkers reduce their alcohol use.

What about individuals who are far enough along the continuum to have developed more severe alcohol problems? There now exist a range of promising and effective approaches for use with different types of drinkers. As individuals with alcohol problems frequently have difficulties in many areas of functioning, several interventions are often combined. For drinkers with more severe problems, detoxification may be necessary to overcome the acute effects of alcohol withdrawal. With proper supervision, an addicted drinker is through the worst withdrawal within a week, and modern medical care can prevent the more uncomfortable and dangerous symptoms of alcohol withdrawal. Detoxification, however, is not treatment. Simply detoxifying a dependent drinker is unlikely to have any long-term effect on drinking.

Various medications have been tested in treating alcohol problems. One of the most popular of these is disulfiram (Antabuse)–a medication that produces a negative physical reaction (nausea, vomiting) when alcohol is ingested. Naltrexone (ReVia) also appears to be a promising agent in reducing relapse and craving. Medications, however, are only an aid in treatment, and are unlikely to be effective when given without other treatment.

Some view alcohol problems as a lack of coping skills. Skills-training approaches view alcohol use as a maladaptive coping strategy, and teach appropriate coping skills as an alternative to drinking. Social skills training is used to help individuals with alcohol problems to interact effectively with other people, to cope with positive and negative feelings, and to handle stressful situations in the environment. The community reinforcement approach similarly emphasizes the need for the drinker to be prepared to cope with stress, and to establish a rewarding, alcohol-free life-style. Efforts are made to get individuals connected to community resources, social supports, employment, and other activities that would contribute to a rewarding life-style without alcohol. From this perspective, the focus is not only on stopping alcohol use but also on helping people to acquire skills and make changes that will support an alcohol-free life-style.

Alcohol problems often affect family functioning. Behavioral marital therapy (BMT) regards the marital relationship as crucial in the maintenance and change of an individual’s drinking behavior. BMT is designed to improve communication skills, teaching spouses how to reinforce changes in drinking behavior, and ways to cope with drinking-related situations and feelings. There are also effective approaches to help concerned family members and friends of individuals with alcohol problems, even if the drinker is unwilling to accept help. These concerned others often wish to help their loved one but lack the knowledge and skills to do so. Concerned family members can be helped to engage the problem drinker in treatment. Such treatments also attend to the needs of the family members themselves– to distance themselves from the drinker and to learn skills for coping with stress and other negative feelings.

Recovery from alcohol problems typically involves relapse. Effective treatment often includes attention to the people, places, and things that are likely to trigger alcohol use in the future. Marlatt’s relapse-prevention (RP) incorporates cognitive-behavioral strategies aimed at anticipating slips and considering how to handle high-risk situations. Specifically, RP stresses anticipating and working to prevent relapses and realistically considering how to recover and learn from relapses if they occur. To this end, clients identify specific high-risk situations and outline a plan for making it through without drinking.

For individuals with less severe drinking problems, strategies to teach skills for moderate drinking are sometimes used. Moderation training programs are designed for risky or heavy drinkers who might not participate in treatment aimed at total abstinence, but who could benefit from reducing their alcohol use. For example, behavioral self-control training (BSCT) teaches clients skills for moderating their drinking. BSCT makes use of behavioral principles of self-control and teaches ways to self-monitor drinking, to set goals for decreasing consumption, and to implement alternative coping skills. BSCT and programs like it may be used with either abstinence or moderation goals.

The above interventions all involve the individual with alcohol problems seeking assistance from a trained professional. Although outcome studies strongly support the efficacy of these treatment strategies, the fact remains that most individuals with alcohol problems never receive professional help and yet “recover” without formal intervention. Many of these drinkers will seek help not from professionals but from others with similar problems. Particularly in North America, mutual-help groups serve as a major source of help and support for many individuals with alcohol problems. The largest and best-known of these groups is Alcoholics Anonymous (AA), serving over two million members in 150 countries around the world. AA emphasizes commitment to abstinence and renewed spirituality recognizing the strength of a “higher power” as necessary to the change process. Other self-help groups, such as Women for Sobriety, SMART Recovery, Rational Recovery, and Moderation Management, emphasize personal control and responsibility in overcoming alcohol problems.

Alcohol problems encompass a range of difficulties. Some individuals with alcohol problems experience minor difficulties in a one area of functioning. Other individuals experience substantial impairment in multiple life areas due to their alcohol use. In this research paper, we have reviewed factors that put people at risk for alcohol problems, as well as theories that seek to explain how alcohol problems develop. There now exists a range of interventions for individuals at all levels of the alcohol problems spectrum. Future research will add to our knowledge of alcohol problems and yield important new information about how such problems develop and how they can be most effectively treated.

Bibliography:

• Blane, H. T., & Leonard, K. E. (Eds.). (1987). Psychological theories of drinking and alcoholism. New York: Guilford Press.
• Diaz, R. M., & Fruhauf, A. G. ( 1991 ). The origins and development of self-regulation: A developmental model on the risk for addictive behaviors. In N. Heather, W. R. Miller, & J. Greely (Eds.), Self-control and the addictive behaviors. Sydney: Maxwell Macmillan Publishing.
• Hester, R. K., & Miller, W. R. (Eds.). (1995). Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed.). Boston, MA: Allyn & Bacon.
• Jessor, R. (1987). Problem-behavior theory, psychosocial development, and adolescent problem drinking. British Journal of Addiction, 82, 331-342.
• Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention. New York: Guilford Press.
• Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.
• Monti, P. M., Abrams, D. B., Kadden, R. M., & Cooney, N. L. (1989). Treating alcohol dependence: A coping skills training guide. New York: Guilford Press.
• National Institute on Alcohol Abuse and Alcoholism. (1993). Eighth special report to the U.S. Congress on alcohol and health. Rockville, MD: U.S. Department of Health and Human Services.
• Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In J. T. Cacioppo & R. E. Petty (Eds.), Social Psychophysiology (pp. 153-176). New York: Guilford Press.
• Vaillant, G. E. (1983). The natural history of alcoholism. Paths to recovery. Cambridge, MA: Harvard University Press.

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INTRODUCTION

Alcohol use, misuse, abuse, and dependence, hazards of use of alcohol, factors that contribute to hazardous use, genetic and familial factors, other factors, adolescent developmental and neurobiological factors, national call to prevent and reduce underaged drinking, role of the pediatrician, recommendations, aap resources, suggested internet resources, self-help and advocacy group resources, committee on substance abuse, 2007–2008, alcohol use by youth and adolescents: a pediatric concern.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

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Committee on Substance Abuse; Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics May 2010; 125 (5): 1078–1087. 10.1542/peds.2010-0438

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Alcohol use continues to be a major problem from preadolescence through young adulthood in the United States. Results of recent neuroscience research have substantiated the deleterious effects of alcohol on adolescent brain development and added even more evidence to support the call to prevent and reduce underaged drinking. Pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment. The integration of alcohol use prevention programs in the community and our educational system from elementary school through college should be promoted by pediatricians and the health care community. Promotion of media responsibility to connect alcohol consumption with realistic consequences should be supported by pediatricians. Additional research into the prevention, screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents continues to be needed to improve evidence-based practices.

Alcohol use and heavy drinking are common during adolescence and young adulthood, although the minimum legal drinking age across the United States is 21 years. Some individuals may start hazardous alcohol consumption earlier in childhood. The prevalence of problematic alcohol use continues to escalate into the late adolescent and young-adult age range of 18 to 20 years. Drinking by college-aged students remains a major issue. Results of recent research that have demonstrated that brain development continues well into early adulthood 1   and that alcohol consumption can interfere with such development 2 , 3   indicate that alcohol use by youth is an even greater pediatric health concern.

Use of alcohol at an early age is associated with future alcohol-related problems. 4 , – , 6   Data from the National Longitudinal Alcohol Epidemiologic Study 4   substantiated that the prevalence of both lifetime alcohol dependence and alcohol abuse show a striking decrease with increasing age at onset of use. For those aged 12 years or younger at first use, the prevalence of lifetime alcohol dependence was 40.6%, whereas those who initiated at 18 years was 16.6% and at 21 years was 10.6%. Similarly, the prevalence of lifetime alcohol abuse was 8.3% for those who initiated use at 12 years or younger, 7.8% for those who initiated at 18 years, and 4.8% for those who initiated at 21 years. The contribution of age at alcohol use initiation to the odds of lifetime dependence and abuse varied little across gender and racial subgroups in the study. Early alcohol initiation has been associated with greater sexual risk-taking (unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy) 7   ; academic problems; other substance use; and delinquent behavior in mid- to later adolescence. 8   By young adulthood, early alcohol use is associated with employment problems, other substance abuse, and criminal and violent behavior. 8   Independent of genetic risk, exposure to alcohol or other drug use disorders of parents predicts substance use disorders in children. 9  

Adolescent drinking behaviors cover the alcohol use spectrum, from primary abstinence to alcohol dependence. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) 10   defines alcohol abuse as a maladaptive pattern of use that leads to clinically significant impairment or distress, as manifested by 1 or more of the following within a 12-month period:

recurrent alcohol use that results in a failure to fulfill major role obligations at work, school, or home;

recurrent alcohol use in situations in which it is physically hazardous;

recurrent alcohol-related legal problems;

continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol; and

the symptoms have never met the criteria for alcohol dependence.

Alcohol dependence is defined as a maladaptive pattern of use that leads to clinically significant impairment or distress, as manifested by 3 or more of the following within the same 12-month period:

withdrawal;

alcohol is often taken in larger amounts or over a longer period than was intended;

there is a persistent desire or unsuccessful efforts to cut down or control use;

a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects;

important social, occupational, or recreational activities are given up or reduced because of use; or

alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

Because these diagnostic criteria were developed largely from research and clinical work with adults, there are limitations to applying these definitions to classify alcohol use and associated risks to adolescents. 11 , – , 13   As defined by the DSM-IV-TR , alcohol abuse or dependence may not have had time to develop in an adolescent, especially a younger one, and yet the adolescent may be engaging in very risky behavior. Applicability is also potentially limited in that several of the criteria, such as withdrawal, are not typically experienced by adolescents, and other criteria, such as tolerance, have low specificity for adolescents. Tolerance can be anticipated as a developmental process that will occur over time in most adolescents who drink. 11  

Alcohol misuse can be defined as “alcohol-related disturbances of behavior, disease, or other consequences that are likely to cause an individual, his/her family, or society harm now or in the future.” 14   Because the term “alcohol misuse” encompasses earlier stages of problematic alcohol use as well as alcohol dependence that do not meet diagnostic criteria, it may be a more useful concept clinically in pediatrics and when developing alcohol use primary prevention programs for youth.

In examining the use of drugs by US youth, the annual Monitoring the Future Study (sponsored by the National Institute on Drug Abuse and implemented by the University of Michigan) 15   has consistently reported that the drug most commonly used by youth is alcohol, exceeding the use of tobacco and illicit drugs. The 2009 survey of more than 46000 8th-, 10th-, and 12th-grade students in more than 380 schools nationwide revealed that the prevalence of alcohol use in the previous 30 days had declined by more than one-third since most recently peaking in 1996 but that less of a decline was found for older students. The prevalence of being drunk at least once in the previous month was 5.4% for 8th-graders, 15.5% for 10th-graders, and 27.4% for 12th-graders. Prevalence of use in the previous 30 days of the relatively new flavored alcoholic beverages, also known as “alcopops” or “malternatives,” decreased somewhat since initial inclusion in this survey in 2004. Alcopop use in the previous 30 days was reported by 9.5% of 8th-graders, 19.0% of 10th-graders, and 27.4% of 12th-graders in 2009. Recent “binge-drinking,” defined as the consumption of 5 or more drinks in a row on at least 1 occasion in the previous 2 weeks, has continued at a relatively stable level, with 7.8% of 8th-graders, 17.5% of 10th-graders, and 25.2% of 12th-graders reporting this activity. Since the start of this century, more than 90% of 12th-graders have reported that alcohol is “fairly easy” or “very easy” to get, and more than 60% of 8th-graders say the same. These epidemiologic statistics are corroborated by data reported from 2 other large surveys of youth alcohol use in the United States: the Youth Risk Behavior Survey 16   of the Centers for Disease Control and Prevention and the National Survey on Drug Use & Health (formerly the National Household Survey). 17  

When compared with use by adults, alcohol use by adolescents is much more likely to be episodic (binge) and heavy, which makes alcohol use by those in this age group particularly dangerous. Rapid binge-drinking, possibly related to a bet or dare, puts the teenager at even higher risk of alcohol overdose or alcohol poisoning, in which suppression of the gag reflex and respiratory drive can be fatal. The adult definition of binge-drinking (the consumption of 5 or more drinks in a row over approximately a 2-hour period) is often also used to describe adolescent or young-adult alcohol use. Recent literature, however, suggests that for 9- to 13-year-old children and girls aged 14 to 17 years, binge-drinking should be defined as 3 or more drinks. For boys, binge-drinking should be defined as 4 drinks or more for those aged 14 or 15 years and 5 or more drinks for those aged 16 or 17 years. 18  

Alcohol use is the primary contributor to the leading causes of adolescent death (ie, motor-vehicle crashes, homicide, and suicide) in the United States. 19   Motor-vehicle crashes rank as the top cause of death for US teenagers and young adults. The Youth Risk Behavior Survey in 2007 revealed that during the 30 days preceding the survey, 29.1% of students nationwide had ridden 1 or more times in a car or other vehicle driven by someone who had been drinking alcohol, and 10.5% of students had driven a car or other vehicle at least once when they had been drinking alcohol. 16   The impressive relationship of alcohol use and motor-vehicle crashes involving youth is also highlighted by the fact that after the legal drinking age was changed uniformly to 21 years across the United States, the number of motor-vehicle fatalities in individuals younger than 21 years significantly decreased. 20   Teenagers drink and drive less frequently than do adults, but their motor-vehicle crash risks are higher than those of adults when they do drink, especially at low and moderate blood alcohol concentrations. 21  

Lower minimum legal drinking ages in the United States have also been associated with higher youth suicide rates. 22   The research literature consistently reports the association of alcohol use or abuse with other risk-taking behaviors, including assault, sexual risk-taking, and other drug use. 12 , 13 , 23 , 24   Thus, alcohol use by adolescents is not safe, even when they are not driving.

Alcohol misuse and alcohol use disorders in adolescents are associated with many other mental and physical disorders. Alcohol use disorders are a risk factor for suicide attempts. 25   Psychiatric conditions most likely to co-occur with alcohol use disorders include mood disorders, particularly depression; anxiety disorders; attention-deficit/hyperactivity disorder (ADHD); conduct disorders; bulimia; and schizophrenia. 23   Associated physical health problems include trauma sequelae, 26   sleep disturbance, modestly elevated serum liver enzyme concentrations, and dental and other oral abnormalities, 27   despite relatively few abnormalities being evident on physical examination. 27 , 28  

Twin studies in adult populations have consistently demonstrated genetic influences on use and abuse of alcohol, 29 , – , 31   but less research has examined genetic influences on the adolescent age range. 32 , – , 34   Through a sibling/twin/adoption study of adolescents, Rhee et al 35   examined the relative contribution of genetics and environment on initiation, use, and problem use of substances. The results of this study demonstrated that for adolescents, compared with adult-twin study findings, the magnitude of genetic influences was higher and that of shared environmental influences was lower for problem alcohol or drug use than for initiation of use.

Families play an important role in the development of alcohol and other drug problems in youth. Drug use by parents or older siblings and permissive parental attitudes toward drug use by young people predict greater risk of youth drug and alcohol use. 36 , 37   Both parental monitoring of children's use and the convincing conveyance of household rules governing use aid in deterring alcohol use among youth. 38 , 39   In the United States, 7 million children younger than 18 years are children of alcoholic parents. Children of alcohol abusers are at increased risk of many behavioral and medical problems, including delinquent behavior, learning disorders, ADHD, psychosomatic complaints, and problem drinking or alcoholism as adults. 40  

Having friends who use alcohol, tobacco, or other substances is one of the strongest predictors of substance use by youth. Patterns of use in the community also predict individual substance use behaviors. Rates of use are higher in communities in which alcohol and other drugs are less expensive and easily obtainable. Other risk factors for substance abuse include poor school performance, untreated ADHD, and conduct disorder. 36  

Media influences on the use of alcohol by young people are substantial. Jernigan et al 41   examined boys' and girls' exposure to magazine advertising for alcohol compared with that of legal-aged adults and found that underaged youth saw 45% more beer and ale ads, 12% more distilled-spirit ads, and 65% more low-alcohol refresher beverage ads (for alcopops or lemonades, iced teas, or fruity beverages containing alcohol) as well as 69% less wine advertising than did people aged 21 years or older. Exposure to alcohol advertising was greater for girls than for boys. Other media, such as television, movies, billboards, and the Internet, are known to be very influential in promoting alcohol use through attractive portrayals of use without associated negative consequences. Considerable research has shown that media exposure can make children and adolescents more likely to experiment with alcohol. 42 , 43  

Over the past decade, great strides have been made in understanding the neurobiological basis of addiction. Studies investigating normal brain development have yielded information that elucidate the effects of alcohol and other drugs on the adolescent brain. As summarized by Sowell et al, 44   results of postmortem studies have shown that myelination, a cellular maturational process of the lipid/protein sheath of nerve fibers, begins near the end of the second trimester of fetal development and extends well into the third decade of life and beyond. Autopsy results have shown both a temporal and spatial systematic sequence of myelination, which progresses from inferior to superior and posterior to anterior regions of the brain. This sequencing results in initial brain myelination occurring in the brainstem and cerebellar regions and myelination of the cerebral hemispheres and frontal lobes occurring last. Converging evidence from electrophysiological and cerebral glucose-metabolism studies has revealed relatively late frontal lobe maturation, and results of neuropsychological studies have shown that performance on tasks that involve the frontal lobes continues to improve into adolescence.

Sowell et al 44   documented reduction in gray matter in the regions of the frontal cortex between adolescence and adulthood, which probably reflects increased myelination in the peripheral regions of the cortex. Gray-matter loss, with pruning and elimination of neural connections during normative adolescent development, seems to reflect a sculpting process that turns the immature brain into a mature one. 45   These changes are thought to improve cognitive processing in adulthood. Results of neuropsychological studies have shown that the frontal lobes are essential for functions such as response inhibition, emotional regulation, planning, and organization, all of which may continue to develop between adolescence and young adulthood. Conversely, parietal, temporal, and occipital lobes show little change in maturation between adolescence and adulthood. Parietal association cortices are involved in spatial relationships and sensory functions, and the lateral temporal lobes are associated with auditory and language processing, and these functions are largely mature by adolescence. Hence, the observed patterns of brain maturational changes are consistent with cognitive development. 44   Connections are being fine-tuned in adolescence with the pruning of overabundant synapses and the strengthening of relevant connections with development and experience. It is likely that the further development of the prefrontal cortex aids in the filtering of information and suppression of inappropriate actions. 45  

The effects of alcohol and other drugs on the adolescent brain are probably multiple, because the immaturity or plasticity of the brain developmental processes likely confers greater vulnerability to both the toxic and the addictive actions of drugs, and drug use itself may directly affect brain development. The use of alcohol and drugs during early adolescence, coupled with genetic predisposition to substance abuse and addiction, may increase the magnitude of risk-taking during adolescence. All substances of abuse that lead to dependence share 2 common effects during withdrawal: a decrease in dopamine 2 (D 2 ) receptors (which can lead to tolerance) and hypofunctioning of the prefrontal cortex. The effects of drugs and alcohol on an immature prefrontal cortex may increase the incentive to seek substances of abuse, especially to decrease the effects that are felt during withdrawal. 46 , 47   Continued use may impair an already immature prefrontal cortex and further affect decision-making once substance use begins.

Results of developmentally focused research on how alcohol affects the adolescent brain have started to demonstrate that adolescents with an alcohol use disorder use fewer strategies to learn new information and demonstrate significantly reduced memory skills that continue to deteriorate with continued alcohol use. In neuroimaging studies of patients with adolescent-onset alcohol use disorders, reduced hippocampal volumes and subtle white-matter abnormalities have been documented. 3   Research continues to explore these brain developmental processes that may confer greater vulnerability to the addictive actions of drugs, including alcohol. 2  

In 2007, The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking 48   was issued after being developed in collaboration with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). This call to action identified 6 goals:

Foster changes in American society that facilitate healthy adolescent development and that help prevent and reduce underaged drinking.

Engage parents and other caregivers, schools, communities, all levels of government, all social systems that interface with youth, and youth themselves in a coordinated national effort to prevent and reduce underaged drinking and its consequences.

Promote an understanding of underaged alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences.

Conduct additional research on adolescent alcohol use and its relationship to development.

Work to improve public health surveillance on underaged drinking and on population-based risk factors for this behavior.

Work to ensure that policies at all levels are consistent with the national goal of preventing and reducing underaged alcohol consumption.

The Surgeon General's report outlined specific strategies for implementing these goals, including recommendations for parents and other caregivers; schools, colleges, and universities; communities; the criminal and juvenile justice systems and law enforcement; entertainment and media industries; the health care system; professional health care associations; and governments and policy makers.

Pediatricians and other health care providers who care for children and adolescents should help prevent, identify, and treat alcohol and other substance use by youth. The American Academy of Pediatrics guidelines for the health care of children and adolescents recommend that pediatricians discuss substance use as part of anticipatory guidance and preventive care. 49   Because of their understanding of family dynamics and long-standing relationships with families, pediatricians can identify substance-abusing families and facilitate their care. 50   Pediatricians can be involved in the primary prevention of alcohol misuse through educational and psychological interventions with youth. Although evaluation of such programs has revealed many methodologic weaknesses, there is some evidence to support the effectiveness of family-focused prevention programs and culturally focused skills training in the long-term prevention of alcohol misuse. 14   Pediatricians should support parenting programs that have been shown to reduce or prevent substance use by youth. The most effective programs emphasize active parental involvement and have components that emphasize development of social skills and promote a sense of personal responsibility among young people, as well as address issues related to substance abuse. 51   Pediatricians also have an important advocacy role in health systems' changes as well as legislative efforts, such as increasing alcohol taxes, 52   resisting efforts to weaken minimum-drinking-age laws, and implementing graduated-driver licensing. 21   A recent Cochrane review showed implementation of graduated-driver licensing to be effective in reducing the crash rates of young drivers and, specifically, alcohol-related crashes in most studies in the United States and internationally. 53  

The American Academy of Pediatrics recommends that pediatricians routinely screen and evaluate youth for substance use and provide office interventions and referrals for patients who are using alcohol or other substances. 49   The American Medical Association Guidelines for Adolescent Preventive Services (GAPS) 54   and the American Academy of Pediatrics Bright Futures guidelines 55   recommend that pediatricians and other health care providers who work with children and adolescents conduct routine annual substance use screening of all adolescents and use brief intervention techniques as indicated. In addition, it is recommended that pediatricians be familiar with community resources and refer patients with problematic use or a substance use disorder for treatment. 56   Despite these recommendations, primary care providers have reported many barriers to implementing alcohol and other drug use screening as a routine. Barriers to such screening have been identified to include insufficient time, lack of training to manage a positive screening, the need to triage competing medical problems, lack of treatment resources, tenacious parents who will not leave the examination room, and unfamiliarity with screening tools. 57  

Brief screening surveys for adolescent substance use are available and include the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization, 58   the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse scale developed by the National Institute on Drug Abuse, 59   and the CRAFFT instrument, a 6-question, developmentally appropriate screening tool developed by Knight et al (see Table 1 ). 60   Although all 3 of these tools have acceptable sensitivity for identifying alcohol problems or disorders in 14- to 18-year-old adolescents, 61   the CRAFFT instrument has emerged as a quick, validated, reliable, and easy-to-use screening tool that can be administered in the primary care setting in verbal or written format and has good discriminative properties for determining substance use disorders in adolescents. 62   Test-retest reliability of the CRAFFT has been shown to be high, especially when the questions are prefaced with the phrase “in the past year” when office-based screening is performed. 63   Recently, the CRAFFT tool use was integrated into an adolescent substance use screening, brief intervention, and referral-to-treatment algorithm and tool kit to augment pediatricians' confidence and ability in responding effectively to screening results. 64  

CRAFFT Questions: A Brief Screening Test of Adolescent Substance Abuse

Two or more yes answers suggest a significant problem, abuse, or dependence. The CRAFFT questions were developed with grant support from the Robert Wood Johnson Foundation, the National Institute on Alcohol Abuse and Alcoholism, and the Substance Abuse and Mental Health Services Administration.

More research is still needed to aid in developing brief intervention strategies (ie, short, efficient, office-based techniques) that health care providers who work with adolescents can use to detect and intervene with alcohol misuse. Motivational interviewing is one of the most promising brief intervention strategies that can be used in an office-based setting. 65   Motivational interviewing is a patient-centered, directive counseling style that builds on the intrinsic motivation of an individual. When conducting a motivational interview, the pediatrician or counselor creates a partnership with the adolescent patient to explore and resolve his or her ambivalence about behavioral change. Motivational interviewing is often associated with the transtheoretical model described by Prochaska and DiClemente, 66   who identified what they called “stages of change,” a continuum of readiness to change behavior. In this model, change is facilitated by matching the counseling strategy to the stage of patient readiness to change behavior. The essential spirit of motivational interviewing comprises 3 elements: collaboration, or forming a partnership with the patient; evocation, or using open-ended questions and reflections to help the patient determine his or her own motivation to change; and autonomy, or accepting that it is the adolescent's responsibility to change his or her behavior and decide how the change will occur and that direct persuasion by a pediatrician or counselor is unlikely to be effective. Expressing empathy, developing discrepancy between goals and current behavior, “rolling” with the resistance a patient may have (ie, avoiding arguing for change), and supporting patient self-efficacy are the 4 principles of motivational interviewing. 67  

Results of research have shown that motivational interviewing as a counseling style has been effective in decreasing alcohol use in both younger and older adolescents. 68 , – , 71   The authors of a recent Cochrane review of primary prevention for alcohol misuse by young people noted that, although much research investigating the effectiveness of alcohol interventions was of poor quality, there was “strong design and consistent pattern of results indicating potential value of motivational interviewing.” 14   Further research is indicated to improve all aspects of adolescent substance abuse intervention and treatment. 72  

Specific recommendations regarding the best management tools and techniques for treatment will be available in a forthcoming statement from the American Academy of Pediatrics on substance use screening, brief intervention, and referral to treatment for pediatricians. For more information, please see the resources listed at the end of this statement.

Pediatricians and other health care providers who work with children and adolescents are recommended to:

Become knowledgeable about all aspects of adolescent alcohol, tobacco, and other substance use through participation in training-program curricula and/or continuing medical education that provide current best-practices training, including media-literacy training.

Obtain a complete family medical and social history at prenatal and health supervision visits to explore potential genetic and family influences regarding alcohol and other substance use.

Recognize risk factors for alcohol (as well as other drug) use among youth and be aware of coexisting mental health problems, such as depression, that may occur in this age group.

Regularly screen for current alcohol (as well as other drug) use by adolescents and young adults by using nonjudgmental, validated screening methods and appropriate confidentiality assurances.

Assess patients whose screening results are positive for alcohol use to determine the appropriate level of intervention.

Use brief intervention techniques in the clinical setting and be familiar with motivational interviewing techniques to work with patients who use alcohol but do not meet criteria for immediate referral. Offer referral to treatment when indicated.

Discuss the hazards of alcohol and other substance use with patients as part of anticipatory guidance and patient/parent education at health supervision visits as well as when relevant at acute-problem visits. Anticipatory guidance aligned with key school calendar events, such as proms and graduation, may be especially meaningful.

Strongly advise against the use of alcohol, tobacco, and other illicit drugs by youth.

Encourage parents to be good role models for healthy life choices and never allow underaged drinking at their home or other property. Empower parents with the realization that their involvement with their adolescents is a powerful deterrent of substance abuse.

Be familiar with local resources to which various pediatric-aged patients with alcohol use disorders, their parents, and other family members can be referred for developmentally appropriate treatment.

Support adolescents with substance use disorders throughout and after their treatment.

Serve as a resource and support for school and other community-based alcohol use prevention programs.

Support advocacy efforts to promote appropriate media modeling of alcohol consumption and consequences, including print media, television, film, and the Internet.

Support advocacy efforts to promote legislation that reduces alcohol-related morbidity and mortality, such as graduated-driver licensing; treatment parity from third-party payers; legal ramifications for parent sponsorship of adolescent drinking; increased alcohol excise taxes; and other prevention and treatment policies recommended in the Surgeon General's call to action. 48  

Support continuation of the age of 21 as the minimum legal drinking age, and support enforcement that decreases access to alcohol for minors.

Support further research into prevention, evidence-based screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents.

Alcohol: Your Child and Drugs (patient education brochure)

Join Together ( www.jointogether.org )

Parent-Teen Driving Agreement and a Message to Parents of Teen Drivers (patient education brochure)

Substance Abuse Prevention (patient education brochure)

Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse 49   (policy statement)

Tobacco as a Substance of Abuse (technical report from Sims TH and Committee on Substance Abuse). Pediatrics. 2009;124(5):e1045–e1053

AAP District II, New York Chapter 2, Committee on Youth and Adolescence.

Teen Parties in Your Home: A Guide for Parents

www.ny2aap.org/teenparties.pdf

Al-Anon/Alateen

www.al-anon.alateen.org

American Council for Drug Education

www.acde.org

American Medical Association

Office of Alcohol and Other Drug Abuse

National Office of the Robert Wood Johnson Foundation

Helping Patients Who Drink Too Much: A Clinician's Guide

http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

College Drinking—Changing the Culture

www.collegedrinkingprevention.gov

Monitoring the Future Study

www.monitoringthefuture.org

National Institute on Alcohol Abuse and Alcoholism

www.niaaa.nih.gov

National Survey on Drug Use & Health (formerly the National Household Survey on Drug Abuse)

www.oas.samhsa.gov/nhsda.htm

Partnership for a Drug-Free America

www.drugfree.org

US Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration's National Clearinghouse for Alcohol and Drug Information

http://ncadi.samhsa.gov

Alcoholics Anonymous–Alcoholics Anonymous World Services, Inc

New York, NY 10163

Telephone: 212-870-3400

www.alcoholics-anonymous.org

Mothers Against Drunk Driving (MADD)

National Headquarters

Victim Assistance and Book Orders

511 E John Carpenter Freeway, Suite 700

Irving, TX 75062

Telephone: 214-744-6233

www.madd.org

Narcotics Anonymous World Services, Inc.

Main Office

PO Box 9999

Van Nuys, CA 91409

Telephone: 818-773-9999

Fax: 818-700-0700

Rue de l'Été/Zomerstraat

B-1050 Brussels, Belgium

Telephone: 32-2-646-6012

Fax: 32-2-649-9239

National Clearinghouse for Alcohol and Drug Information

PO Box 2345

Rockville, MD 20847-2345

Telephone: 800-729-6686 (toll-free), 301-468-2600 (local), 811-767-8432 (in Spanish), or 800-487-4889 (TDD)

Fax: 301-468-6433

Students Against Destructive Decisions (formerly Students Against Drunk Driving) (SADD)

SADD National

255 Main St

Marlborough, MA 01752

Telephone: 877-SADD-INC (877-723-3462)

Fax: 508-481-575

www.sadd.org

Janet F. Williams, MD, Chairperson

Marylou Behnke, MD

*Patricia K. Kokotailo, MD, MPH

Sharon Levy, MD, MPH

Tammy H. Sims, MD

Martha J. Wunsch, MD

Deborah Simkin, MD – American Academy of Child and Adolescent Psychiatry

Karen Smith

*Lead author

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision

attention-deficit/hyperactivity disorder

Competing Interests

Response to dr sascha meyer.

Dear Dr. Meyer: We thank you very much for your extremely thoughtful response to the Policy Statement "Alcohol Use by Youth and Adolescents: A Pediatric Concern". You provide information regarding alcohol use by children and adolescents in Europe that supports our policy statement well, and emphasize the worldwide need for further work in this area, especially in the development and implementation of short-term and long-term medical intervention strategies in order to prevent acute injury and the development of alcohol dependence at an early age. We appreciate your recommendation of employment of key personnel to screen in acute settings, and to implement effective referral pathways to adolescent mental health and alcohol services. We hope that these recommendations may be taken up worldwide to improve the health of children and adolescents.

Best regards, Patricia Kokotailo, MD, MPH

Conflict of Interest:

None declared

Pediatric alcohol abuse: The need for a holistic approach

Dear Editor,

We would like to comment of the paper “Alcohol use by youth and adolescents: A pediatric concern (Pediatrics 2010; 125:1078-1087) published by the Committee on Substance Abuse.

As alcohol consumption in the population as a whole is increasing steadily in many countries, the deleterious effects of alcohol on the individual and society are increasingly being recognised. Alcohol consumption and abuse in the young and in school children also seems to be on the rise. Of concern, data from the United States indicate that children of an increasingly younger age are consuming alcohol, and a substantive proportion of adolescents have difficulties with alcohol intoxication, self-poisoning or dependence [1-4]. In Australia, 90% of teenagers aged 15 to 16 years report having drunk more than two alcoholic beverages in their lifetime, and 29% describe drinking to the point of intoxication [5]. Similar data is available for European countries [6-8]. This is likely to lead to the development of alcohol dependence at an earlier age in a proportion of young drinkers, and the subsequent development of physical complications [9], thus increasing the burden of alcohol-related illnesses on the health-care system. As a consequence, reduction of alcohol consumption is one of the health priorities of the WHO [10-12].

As outlined by the Committee on Substance Abuse health care professionals must be able to identify children or adolescents who are having difficulties with alcohol abuse or dependence [13]. This problem may come to their attention when a child or adolescent with acute alcohol intoxication or self-poisoning presents to an emergency department, or other health care facilities. While some data exit on the number of children and adolescents presenting to emergency departments [14, 15], scant data are available on the number of paediatric patients requiring in -patient treatment ≥24 hours secondary to alcohol intoxication [16].

In a national German study, we demonstrated that the number of alcohol-intoxicated children and adolescents requiring in-patient hospital treatment (≥24 h) increased significantly in the years 2000-2002, the most prominent increase being seen in adolescents aged 13-17 years, and female patients [17]. Neither a rise in population and hospital admissions nor a change in age structure of the study population, nor differences in recording were likely to account for this increase. The increase in recorded acute alcohol intoxication admissions in our survey corresponds to an increase in alcohol consumption levels that has occurred over the same time period in children and adolescents in Germany as reported by the German Federal Centre for Health Education [18]. The high proportion of females in our study is in accordance with previous reports [14], and probably mirrors real changes in drinking patterns in girls.

The troubling aspects of the findings of our study are corroborated by the results from previous reports that demonstrated a substantial proportion of under-age drinkers seen in the accident and emergency departments [14]. In the study by O’Farrell et al. almost 10% of all hospital admissions for acute alcohol intoxication were under 18 years of age, and 3% were aged 10-14 years [16]. In Germany, in the year 2000 the overall rate of hospital admissions in children and adolescents aged 10-17 years secondary to acute alcohol intoxication was estimated to be 1 ‰ [19].

To tackle the pattern of excessive drinking in young people effective legislative measures as well as policies regulating availability through access, pricing and promotion, as recommended by various task forces on Alcohol [11, 20] are required to minimize the harmful affects of alcohol within this specific age cohort. It is also very important to take into consideration underlying risk factors for alcohol abuse in this age cohort, e.g. psychosocial problems, history of physical and/or sexual abuse as mentioned and biological factors as outlined by the Committee on Substance Abuse [13, 21-23].

Furthermore, the problem of drinking in children and adolescents requires the development and implementation of short-term and long-term medical intervention strategies in order to prevent acute injury and the development of alcohol dependence at an early age. In accordance with current paediatric and psychiatric literature it is recommended that once the child or adolescent presenting to the hospital with acute alcohol intoxication is medically stable, mental health and drug and alcohol issues (comprehensive assessment of alcohol and drug history, psychosocial risk factors, and treatment history) be explored and appropriate follow-up arranged [4, 24]. Although a large proportion of health promotion needs to be performed in primary care, hospitals and emergency departments can deliver effective early interventions [25]. Although the age group of 13- 17 year-old children and adolescents may represent a cohort which may be especially amenable to such interventions, often comprehensive assessment and adequate follow-up are not performed in the emergency department [14]. The employment of key personnel (e.g., alcohol specialist nurses trained in alcohol-related problems) and the implementation of effective referral pathways to adolescent mental health and alcohol services might be a promising approach to cope with the burden posed by alcohol intoxication in this age group on hospitals. Once realised, these intervention measures then mandate ongoing assessment as to whether they improve the outcomes of this group of children and adolescents.

With kindest regards Dr Sascha Meyer, Consultant Pediatrician, Consultant Intensivist (MD, PD) University Children´s Hospital of Saarland Department of Pediatrics/Poison Control Center 66421 Homburg Germany

Conflict of interest: The author has no conflict of interest to disclose.

References 1 Gilvarry E. Substance abuse in young people. J Child Psychol Psychiatry 2000; 41: 55-80

2 Halmandaris PV, Anderson TR. Children and adolescents in the psychiatric emergency setting. Psychiatr Clin North Am 1999; 22: 865-874

3 Ellickson PL, McGuigan K, Adams V, Bell RM, Hays RD. Teenagers and alcohol misuse in the United States: by any definition, it's a big problem. Addiction 1996; 91: 1489-1503

4 Bukstein O. Practice parameters for the assessment and treatment of children and adolescents with substance use disorders. American academy of child and adolescent psychiatry. J Am Acad Child Adolesc Psychiatry 1997; 36: 140-156

5 Australian Institute of Family Studies. Patterns and Predictors of Teenagers’ Use of Licit and Illicit Substances in the Australian Temperament Project Cohort Melbourne, Australia: University of Melbourne 2000

6 Hibell B, Andersson B, Bjarnason T, Kokkevi A, Morgan M, Naruk A. et al. The 1995 ESPAD Report: Alcohol and other drug use among students in 26 European countries Swedish council for information on alcohol and other drugs, Stockholm 1997

7 Hibell B, Andersson B, Ahlstöm S, Blakireva O, Bjarnason T, Kokkevi A. et al. The 1999 ESPAD Report: Alcohol and other drug Use among students in 30 European countries Swedish Council for Information on Alcohol and Other Drugs, Stockholm 2001

8 MacMiller P, Plant M. Drinking, smoking, and illicit drug use among 15 and 16-year-olds in the United Kingdom. Br Med J 1996; 313: 394-397

9 Leon DA, MacCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet 2006; 367: 452-456

10 World Health Organisation. Global Strategy for Health for All by the Year 2000 Geneva, WHO 1981

11 Saunders JB, Aasland OG, Babor TF, Fuente JRdela, Grant M. Development of Alcohol Use Disorders Identification List (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption - II. Addiction 1993; 88: 791-864

12 World Health Organization. International Guide for Monitoring Alcohol Consumption and Related Harm Geneva: Department of Mental Health and Substance Dependence, WHO 2000

13 Committee on Substance Abuse. Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics 2010;125: 1078-1087

14 Woolfenden S, Dosseter D, Williams K. Children and adolescents with acute alcohol intoxication/self-poisoning presenting to the emergency department. Arch Pediatr Adolesc Med 2002; 156: 345-348

15 Felter R, Izsak E, Lawrence HS. Emergency department management of the intoxicated adolescent. Pediatr Clin North Am 1987; 34: 399-421

16 O’Farrell , Allwright S, Downey J, Bedford D, Howeell F. The burden of alcohol misuse on emergency in-patient hospital admissions among residents from a health board region in Ireland. Addiction 2004; 99: 1279- 1285

17 Meyer S, Steiner M, Mueller H, Nunold H, Gottschling S, Gortner L. Recent trends in the burden of alcohol intoxication on pediatric in- patient services in Germany. Klin Padiatr 2008; 220: 6-9

18 http://www.bzga.de/botpresse_251.html(accessed May, 4th, 2010)

19 Bundesministerium für Gesundheit und Soziale Sicherung Bonn. Wissenschaftliche Begleitung des Modellprogramms „Alkoholvergiftungen bei Kindern und Jugendlichen” Bundesweite Datenerhebung - Kurzanalyse 2004, p. 10-11

20 Department of Health and Children. Strategic Taskforce on Alcohol Interim Report Dublin, Ireland: Department of Health and Children 2002

21 Clark DB, Lesnick L, Hegedus AM. Traumas and other adverse life events in adolescents with alcohol intoxication/self-poisoning and dependence. J Am Acad Child Adolesc Psychiatry 1997; 36: 1744-1751

22 Lamminpaa A, Vilska J. Alcohol intoxication and psychosocial problems among children. Acta Psychiatr Scand 1990; 81: 468-471

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Teenagers today confront coping with a broad spectrum of influences on decision-making and behavior. Prescription medication abuse by teens and young adults is a serious problem in the United States. Many teens think these drugs are safe because they have legitimate uses, but taking them without a prescription to get high or “self-medicate” can be as dangerous – and addictive – as using street narcotics and other illicit drugs. [1] There are several studies that have proven beyond doubt that several such influences have potentially negative effects on growth and development. Besides drug abuse has also become a serious problem.

There are several reasons contributing to the fact that some of the individuals particularly the youths are trapped in these negative moral influences. The lack of healthy parental guidance and monitoring is one factor that is contributing to the increasing numbers. Several studies suggest that conditions such as poverty, unemployment, poor education, discrimination, and despair lay the foundation for alcohol and other drug-related problems. A coordinated effort from the family, schools, and society is essential in order to create willingness among individuals for a change. It is also important to focus on increasing the skills or abilities of teenagers and it is equally vital to focus on changing and improving social systems that create these conditions. This paper will examine teen drug abuse in today’s society involving prescription drug abuse in the medicine cabinet and also suggest some remedial measures that need to be taken to prevent teenagers from these self-defeating habits.

Drug and alcohol abuse is a common problem around the world and teenagers are mainly facing this problem of decision making and behavior. Many teenagers’ social environments have been linked with participation in potentially “at-risk” behaviors such as the use of alcohol, tobacco, and marijuana (Hundleby and Mercer, 151-64). Globally, drug abuse is also linked with street gangs and drug trafficking and has become a major cause of concern. The most vulnerable sector in society is the youth.

While some communities acknowledge difficulties in dealing with the teenage problem, they fail to concede that they have a problem until the gangs become firmly deep-rooted. Trade-in drugs of abuse such as cocaine, heroin, and amphetamines (synthetic stimulants) have long been a frustrating feature, especially in the third world. However today it is prescription drug use and abuse that is emerging as a major problem that is going unchecked. It is such a difficult situation to differentiate the user from the abuse.

There are studies that have proven beyond doubt that the use of prescription drugs can have potentially negative effects on growth and development. The prescription drugs that are most frequently abused by teens are painkillers, depressants, and stimulants. Painkillers are in general powerful narcotics given to treat pain such as those drugs prescribed after surgery. Depressants, such as sleeping pills or anti-anxiety drugs are common prescription drugs that are given to treat depression or mood swings and stimulants are mainly prescribed to treat attention-deficit hyperactivity disorder (ADHD) (Office of National Drug Control Policy, 2008).

Some of the statistics from different studies are as follows:

• An estimated 1 in 5 teens has abused a prescription pain medication
• 1 in 5 teenagers reported abusing prescription stimulants and tranquilizers
• And 1 in 10 has misused cough medication (Partnership for a Drug-Free America, 2008)
• A study by NSDUH (2007) said that in 2006, more than 2.1 million teens abused prescription drugs and one-third of all new abusers of prescription drugs in 2006 were between the age of 12 and 17-year-olds.
• Since prescription drugs are easily accessible when compared to drugs such as marijuana, cocaine, and heroin it was found that 3 % of teens between the age of 12 and 17 reported abuse of prescription drugs in 2006, following only marijuana (7%) and well ahead of cocaine (0.4%), ecstasy (0.3%), meth (0.2%), and heroin (0.1%). (NSDUH, 2007)
• Prescription drugs are the drug of choice among 12- to 13-year-olds. (NSDUH, 2007)
• According to another study it was found that every day 2,500 youth between the age of 12 and 17 abuse prescription pain killers for the very first time. (SAMHSA, 2007a) (Office of National Drug Control Policy, 2008)

If we have to examine why this trend is growing especially among teenagers, it is important to study them from various perspectives. There are several reasons contributing to the fact that some of the individuals particularly the youths are trapped in these negative moral influences. One of the most important reasons for this is the lack of strong parental guidance and monitoring.

Some teenagers have psychological problems which make their social and academic success difficult which in turn results in them using these drugs. In other cases, they attend disorganized and disruptive schools and fail to engage in academic pursuits. Peer pressure is a major problem that many teenagers face. Some of them live in unsystematic neighborhoods with few funds or outlets for positive social activities and others are disqualified from peer groups and have few if any, wholesome friends.

Today, many teens are under the impression that these drugs are safe since they have legitimate uses. However, they do not know the fact that taking them without a prescription to get high or self-medicate is as perilous and addictive as using narcotics and other illegal drugs (Partnership for a Drug-Free America, 2008). The increasing trend of use of prescription drugs by teens is turning them away from street drugs but they are failing to realize that prescription drugs are also as perilous as illicit drugs. The easy availability of these drugs in the family medicine cabinet that includes prescription (Rx) and over-the-counter (OTC) drugs is one of the reasons for this trend.

There are different ways in which youth may get involved with prescription drugs. During the initial stage or the experimental stage, these drugs can turn out to be very dangerous, since they ignore the effects of these drugs. For instance, if a teenager uses the drug for cough in a high dose and goes on a ride, it may result in road accidents. Teenagers often do not think of their actions the consequences of their actions that can affect their life drastically.

There are also some teens who will experiment and stop, but some of them get addicted or and may continue to use occasionally without any significant problem. Those teenagers who get addicted are the ones that need immediate intervention and help to learn to make better decisions. However, it is almost impossible to forecast which teens will experiment and stop and which ones will develop serious problems. For instance, one of my cousins- Michel began the use of cough medicine on regular basis. Then he began the use of the painkillers that were used by his mother for the arthritis problem without the knowledge of what these medicines are used for. His parents were ignorant about this fact until the problem was serious and they had to take him for treatment. It is important for parents to know what their teens are doing and who they are doing it with.

Though it is difficult to identify these problems following are some warning signs of teenagers at risk for developing serious prescription drug addiction:

• “A family history of substance or alcohol abuse
• Low self-esteem
• Feel like they don’t fit in and are not popular with the mainstream
• frequently feel sluggish and have difficulty sleeping
• Aggressive and rebellious attitude toward authority figures” (Teen drug abuse blogs, 2008)

Parents who notice or are aware of these signs need to be very careful and if they realize that their child has one or more of the above behaviors, they should rush to seek help from a professional. This is because parents and caregivers are the first line of defense in addressing this troubling trend. Just because these drugs are so readily available and are sometimes easily accessible from the family medicine cabinet many teens today believe they are a safe way to get high and this is one of the reasons that teens who are not using illicit drugs might end up the abuse of prescription drugs. In fact, studies show that not many parents are talking to them about it, even though teens report that parental disapproval is a powerful way to keep them away from drugs (Partnership for Drug-free America, 2007).

If we look at the modes of obtaining these prescription drugs, as mentioned earlier it is commonly from the family medicine cabinet. In some cases with the development of internet technologies, these prescription drugs are easily obtained over the Internet. Some of them get it free from friends or taking them from someone’s medicine cabinet. According to an analysis of national surveys prepared by Walters’ office “while the use of marijuana declined from 30.1 percent to 25.8 percent from 2002 to 2006, use of OxyContin, a painkiller, increased from 2.7 percent to 3.5 percent over the same period. Use of Vicodin, another painkiller, increased slightly from 6 percent to 6.3 percent”.

This study also found that teens are also abusing stimulants like Adderall and anti-anxiety drugs like Xanax because they are readily available and supposed as safer than street drugs. According to Dr. Terry Horton, the medical director of Phoenix House, who operates nearly 100 substance abuse programs in nine states, said “the belief that prescription drugs are safer than street drugs is false. These medicines cause dependence and addiction when misused and have the potential to cause death,” he said. “We’re talking about medicines that are related, pharmacologically, to heroin and have very similar effects.” (msnbc.msn.com, 2007)

Long-term studies have found that prescription drugs have serious health risks on regular use. Hence there is no doubt that these will have a similar or serious impact on abuse. A single overdose of prescription or over-the-counter (OTC) painkillers or depressants can cause serious problems such as respiratory difficulty that can lead to even death. Further, it is also found that stimulant abuse can result in aggression or obsession. There are also chances that these drugs have the potential for heart system failure or fatal seizures. Researchers have also found that even in small doses, depressants and painkillers have subtle effects on motor skills, judgment, and also it can hamper the ability of teenagers to learn.

Studies also point out that the abuse of OTC cough and cold remedies can cause blurred vision, nausea, vomiting, dizziness, coma, and even death. There are also cases where many teens are found to mixing prescription drugs, OTC drugs, and alcohol. This can not only harm their entire system but also at times cause mental instability. Besides, these combinations can cause respiratory failure and death. According to a study conducted between 1995 and 2005, treatment admissions for prescription painkillers increased more than 300 percent (SAMHSA, 2007).

There are several ways to prevent these things from preventing teens or any other person from getting involved with prescription drug abuse. The best thing and the first step towards this are to keep prescription drugs in a safe place under a lock and key system. It is important not to put them in the medicine cabinet in common places because that is the first place teenagers will look. Secondly, once it is conformed that the teens are into such habits it is important to have an open conversation with them and warn them of the dangers of prescription drug abuse.

The following are few important subjects that need to be shared with the teen about prescription medications:

• Drugs taken without a prescription or a physician’s supervision can be just as hazardous as taking illicit drugs.
• Abusing these drugs whether it is painkillers or stimulants or any of the OTC drugs is like abusing heroin because their ingredients are similar. Some of these contain harmful substances called opiates.
• When these drugs are taken without prescriptions by a normal individual it can be deadly.
• Mixing up drugs with alcohol and other drugs can have serious consequences on health and mental stability. These may also result in allergic reactions to different chemicals when they are mixed together (Teen drug abuse blogs, 2008)

According to some of the recent surveys it was found that up to 60% of students receiving legitimate prescriptions had been approached to divert their medications. About 1 in 10 traded medication. A smaller proportion sold it, and as many as 25% gave it to friends or family members. This study was conducted among more than 1,000 middle and high school students.

According to Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter , says that “What helps an anxious child may be poison for a substance-abusing child, but sometimes the two illnesses occur in the same child. Thus a simple solution like reducing the total number of prescriptions cannot work. The real task is to figure out which kids need which medicines and make sure that only those kids get the medicines. Not easy.” (Harvard health publications, 2007)

Other than the intentional abuse of prescription drugs by teens, researchers have found that:

• “Use of heroin by youths and young adults has increased, as shown in the rise of “cheese heroin” (a mixture of Tylenol PM and heroin) in Dallas.
• Methamphetamine has spread from the Pacific Coast eastward.
• Abuse of the tranquilizer Xanax and the muscle relaxant Soma has increased.
• The use of Ecstasy has increased as the drug spreads from the club scene to the street.
• Crack cocaine users are now more likely to be white or Hispanic than African American.
• Alcohol and cocaine are the primary drugs for which Texans enter treatment”. (Office of Public Affairs, 2007)

Experts are of the opinion that the increasing trend of abuse of prescription drugs is because physicians are prescribing more drugs for more health problems. Secondly, online pharmacies make it easy to get prescription drugs without a prescription, even for teenagers. Therefore, anyone having access to the internet can obtain these drugs without much problem. Drugs such as Vicodin, OxyContin, and Xanax are among the drugs that are most likely to be abused. There are also reports of teenagers and young adults mixing Xanax with cola drinks and some are taking Vicodin before they start drinking to get drunker faster. These drugs are often seen in fatal traffic accident reports (Office of Public Affairs, 2007).

Since most of the prescription drug problem begins from home it is easy for parents, teachers, and other social workers to prevent it by creating awareness. Additionally, it is also important to recognize the signs and symptoms of prescription drug abuse and encourage parents and other adults to:

• “Safeguard all drugs in their homes by a lock and key system. Monitor quantities and control access.
• Set clear rules for teens regarding all drug use, including not distributing medicine and for all time following the medical provider’s counsel and dosages.
• Set the same set of rules for rules and be a role model with their own medicines.
• Properly cover and dispose of expired or unused medicines in the trash.
• Take the help of friends and family members to safeguard their prescription drugs as well (PTA, 2008).

Above all, it is also important to understand the mindset of the teens as to why they take up such dangerous tasks. Some of them use alcohol and other drugs for impressing their peer group. This is an age when most of them want to behave like adults and also take risks. Teens tend to try new things and take risks because it seems exciting.

There are also studies that show that teens with family members who have problems with alcohol or other drugs are into trouble to have serious substance abuse problems. Teens are in a move to show their importance in family and also the peer group. They want to be always noticed and recognized for their acts. Therefore, those teens who feel that they are not connected to or valued by their parents are at greater risk of drug abuse. Additionally, there are also studies that show that teens with poor self-esteem or emotional or mental health problems, such as depression, easily fall into such risky behavior.

The impact of drug and alcohol abuse can have serious consequences on the entire life of a person. It is found that substance abuse can result in problems such as poor schoolwork, loss of friends, problems at home, and lasting legal problems. Alcohol and drug abuse is a foremost reason for teen death or injury related to accidents, suicides, violence, and drowning. Besides substance abuse can add to the risk of pregnancy and sexually transmitted diseases (STDs), including HIV, because of unprotected sex. And teens are the most vulnerable to all these problems (WebMD 2008).

Several studies show that conditions such as poverty, unemployment, poor education, inequity, and hopelessness place the foundation for alcohol and other drug-related problems. Therefore, it is important that a coordinated effort from the family, schools, and society is necessary to create awareness about the harmful short-term and long-term impact on individuals. Simultaneously, it is also vital to focus on the rising skills and abilities of teenagers and to focus on changing and improving social systems that create these conditions.

The steps parents can take to educate and communicate with their teens regarding prescription drug abuse are as follows:

• Parents need to create awareness among the teens that the prescription drugs present in their home are for specific purposes and if taken without the physician’s advice it can have serious problems.
• These drugs need to be kept in a separate cabinet under the lock and key system.
• It is important to keep a check on the number of prescription drugs purchased and consumed by adults.
• Expired or unwanted drugs need to be disposed of safely.
• Should not stock drugs for a long time.
• Keep a watch on the teens and their peer groups.
• Name of parent
• Parent’s Educational Level (years of studies)
• Have you ever had a member of your family suffering from a mental disorder, depression, arthritis, or any other pains?
• Do you have drugs prescribed by the physicians for the above problems stored in your house?
• If yes, are they kept under a lock and key system?
• If no, do you keep a check on the quantity of these drugs?
• Do you believe that psychotropic drugs may cause more damage to children, due to their age?
• Age of teenagers
• Do you find any symptoms of abuse of prescription drugs by your teenagers? If yes, list them.
• What are the sources of these drugs for them?
• Do you have frequent talks with teenagers on issues such as drug abuse, teenage sex, violence, and other social problems?
• What are the sources of help that you have?
• Have you ever used unwanted drugs without the prescription of a physician?
• Does your spouse use drugs without the prescription of a physician?
• Do you order drugs through the internet?

Harvard health publications, (2007) Teen prescription drug abuse . Web.

Hundleby J. D. and Mercer G. W., (1987) Family and Friends as Social Environments and Their Relationship to Young Adolescents’ Use of Alcohol, Tobacco, and Marijuana,” Journal of Marriage and the Family , XLIX, 151-64.

msnbc.msn.com, (2007) Teen abuse of prescription drugs holds steady, The Associated Press. Web.

Office of National Drug Control Policy, (2008) Prescription for danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens, Web.

Office of Public Affairs, (2007) Feature Story: Generation Rx . Web.

PTA, (2008) What Parents Need to Know About Teen Prescription Drug Use, Web.

Partnership for Drug-free America, (2007) Partnership Attitude Tracking Study [PATS] 2007.

Partnership for a Drug-Free America, (2008) Prescription medicine abuse: A serious problem. Web.

Substance Abuse and Mental Health Services Administration [SAMHSA] (2007).

National Survey on Drug Use and Health, 2006. Office of Applied Studies.

Teen drug abuse, (2005) Teenage Prescription Drug Abuse . Web.

WebMD (2008) Alcohol Abuse Health Center. Web.

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Effects Of Drug Abuse And Alcohol Addiction Research Paper Examples

Type of paper: Research Paper

Topic: Drugs , Health , Drug Abuse , Alcoholism , Bullying , Alcohol , Family , Violence

Words: 2000

Published: 01/14/2020

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Introduction

Most educated people are aware that substance abuse – using recreational drugs or regularly consuming excessive amounts of alcohol can lead to addiction and/or cause a number of harmful effects. This paper discusses those effects which are wide ranging, can affect the health and the safety of the subject and the subject’s family and friends, and can lead to criminal activity and even the death of the subject.

The Research

- General definition of the problem. Excessive use of drugs and/or alcohol is collectively termed “substance abuse” – a recognized disease. A Florida Institute of Technology article “Facts about Alcohol and Drug Abuse” ( n.d.) reminds readers that although we may often drink with dinner, after work, or at a ball game, it can be a problem if a drinking pattern emerges. It also points out that drugs use in the USA is now more common. Over 90 percent of teenagers have tried alcohol, marijuana more than 50 percent, cocaine 17 percent and hallucinogenic drugs 12.5 percent. The same article gives some of the more common reasons why people do turn to drink or drugs, such as for social reasons: feeling the need to join in with drinking or experimenting with drugs at parties and other social gatherings; to cope with some form of stress, perhaps work or school-related, or marital / relationship stress, or stress caused by a physical illness; as a substitute for personal or work challenges or a personal relationship; or to compensate for feelings of diminished self-esteem, shyness, guilt, etc. It also explains that turning to drink and/or drugs to cope with life’s problems can lead to addiction, and that because alcohol and certain drugs are now more available and more acceptable in a social context, it is easier for young people to experiment with them. To underline the seriousness of the consequent problems, the article lists key facts, including: - Age of first-time trying drugs in the U.S. averages 13; even lower for alcohol; - In the U.S., alcohol is the widest-used drug and the third largest cause of death, after heart disease and cancers; - Drugs and alcohol contribute to over half of all suicides, more than 50 percent of violent crimes and over 60 percent of emergency hospital admissions; - In excess of 50 percent of traffic accidents involve drugs or alcohol use; - Drugs or alcohol are factors in circa 80 percent of domestic violence incidents; - Circa half of all sub-standard job performances and industrial accidents can be attributed to drug or alcohol use; - Driving While Intoxicated (DWI) arrests between 1986 and 1996 were highest for drivers aged 21, and over a third of all alcohol-linked traffic accidents involved young people between the ages of 16 and24; - Alcohol is a factor in over 95 percent of campus violence, and over 40 percent of students experiencing academic difficulties are users of alcohol. - Effects on Health. The Bowles Center for Alcohol Studies at the University of North Carolina published an article entitled “Alcohol & Drug Abuse Prevention” with a section on the effects of abuse on health, sub-divided into Alcohol and Drugs parts. Alcohol. The article cautions that alcohol consumed goes straight into the bloodstream, producing physical effects throughout the body and causing illnesses and other health problems, including: - Hangovers: excessive drinking causes headache, nausea, general pain, etc; - Gaining weight: alcohol – unlike water – contains calories termed as “empty” calories because they provide little nutrition. (A beer is about 150 calories); - Raised blood pressure: coupled with weight gain, heightened blood pressure is the cause of various more serious health issues; - Impaired immune system: increases risk of viral diseases such as influenza; - Cancers: various cancers more likely due to alcohol consumption; - Liver disease: because the liver can only cope with one drink per hour, excessive drinking can cause hepatitis, cirrhosis and cancer of the liver; - Alcohol poisoning: unconsciousness and death can follow heavy drinking, due to alcohol poisoning. The breathing rate slows and the skin may turn blue If this happens call 911 and do not let the person fall asleep; - Respiratory or heart failure: a most serious reaction to heavy drinking. The article also notes that longer term effects of alcohol addiction can include appetite loss, vitamin deficiency, impotence, damage to the central nervous system and memory loss. Also alcoholism can shorten lifespan by more than 10 years. It is incurable but can be treated. Drugs. The article noted that just like many prescription drugs, recreational drugs have potentially harmful side effects that can cause serious / long term health consequences. Taking high doses of them or their impure substitutes is very dangerous – respiratory failure, heart attacks or coma can result. Problems are even more likely if multiple drugs are taken or in combination with alcohol. Specific problems can be: - Barbiturates / tranquilizers: nausea, seizures, coma. Plus alcohol: may be fatal; - Cocaine: heart / respiratory failure, tremors, seizures and psychosis; - LSD: disorientation, depression, nausea, increased heart rate and longer term effects such as paranoia and psychosis; - Marijuana and hashish: elevated heart rate and memory loss, ongoing problems like infertility, cognitive issues, lung damage, poor immune system; - Heroin: reduced respiratory and circulatory functions, dizziness, sexual impotence, constipation, withdrawal problems, seizures and death; - PCP or “angel dust”: can cause unpredictable or violent behavior plus convulsions, dizziness, numbness, elevated heart rate and blood pressure, even fatal heart or lung failure and rupturing of blood vessels. - Amphetamines and other stimulants: cause many of the symptoms as above. - Effects on Families. Lameman (2012) published an article about the effects of substance abuse on families, based on the premise that substance abuse affects not only the abuser and his/her health and life but also the lives of those around them, especially family members. She pointed out that the addiction creates interpersonal problems within a family such as jealousy and resentment, or conflicts with partner and/or children who may as a consequence grow apart from the addicted person, in some cases separation or divorce being the eventual outcome. There are also likely to be conflicts over money, perhaps because of losing a job through addiction or simply because of spending too much of the family income on drink or drugs. Mood swings can cause emotional trauma; the subject can also become violent, be unfaithful (finding someone who “understands” him or her better). In such family situations it is also a real, increased risk that the children will also become addicted in a similar way. - Effects in Pregnancy. Marchick (2010) described the seriousness of pregnant women using drugs and/or alcohol. She explained that according to the American Counsel for Drug Education, birth defects resulting from women taking any form of drugs including prescription drugs, illegal drugs and tobacco, are totally preventable. A 2005 study found that approaching four percent of pregnant women used drugs such as “marijuana, cocaine, ecstasy, amphetamines or heroin.” Problems caused to the baby can include premature birth, birth defects, and permanent learning and behaviour difficulties. The effects can also cause the baby to exhibit something called neonatal abstinence syndrome (NAS) – a sort of withdrawal cycle that causes “trembling, excessive crying, seizures, poor feeding, diarrhea, dehydration and fever.” Even legal drugs are hazardous during pregnancy. Marchick reported that smoking almost doubles the risk of the baby being born underweight, which can in turn heighten the risk of the baby suffering from mental retardation and learning difficulties. Similarly, drinking during the pregnancy can cause Fetal Alcohol Spectrum Disorder (FASD), which can result in serious physical problems for the baby including facial and head deformities, eye and/or ear problems, and lack of coordination. Also, effects on the brain of the fetus can cause subsequent problems such as low IQ, poor memory, slow learning (including speech). Other potential effects from FASD include hyperactivity and aggressive behaviour, poor reasoning and judgment. Combining these problems can cause difficulties in later life in employment, relationships, and even problems with the law. - Effects for Elderly Citizens. “Elderly Alcohol and Substance Abuse” (2002) published by the New York State Office of Alcoholism and Substance Abuse Services described alcohol and substance abuse in our elderly population a “hidden national epidemic.” Whereas an estimated 10 percent of the population overall are involved in alcohol abuse, surveys have shown that up to 17 percent of over-65’s have that problem. Because alcohol is absorbed at a greater rate by the elderly (as it also does in women), the same amount of alcohol produces more intoxication in the over-65’s than it would in younger men. Further, because many of the elderly are on medications, alcohol combined with medications can produce adverse reactions. One such can be delaying the metabolism of the medications, causing prolonged sedative effects, resulting in possible confusion and increased risk of injury from falls. Combining alcohol with medications such as antihistamines can cause raised blood pressure and possible strokes. - Substance Abuse Leading to Crime. An article entitled “Crime and Substance Abuse: Criminality and Substance Abuse Linked” (n.d.) reiterated the long held belief that criminality and substance abuse are closely linked. However, it poses the question: “Do drugs or alcohol lead to criminal activities or is it the other way around?” The article continues by stating that statistics reveal that most drugs or alcohol users do not turn into addicts, but those that do become addicts often turn to crime. It suggests the reasons are varied and include poor living conditions, lack of employment, mental problems, and more. However, the article does also note that certain crimes such as robbery are strongly linked to the need to support a drug habit. Another rather tragic aspect of drug and crime links is that drugs use is practiced by 40 to 85 percent of prostitutes. They are also in many cases victims of serious crime such assault and rape themselves, but because of their situation and their lifestyle, most of those crimes are never reported.

Conclusions

The research undertaken has shown that drugs and/or alcohol abuse can and do have serious – and in extreme cases fatal – effects, not just on the subject, but on the subject’s family, friends and work colleagues. Health problems are of course the main effects for all groups in society from children to people of all ages, but particularly for certain higher risk groups such as pregnant women (and their babies) and for elderly people, especially those who combine alcohol abuse with the consumption of certain medications. Not only do those drugs or alcohol abusers risk their own health, they can in many cases be risking the health of others. For example when a drug or alcohol addict becomes violent in a domestic situation, or drives a vehicle while under the influence of an illegal substance. That of course is just one example of substance abuse leading to criminal activity.

Works Cited:

“Alcohol & Drug Abuse Prevention.” (n.d.). The Bowles Center for Alcohol Studies at the University of North Carolina. Web. 27 November 2012. “Crime and Substance Abuse: Criminality and Substance Abuse Linked.” (n.d.). Drug & Alcohol Rehab Asia. Web. 28 November 2012. “Elderly Alcohol and Substance Abuse.” (2002). New York State Office of Alcoholism and Substance Abuse Services. Web. 28 November 2012. “Facts about Alcohol and Drug Abuse.” (n.d.). Florida Institute of Technology. Web. 27 November 2012. Lameman, B., A. “How drug and alcohol abuse affects families and steps to recovery for all family members.” (2012). Chicago Tribune. Web. 28 November 2012. Marchick, R. “Effects of Alcohol and Drugs During Pregnancy.” (May 2010). The Livestrong Foundation. Web. 28 November 2012.

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