Search

Epidemiologists have conducted nationwide surveys, such as the National Household Survey on Drug Abuse (NHSDA) and the National Comorbidity Survey (NCS), to estimate the prevalence of either the individual or the concurrent consumption of and dependence on alcohol and tobacco. These estimates indicated that for both alcohol and tobacco, use was already relatively high among the youngest respondents, peaked among young adults, and declined in older age groups. A similar pattern existed for concurrent alcohol and tobacco use. Moreover, these estimates showed only moderate gender differences. With respect to dependence, the age-related prevalence patterns differed somewhat for alcohol and tobacco, with the prevalence of tobacco dependence relatively lower among the youngest respondents compared with the prevalence of alcohol dependence. The age-related pattern for concurrent alcohol and tobacco dependence was similar to that found for tobacco dependence.

The community-reinforcement approach (CRA) is an alcoholism treatment approach that aims to achieve abstinence by eliminating positive reinforcement for drinking and enhancing positive reinforcement for sobriety. CRA integrates several treatment components, including building the client's motivation to quit drinking, helping the client initiate sobriety, analyzing the client's drinking pattern, increasing positive reinforcement, learning new coping behaviors, and involving significant others in the recovery process. These components can be adjusted to the individual client's needs to achieve optimal treatment outcome. In addition, treatment outcome can be influenced by factors such as therapist style and initial treatment intensity. Several studies have provided evidence for CRA's effectiveness in achieving abstinence. Furthermore, CRA has been successfully integrated with a variety of other treatment approaches, such as family therapy and motivational interviewing, and has been tested in the treatment of other drug abuse.

The high prevalence of alcohol use and its consequences among American Indians may be attributed to a number of factors, including the influence of the European colonists who first made large amounts of alcohol available to Indians, as well as current social and cultural factors. Efforts to prevent and treat alcohol problems among the American Indian population may be more effective if native beliefs and approaches are incorporated. Alcohol problems also may be prevented through policies regulating the sale and use of alcohol in Indian communities.

Researchers are increasingly investigating the drinking behavior and associated consequences among Asian-Americans and Pacific Islanders (APIs) in the United States. Among adolescents, APIs generally have lower rates of alcohol consumption and appear to be at lower risk for alcohol abuse compared with other ethnic groups. Similarly, the rates of drinking and heavy drinking have been found to be lower among API college students than among other ethnic groups. Among adult Asian-Americans, Japanese-Americans have the highest and Chinese-Americans have the lowest lifetime prevalence of drinking and heavy drinking. Southeast Asians (e.g., Vietnamese) living in the United States appear to be at high risk for heavy drinking. Numerous factors help determine the drinking patterns of APIs, including their economic status, educational attainment, and degree of acculturation as well as genetic and environmental factors, such as drinking norms and alcohol availability.

Ethnic minorities (e.g., Hispanics, blacks, Asian-Americans, and Native Americans) are still underrepresented in alcohol research in the United States. Furthermore, existing studies often do not take into consideration the variability that exists within each ethnic group, resulting in inaccurate generalizations. Studies among Hispanics have found substantial differences among Hispanic subgroups in drinking patterns and rates of alcohol-related problems. Moreover, no single variable can explain the observed patterns. Similarly, numerous factors have been shown to shape drinking patterns among blacks, including individual and environmental characteristics as well as historical and cultural factors. Different subgroups of Asian-Americans also vary substantially in their rates of drinking and heavy drinking, although their lifetime alcohol use is lower than the national average. Genetic and cultural factors, as well as stress and historic experiences, may influence drinking patterns of Asian-Americans. The widely differing drinking patterns among Native Americans also are likely shaped by a variety of influences.

Although behavioral problems associated with abuse of alcohol emerge during late adolescence and adulthood, some behavioral characteristics indicative of an increased risk of alcoholism may already be obvious during early childhood. Studies in several countries have demonstrated that children with high levels of novelty-seeking behavior and low levels of harm-avoidance behavior are more likely to develop alcohol-related problems during adolescence. Moreover, as early as age 3, children at high risk of future alcoholism because of a family history are more active, more impatient, and more aggressive than matched controls of low-risk children. Causal influences on the initiation of drinking must be distinguished from those that affect patterns of consumption once drinking is initiated. Studies of adolescent twins have demonstrated that initiation of drinking is primarily influenced by the drinking status of parents, siblings, and friends and by socioregional differences in the environments within which adolescent twins reside. The influence of genetic factors is negligible. Conversely, once initiated, differences in frequency and quantity of drinking are strongly influenced by genetic factors. However, these influences, too, are modulated by sibling and peer effects and by regional environmental variation.

Alcoholics differ in many of their personal and drinking-related characteristics, and for the past 150 years, clinicians and researchers have tried to categorize alcoholics based on these differences. Such typologies can advance our understanding of alcoholism as well as improve treatment of the disease. The history of alcoholism typology can be divided into three periods: the prescientific period, the Jellinek era, and the post-Jellinek era. During the prescientific period, physicians—especially those specializing in treating mental illnesses and addictions—developed numerous typologies, building primarily on clinical observation, anecdotal evidence, and armchair intuition. E.M. Jellinek has been credited with creating the first scientific typology that was developed into a comprehensive theory of alcoholism as a disease. The typologies that have evolved since Jellinek’s landmark work have been derived mainly from empirical research data. Despite the wide variety of methodological approaches used, it appears that subtypes from all typologies developed since the 19th century can be classified into two major categories, the Apollonian and Dionysian subtypes.

Young adults have a higher prevalence of alcohol consumption and binge drinking than any other age group. They also drink more heavily and experience more negative consequences of drinking. Rates of alcohol abuse and dependence are disproportionately higher among those between the ages of 18 and 29 compared with other age groups. Young adults are also overrepresented among alcohol-related traffic fatalities. Over time, distinct patterns of change in frequent binge drinking occur, and most heavy-drinking young adults appear to “mature out” of abusive drinking patterns as the responsibilities of later adulthood supervene. Drinking patterns are affected by demographic, psychological, behavioral, and social factors as well as minimum drinking age legislation and the cost of alcohol. Motivational programs designed to reduce risks and consequences associated with young-adult drinking may help in reducing alcohol consumption and its consequences.

Research indicates that the link between alcohol and poor nutrition is highly complex. Alcohol consumption is known to disrupt nutritional status via several mechanisms. One mechanism by which alcohol may affect nutrition is by inducing changes in dietary practices. Findings are presented based on 2 years of data from a national survey of health-related activities. The relationship between alcohol consumption and dietary practices—such as types of food consumed, whether vitamins were taken, belief that diet influences health, and frequency of eating out—is examined. The results show that associations exist between alcohol and diet after controlling for demographic and health variables. These findings have important implications for understanding the interaction between alcohol intake and nutritional status and the effect of this interaction on overall health.

Marriage, a marker event for the transition from adolescence to young adulthood, brings with it many changes, including shifts in values, new roles, and adjustments in a couple's relationship. Marriage also appears to generate shifts in alcohol use and alcohol consumption, changes that can occur even before the marriage ceremony takes place. Alcohol plays a role in marital violence, marital quality, and marital disruptions. However, high levels of individual alcohol consumption in a marriage do not uniformly lead to lower marital quality. Rather, it may be the nature of a couple's drinking partnership (i.e., the interplay of each spouse's drinking context and drinking patterns) that has the most effect on the health of a marriage.

Drinking practices vary substantially among different countries. An understanding of such differences can help researchers, clinicians, and policymakers develop prevention, diagnostic, and treatment measures as well as overall alcohol policies that are appropriate for a given country. Accordingly, researchers have conducted cross-cultural analyses of drinking patterns and practices. Three countries included in such analyses are India, Mexico, and Nigeria. These countries differ substantially in their ethnic and cultural characteristics, including the role that alcohol plays in daily life. To gain a better insight into the attitudes toward alcohol in these countries, researchers have analyzed the alcoholic beverage preferences, gender and age differences in alcohol consumption patterns, drinking contexts and drinking patterns, alcohol-related problems, approaches to prevention and treatment, and drinking indicators in each nation. These analyses demonstrate that no single definition of “normal” drinking, problem drinking, or alcohol dependence can apply equally to all countries or cultures.

The findings of recent research on drinking patterns and problems among African-Americans can be summarized as follows: (1) African-Americans report higher abstention rates than do whites; (2) African-Americans and whites report similar levels of frequent heavy drinking; (3) rates of heavy drinking have not declined at the same rate among African-American men and women as among white men; and (4) variables such as age, social class, church attendance, drinking norms, and avoidance coping may be important in understanding differences in drinking and drinking problem rates among African-Americans and whites. Limitations of the research are described and suggestions are made for possible directions for future research.

The consequences of maternal alcohol use during pregnancy on the outcome of offspring depend, among other factors, on the amount and pattern of alcohol consumption. Animal studies found that bingelike drinking patterns, in which the fetus is exposed to high blood alcohol concentrations (BACs) over relatively short periods of time, are particularly harmful, even if the overall alcohol amount consumed is less than those of more continuous drinking patterns. Long-term studies in humans have confirmed that children of binge-drinking mothers exhibited especially severe cognitive and behavioral deficits. Binge drinking may be particularly harmful because it results in high BACs, may occur during critical periods of brain development, and may be associated with repeated withdrawal episodes.

Research suggests that a decreasing share of violent crime is attributable to offenders who had been drinking alcoholic beverages. Surveys of victims indicate that the rate of alcohol-involved violent crimes (i.e., crimes in which the perpetrators had been drinking, as perceived by the victims) decreased 34 percent from 1993 to 1998, whereas the rate of non-alcohol-involved violence decreased 22 percent. Surveys of some offenders also suggest that alcohol’s role in violence is decreasing. The decrease in alcohol-involved violence is consistent with declines in other measures of alcohol use and misuse, including per capita alcohol consumption and alcohol involvement in traffic crashes. In contrast, violent offenders in State prisons are increasingly likely to report having used alcohol before committing their offenses, possibly illustrating the effect of more severe sanctions for alcohol-involved offenses.

Researchers have long sought an animal model for human alcohol consumption. This article describes an economic-based approach to a model of alcohol preference in rats. The procedures are based on an analogy between clinical accounts of human drinking and the economic analysis of consumption. Both clinical and economic investigators typically define consumption patterns in terms of the influence of negative consequences. For example, the clinical account emphasizes the persistence of heavy drinking despite mounting alcohol-related aversive consequences, and in economic analyses, the term “inelastic demand” is used to refer to the persistence of consumption despite large increases in prices. In the experimental procedure described here, rats worked for alcohol and food. Presses on one lever earned a drink of 10 percent alcohol plus saccharin, and presses on a second lever earned isocaloric drinks of a starch solution. After behavior stabilized, the response requirements (which are analogous to prices) for one or both drinks were increased. The rats maintained baseline alcohol consumption levels despite large increases in the “price” of alcohol. In contrast, the same price increases markedly reduced starch intake. That is, food consumption was sensitive to price hikes, but alcohol consumption was not. The results demonstrate that a common economic framework can be used to describe human and animal behavior and, hence, the possibility of an animal model of human alcohol consumption. The article also points out that economic concepts provide a framework for understanding a wide range of human drinking patterns, including controlled social drinking and excessive alcoholic drinking.