The Epidemiology of Alcohol Use, Alcohol Abuse and Dependence. Alcohol-related Morbidity and Mortality. Lecture Summary

Introduction:
Epidemiology-the study of the natural history of a condition with attention to factors that influence its distribution in a population, the purpose of which is to provide a basis for interventions to prevent ill health related to the condition. Multi-faceted nature of alcohol illustrated by title of this lecture Excessive or maladaptive consumption causes the psychiatric disorders, alcohol abuse and alcohol dependence, and it also represents a risk factor for a number of acute health problems and chronic diseases.

Alcohol use:
Sources of data on alcohol use-per capita sales data, key surveys, measurement issues, Ledermann theory. Secular trends and sociodemographic correlates of alcohol use.

Alcohol Abuse/Dependence:
Brief history, with particular attention to factors influencing measurement/definition of people with the condition (DSM-IV and ICD-10). Jellinek's natural history, focus on severely affected persons who had "hit bottom." Influence of survey research on understanding of natural history-longitudinal studies indicating potential for recovery; the development of structured diagnostic interviews that could be administered by lay interviewers to assess psychiatric disorders, including alcohol abuse and dependence; recognition that a large proportion of the population have serious problems related to their alcohol use; the majority do not receive treatment; recovery without treatment is not uncommon. Alcohol typologies: antisocial, developmentally limited, developmentally cumulative, and negative affect alcoholism.

Alcohol-related morbidity, mortality:
In addition to morbidity and mortality stemming from conditions directly caused by alcohol, such as alcohol poisoning, alcoholic liver disease, etc., alcohol can act as a risk factor that increases morbidity and mortality associated with conditions having a multifactorial etiology. Attributable Risk Factors estimate excess morbidity and mortality associated with alcohol use. Alcohol-related morbidity and mortality often affects people at ages that are relatively young compared to the ages of people affected by chronic conditions such as heart disease and many cancers. Full impact on society of alcohol-related morbidity and mortality is better expressed in terms of Years of Potential Life Lost than simply in terms of rates per 100,000. Acute effects on judgment, balance, coordination, etc. associated with accidents-principally car crashes, also falls, drownings, and burns. Heavy drinking also associated with intentional injuries, to self and others. Chronic heavy drinking damages the liver, heart, is implicated in some cancers. Light, moderate drinkingconsistently associated with a protective effect on heart disease, but not as reliably linked to lower overall mortality rates. The influence of drinking pattern on morbidity and mortality not well studied.