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Natural History and Background

Alcohol is widely used in our society. Most individuals drink alcohol in ways that do not increase risk for alcohol use problems and may also derive a health benefit. For others, use of alcohol will increase their risk for alcohol problems. Defining precisely who is at risk for alcohol problems and assessing the risks versus the benefits of alcohol use are important to designing effective interventions to reduce alcohol problems and providing accurate public health information.

Alcohol consumption is associated with a wide range of adverse health and social consequences, both acute (e.g., traffic deaths, other injuries) and chronic (e.g., alcohol dependence, liver damage, stroke, cancers of the mouth and esophagus). The scope and variety of these problems are ttributable to differences in the amount, duration, and patterns of alcohol consumption; differences in genetic vulnerability to particular alcohol-related onsequences; and differences in economic, social, and other environmental factors. Alcoholism is a chronic disease that may strike at any age. Research to date has suggested that alcoholism may or may not be progressive in nature. Some people develop the symptoms of alcoholism after only months of heavy drinking, whereas other alcoholics may drink heavily for years before developing the disease.

Ethnic and cultural disparities in alcohol-related problems are of pressing public health concern. Alcohol-related death rates (for all categories of alcohol-related mortality combined) are higher among Blacks than whites. Recent research indicates that cirrhosis death rates are higher among white men and women of Hispanic origin than among non-Hispanic black and white Americans. In the U.S., the rates of alcohol-related traffic deaths are highest among American Indians or Alaska Natives.

Alcohol problems, both those of individuals and those that affect society at large, continue to impose staggering social and economic burdens. In addition to negatively affecting health, a wide range of social ills including domestic violence, child abuse, fires and other accidents, and other crimes against individuals such as rape, robbery, and assault have all been linked to alcohol misuse. An estimated 20 to 40 percent of patients in large urban hospitals are there because of illnesses that have been caused or made worse by their drinking. This means that out of every 100 patients in such hospitals, almost half may be there because of their alcohol use. In spite of the severity of the alcohol-related problems, many people do not yet understand that alcohol problems can yield to scientifically-based medical and psychosocial intervention in the same way as other health conditions are responsive to prevention and treatment.