One of four 10th graders reported being intoxicated at least once in their lifetime Johnston et al, The rate of current heavy drinking was also relatively high among high school students. One of every three 12th graders, one in four 10th graders and one in seven 8th graders reported heavy alcohol use in the 30 days prior to the survey Johnston et al, Among men, the rate of alcohol dependence was inversely correlated with the individuals' ages.
Module 1: Epidemiology of Alcohol Problems in the United States
A similar trend was found for women, except for a slightly higher rate of abuse among the year olds compared to the younger age group. The age of drinkers appears to be inversely related to the risk for becoming dependent, and this relationship is consistent with age trends for heavy drinking. Alcohol problems are observed among elderly individuals, as well. This becomes an increasingly important issue as the nation's demographics shift to include large numbers of aging "baby boomers. Epidemiological studies of the general population find that people over 65 years of age generally consume less alcohol and have fewer alcohol-related problems than do younger people.
However, high rates of alcohol abuse symptoms have been found among clinical samples of elderly who are admitted to hospitals, psychiatric facilities, and emergency rooms NIAAA, a. Alcohol use among the elderly is associated with increased risks for hip fracture, alcohol-related traffic accidents, adverse interactions with medications, and risk for co-morbid depression NIAAA, a. Because of their reluctance to seek help, and the tendency of health care professionals to mistakenly assume senility rather than suspect alcohol-related consequences, it may be difficult to assess the extent of problem drinking among older people SAMSHA, Further, memory loss and the effects of prescription medications may affect clinical interviews with the elderly.
Obtaining collateral information from family members or friends may be necessary to compensate for memory difficulties when assessing some clients. In , an estimated 4. Risk factors that have been associated with adolescent alcohol use include: Alcohol use not only promotes aggressive behavior, but victimization may also lead to excessive alcohol use NIAAA, c. Similarly, Parker and Auerhahn , in their review of studies on alcohol, drugs and violence, suggested that alcohol was the most frequently implicated substance used in violent crimes, and found little evidence that illicit drugs are uniquely associated with violent crime.
It is important to note that rates of alcohol involvement vary across studies depending on the methodology and definition of alcohol involvement. This makes the comparison of specific rates difficult. Moreover, despite a consistent association between alcohol use and the occurrence of violent crime, it is difficult to establish a causal association without considering additional factors that may interact or modify the hypothesized causality.
Roizen reviewed empirical studies of police reports concerning rape offenders and their victims between and in the U. Shepherd and Brickley found similar amounts and frequency of drinking for young men ages 18 to 35 who visited the emergency room as the result of being injured in an assault compared with patients who were not involved in an assault. However, the young men who visited the emergency room after being injured in an assault tended to drink more on weekends and had a tendency for binge drinking.
Alcohol use is more often associated with intimate partner violence i. Alcohol and drug use are associated with arrest. In California, about half of arrestees, male and female, reported that the reason for their arrest was tied to alcohol. The rate of frequent alcohol use was higher for men, but the rate of regular drug use was similar for both men and women in this population.
There is a high prevalence rate of past alcohol use among individuals on probation. As stated earlier, alcohol was more frequently involved in the commission of crimes than were other drugs. A NIAAA surveillance report on alcohol-related morbidity showed that approximately , hospital discharge episodes of persons age 15 and older had a first-listed primary alcohol-related diagnosis.
Alcohol misuse was mentioned in 1. The data came from the National Hospital Discharge Survey, a national sample of hospital discharge episodes compiled by the National Center for Health Statistics Cirrhosis of the liver. Prohibition period rates were not estimated, but the rate of cirrhosis gradually increased after post- Prohibition , and peaked during the s. The mortality rate slowly declined through the s and became steady in the s. The reported rate is consistently higher for men Saadatmand et al.
The level of susceptibility to liver disease and the severity of alcohol-related liver disease vary considerably, even among drinkers with similar drinking patterns and drinking histories. The age-adjusted death rates for alcohol-related cirrhosis are higher among Hispanic men than any other ethnic group, followed by non-Hispanic Blacks and lastly, non-Hispanic whites. This trend also applies for females, with Hispanic females having the highest risk followed by black non-Hispanic females and white non-Hispanic females NIAAA, b.
Different drinking patterns among ethnic groups may explain increased risk for liver cirrhosis. It has been noted that some Hispanic groups are more likely to engage in drinking styles marked by periodic consumption of large amounts of alcohol NIAAA, b. Maternal alcohol consumption during pregnancy can result in the development of Fetal Alcohol Syndrome FAS , a condition characterized by certain facial features; postnatal growth deficiency; and central nervous system, cognitive, and behavioral deficits.
Fetal Alcohol Syndrome is a life-long condition, and the affected child can experience varying degrees of mental retardation, learning difficulties, and behavioral problems CDC, a. The Surgeon General's official advisory warnings against the use of alcohol by pregnant women and women considering pregnancy were released in , and The rates jumped to 6.
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While epidemiological studies show that drinking during pregnancy provides an increased risk for FAS or other effects from fetal exposure, it is difficult to determine an exact dose effect relationship between the level of exposure and the incidence of FAS. The incidence of infants who do not exhibit full diagnostic criteria of FAS but show some FAS signs was estimated at 9. Even though FAS is one of the most preventable birth defects, knowledge about FAS is low among women, particularly among those without a college education CDC, a; b. Many pregnant women first contact an obstetrician or gynecologist regarding prenatal care, but these physicians often fail to inquire adequately about the expectant mother's drinking practices.
In a recent survey of obstetricians and gynecologists, almost all physicians surveyed reported assessing patients' alcohol use at the initial visit. However, these assessments were completed by non-physician staff or by self-administered patient questionnaires. Only one-half of the physicians surveyed reported asking patients directly about their alcohol use.
Among the most common risk factors for FAS are maternal health characteristics. Multiple studies have identified health-related risk factors, such as co-use of tobacco and other drugs, and alcohol NIAAA, Alcohol consumption during pregnancy is often associated with smoking, which is also found to be associated with increased risk during pregnancy.
A recent study of Alaskan Native women found that those who smoked were more likely to report heavy drinking than were nonsmokers CDC, b. Ebrahim, Ducoufle, and Palakathodi reported that one of seven women between the ages of 18 and 44 used tobacco and alcohol. While most pregnant women quit using both alcohol and tobacco when they realized they were pregnant, those who continued to use both substances faced an increased risk to the developing fetus.
In short, fetal exposure to alcohol is associated with a host of developmental risks and other problems of concern to social workers. While a dramatic decline was observed among non-white males over the past 20 years, their rate of alcohol-related death was still highest, followed by white males. Death rates for nonwhite females have also declined over the past 20 years. The death rates for white men and women were unchanged, and remained lower than for nonwhites. National Vital Statistics Report.
The primary indicator of alcohol-related cause of death, liver disease, was the 11th highest cause of death in Hoyert et al. Alcohol use is also involved with other causes of death including car accidents, other accidents, suicide, and homicide. If added together, these alcohol-related causes of death would be the third highest cause of death in the U. From to , the number of fatalities among men was more than twice the rate for women, however, the rate of increase among women was much higher than that of men.
The number of drug-related deaths was the highest among people 35 years or older, followed by the 26 to 34 year old age group and the 18 to 25 year old age group. Although the number is very small, cases of drug-related deaths occurred among children and youths ages 6 to 17 during SAMHSA, While it is difficult to separate alcohol-specific causes of death from the DAWN data, the majority of drug-related deaths involved a combination of alcohol and other drug use.
Alcohol is also associated with fatalities from injury, homicide, suicide, and motor vehicle accidents. While the proportion of alcohol-related traffic crash fatalities declined from 17, in to 12, in , the rate included nearly 4, people under the age of 25 Yi et al. The decline in the number of crash fatalities could be due to increased safety regulations and features adopted by car manufacturers, reductions in legal blood alcohol driving limits imposed in many states, or to national policies linking federal highway funds to state adoption of a uniform 21 year old minimum legal drinking age.
Hingson, Heeren, and Winter's study clearly showed that lowering legal blood alcohol limits from 0. This is one area where epidemiological findings have clearly played a role in changing alcohol policies. Alcohol consumption may increase the risk for many types of accidental death. Smith, Branas, and Miller abstracted the cause of death from medical examiners' reports of non-traffic fatalities. They conducted a meta-analysis of aggregated data from 65 studies published between and Alcohol involvement in decedents was defined as any blood alcohol content BAC level greater than zero.
The investigators found that a high rate of alcohol involvement was associated with a variety of deaths due to accidental injuries, homicide, suicide, and motor vehicle accidents. The aggregate percentage of intoxication was the highest for homicide Nearly one-half of drowning, gunshot, and homicide victims were found to be positive for alcohol use. Victims of burns and hypothermia had the highest intoxication levels, followed by drowning, falls, motor vehicle accidents, homicides, and suicides.
While the levels of alcohol involvement vary by cause of death, this study demonstrates that stopping or reducing the victims' alcohol consumption may have prevented many fatal injuries. Alcohol use is also associated with traumatic injury. Macdonald, Wells, Giesbrecht, and Cherpitel compared violent and accidental injuries among emergency room patients.
They found that violent injuries were likely to occur in a bar or restaurant, and to involve alcohol use by one or more of the participants. More than one-third of trauma injury from falls or stabbing, one-third of car or motorcycle accidents, and one-third of pedestrian accidents are associated with alcohol use on the part of the injured person NIAAA, a.
The highest prevalence of trauma involving both intoxication and non-intoxication occurs among the year old age group, followed by the year old group, and the year old group. The prevalence of traumatic injury declines after age 45, but begins to increase again after age As people age, the association between intoxication and traumatic injury tends to decline.
More recent examinations of historical trends and empirical data have provided a broader view of alcohol consumption and mortality from all causes. For example, Hart, Smith, Hole, and Hawthorne followed a cohort of Scottish men for 21 years and found that those who ranker 15 units of alcohol per week were at greater risk of mortality from all causes than non-drinkers. The strongest correlation was between weekly alcohol use and death from stroke, with those men drinking 35 units a week 2 times at greater risk of death from stroke than non-drinkers.
Beneficial Effects of Moderate Alcohol Consumption: Empirical evidence indicates that heavy alcohol use is associated with increased health risks NIAAA, a; However, studies also suggest an association between moderate drinking and certain health benefits. The relationship between the amount of alcohol consumed per occasion and health risks is described as a J- or U-shaped curve, showing higher mortality rates among lifetime abstainers and heavy drinkers than among moderate drinkers.
Mortality rates also increase with the frequency of heavy drinking.
Alcohol abuse
However, it is difficult to determine a 'safe level' of alcohol consumption or to determine a consumption level that increases risks for mortality and morbidity. Those reporting lower levels of alcohol intake seemed to have a reduced mortality risk when compared to abstainers, while large amounts of alcohol intake increased mortality risk. Moderate alcohol consumption was associated with slightly reduced overall mortality. Mortality from alcoholism, cirrhosis, and alcohol-related cancers was positively associated with the baseline level of alcohol consumption among daily drinkers.
A low level of alcohol consumption may improve mortality risk, but the overall benefit is small and alcohol consumption increases the risk for an alcohol-related death. Significant independent factors negatively associated with coronary heart disease were race non-whites , female gender, alcohol intake, exercise or physical activities, and intake of fish, cheese, and dessert.
However, the level of alcohol use was found to interact with cholesterol level and age. Alcohol intake was also associated with a high rate of CHD among year olds, while the incidence of CHD was lower among people 50 years of age or younger. Using the same data set, Rehm, et al. However, they also found an association between smoking and high levels of alcohol consumption that may have contributed to an increased risk for CHD among female heavy drinkers. More recently, Rehm, Greenfield, and Rogers investigated alcohol consumption and all-cause mortality data from the National Alcohol Survey.
Using the adjusted relative risk for lifetime abstention as a standard, men were found to be at increased risk when consuming more than 6 drinks per day. For women, the relative risk for mortality from all causes was lower among those consuming drinks per day, but increased when consumption was over four drinks per day on average. Dietary Guidelines," which is updated every five years to advise the American public on the promotion of health. The most recent version provides recommendations in relation to daily alcohol consumption.
The guideline recommends moderate consumption for most adult Americans who consume beverage alcohol.
It is important to understand that the guidelines apply only to drinkers; they are not for the purpose of encouraging everyone to drink. Total abstention from consuming alcohol is suggested for all children and adolescents, for people who are unable to limit their amount of drinking, for women who are pregnant or trying to conceive, for people who will be operating a motor vehicle or are planning to do activities that require attention or skill, for people who have family members with alcohol problems, and for people using prescription and over-the-counter medications DuFour, In addition, persons with a variety of health conditions should be advised to drink less than the guidelines or not to drink at all.
Individuals participating in substance abuse treatment within the U. The number of clients in treatment has increased from , during to nearly one million in The average age of clients in treatment during , compared to , shows an aging trend over the years. The proportion of clients over age 45 has been increasing, while the proportion of clients 25 or younger has been decreasing. Not everyone with a substance abuse problem seeks treatment. While the increase in numbers of individuals who reported treatment for alcohol problems was consistent between and National Household Survey, employing direct interview method , these increases were not reflected in the UFDS.
It is helpful to understand how epidemiological data are collected and analyzed. How do these rates compare to rates in other regions of the nation? Or, What are the rates of alcohol dependence in a specific population not previously discussed-perhaps gay, lesbian, bisexual and transgender individuals nationally; dormitory vs. MSW social workers nationally? Next, brainstorm ways of locating or collecting the information needed to answer your group's question.
Discuss the limitations and research decisions that relate to the strategies you explored. Discuss the significant implications for social work practice of the various possible results. Can they interpret the output? The programs are in the public domain and available on the Internet at http: Link to Prevention Practice. How will future epidemiological data help you to evaluate the impact of your intervention efforts?
The strategies should be grounded by the epidemiological data! Age, alcohol and violent death: Journal of Studies on Alcohol, 46, Alcohol Epidemiology Program Alcohol Policies in the United States: Highlights From the 50 States. Alcohol-related intimate partner violence among whit, black, and Hispanic couples in the United States. Alcohol Research and Health, 25, Alcohol problems and their prevention: Public attitudes in California.
Report of a conference pp. California State Office of Alcoholism. Centers for Disease Control and Prevention. Frequent alcohol consumption among women of childbearing age - Behavioral Risk Factor Surveillance System, Prevalence and characteristics of alcohol consumption and fetal alcohol syndrome awareness-Alaska, and Alcohol consumption among pregnant and childbearing-aged women-United States, and Fetal Alcohol Syndrome Surveillance Network.
State University of New York Press. Acute and chronic effects of alcohol use on violence. Journal of Studies on Alcohol, 49, A survey of obstetrician-gynecologists on their patients' alcohol use during pregnancy. Obstretrics and Gynecology, 95, What is moderate drinking? Defining "drinks" and drinking levels.
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Alcohol Research and Health, 23, Combined tobacco and alcohol use by pregnant and reproductive-aged women in the United States. Obstetrics and Gynecology, 96, Journal of the American Medical Association, , The most common method of raising prices is to increase Federal, State, or local taxes on alcoholic beverages. Studies show that underage youth are particularly sensitive to increased prices, decreasing their alcohol consumption by a greater amount than older drinkers A few studies have looked at how alcohol prices affect drinking among college students and young adults One study showed that college students faced with higher alcohol prices were less likely to transition from being abstainers to moderate drinkers and from moderate to heavy drinkers Another study found that low sale prices were associated with higher rates of heavy episodic drinking among college students Prevention of Drinking and Driving —Traffic crashes are the leading cause of death among teens, and more than half of drivers ages 21—24 who died in traffic crashes in tested positive for alcohol 7.
Raising the minimum legal drinking age MLDA to 21 has produced significant reductions in traffic crashes among to year-olds, and it appears to have had a spillover effect on the drinking behavior of to year-olds.
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One study found that college students who had been high school seniors in States when the MLDA was 18 drank more while in college than their counterparts who had been high school seniors in States with an MLDA of High school graduates of the same age who were not attending college also drank more on average if they had been seniors in States with an MLDA of 18 Another effective strategy to reduce drinking—driving is to lower the legal limit for allowable blood alcohol content BAC for drivers.
Studies have found that laws setting the legal allowable BAC at 0. Laws setting the limit at 0. Comprehensive Community Prevention Approaches —Perhaps the best way to reduce harmful drinking and alcohol-related problems in young adults is through comprehensive approaches that rely heavily on community action. Whether they are working, attending college, or in the military, young adults typically are part of a community. To be effective, community prevention interventions require a mix of research-tested programs and policy strategies, along with strong enforcement of those laws. Three NIAAA-sponsored community trial projects have been extensively studied and are showing promise: These trials provide strong evidence for the positive effects of research-based local prevention efforts that take a comprehensive approach using a variety of strategies.
Research consistently shows that people tend to drink the heaviest in their late teens and early to mid-twenties. This high level of alcohol use comes at an age when people are moving away from parental restrictions but before they take on the full responsibilities of adult life. As young people begin to assume more adult roles—full-time employment, marriage, and parenthood—they often reduce their drinking. Young adults who drink in ways that are especially harmful—those who fit the diagnostic criteria for alcohol dependence—may have predisposing personality characteristics and other factors that place them at greater risk for problems with alcohol.
Prevention strategies that may be especially useful in curbing young adult alcohol use are those that focus on restricting the availability of alcohol. Such measures include raising the cost of alcohol through taxes, limiting when and where alcohol can be consumed, and enforcing policies that help to reduce problems such as drinking and driving.
Binge drinking among U. Journal of the American Medical Association A meta-analysis of life course variation in drinking. British Journal of Addiction Dietary Guidelines for Americans Magnitude of alcohol-related mortality and morbidity among U. Changes from to Annual Review of Public Health National Institute on Alcohol Abuse and Alcoholism, Traffic Safety Facts Annual Report: How and why the understanding of developmental continuity and discontinuity is important: The sample case of long-term consequences of adolescent substance use. Handbook of the Life Course.
What can be learned from animal models. Hippocampal function during adolescence a unique target of ethanol effects. Annals of the New York Academy of Sciences Alcohol and the adolescent brain: Alcohol consumption among young adults ages 18—24 in the United States: Changes in drinking patterns among Whites, Blacks, and Hispanics, — Journal of Studies on Alcohol Environmental policies to reduce college drinking: Options and research findings.
Journal of Studies on Alcohol Suppl. Drinking among college students: Alcohol Problems in Adolescents and Young Adults. Changes in substance use during the transition to adulthood: A comparison of college students and their noncollege age peers. Journal of Drug Issues National Survey Results on Drug Use, — College Students and Adults Ages 19— National Institute on Drug Abuse, The development of heavy drinking and alcohol-related problems from ages 18 to 37 in a U.
Lawrence Erlbaum Associates, Research Triangle Park, NC: Peer influences on college drinking: A review of the research. Journal of Substance Abuse Descriptive and injunctive norms in college drinking: Social norms and the prevention of alcohol misuse in collegiate contexts. Social network drinking and adult alcohol involvement: A longitudinal exploration of the direction of influence. Does marital status predict long-term drinking? Five-year observations of dependent and problem drinkers. The developmental context of substance use in emerging adulthood. Understanding individual variation in college drinking.
A motivational perspective on risky behaviors: The role of personality and affect regulatory processes.
Journal of Personality Examining the role of drinking motives in college student alcohol use and problems. Psychology of Addictive Behaviors A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Expectancy for social facilitation from drinking: The divergent paths of high-expectancy and low-expectancy adolescents. Journal of Abnormal Psychology Parental modeling and parenting behavior effects on offspring alcohol and cigarette use: A growth curve analysis.
Transitioning into and out of large-effect drinking in young adulthood. Serotonin transporter promoter polymorphism and differences in alcohol consumption behaviour in a college student population. Alcohol and Alcoholism A genetic association with the development of alcohol and other substance use behavior in Asian Americans.
American Journal of Human Genetics Clinical and Experimental Research Evidence of common and specific genetic effects: Association of the muscarinic acetylcholine receptor M2 CHRM2 gene with alcohol dependence and major depressive syndrome. Human Molecular Genetics Association between alcoholism and gamma-amino butyric acid alpha2 receptor subtype in a Russian population.
CHRM2 gene predisposes to alcohol dependence, drug dependence and affective disorders: Results from an extended case-control structured association study. Early adolescent through young adult alcohol and marijuana use trajectories: Early predictors, young adult outcomes, and predictive utility. Development and Psychopathology Trajectories of dynamic predictors of disorder: Their meanings and implications. Pathways to alcohol problems and alcoholism: