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Researchers Call for New Classification of Alcohol Misuse
June 20, 2008

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Research Summary

"Alcohol abuse" and "alcohol dependence" should be joined by "hazardous drinking" in diagnostic criteria, some researchers say.

Medical News Today reported June 19 that a new study from Finland finds that 5.8 percent of the population meets the criteria for hazardous drinking -- defined as drinking too much and being at risk but not alcohol dependent.

The Finnish researchers considered men who consumed 24 or more drinks weekly or women who consumed 16 or more drinks weekly to be hazardous drinkers.

Hazardous drinking is not included as a recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders, however. "This is an issue that needs to be debated," said Mauri Aalto, chief physician at Finland's National Public Health Institute and corresponding author of the study.

"A hazardous drinker may see many other people around him or her drinking as much as him or herself," said Aalto. "This, together with not yet experiencing any alcohol-related harm, may lead the individual to wrongly think that there is no need to reduce drinking. However, hazardous drinkers do not include alcohol dependents, who usually drink a lot more. Alcohol-dependent drinkers already have significant alcohol-related harms and it is more difficult for them to change their drinking habits."

The study was published online in the journal Alcoholism: Clinical & Experimental Research and will appear in the September 2008 issue of the publication.
This article summarizes an external report or press release on research published in a scientific journal. When available, links to the sources are provided above.

COMMENTS ON THIS ARTICLE:
(Comments now appear first to last)

Posted by John French on 23 Jun 08 08:54 AM EDT
Here's a great example example of how some researchers try to create diagnostic categories that cross the boundary into risk without the presence of disease. Drinking more than these people think is appropriate, and in fact being more at risk for dependence or abuse by doing so, is not a disease! It is a risk factor!

Posted by Chuck Ebefrly on 23 Jun 08 11:15 AM EDT
What would be the difference between using the term, "hazardous drinking", as this author does, and "high risk" drinking as used in current prevention literature? Is "hazardous" beyond "high risk" or is it relatively the same concept?

Posted by Brian Serna on 23 Jun 08 11:21 AM EDT
Keep in mind that the DSM is a manual of mental disorders, not of "disease". Therefore, adding a new diagnostic category has little to do with the "disease" debate. Furthermore, few would consider alcohol abuse a "disease", in fact the consensus is that the term of disease implies addiction or dependence. At any rate, this diagnostic category is long overdue in the era of "funding by diagnosis". Too many hazardous drug and alcohol users (or problem gamblers for that matter) do not meet full criteria for an abuse or dependence diagnosis. This means that insurance companies will not cover the service, which translates into no treatment for those folks due to prohibitive cost. Ironically, these hazardous drinkers are at least as likely as abusers and dependent drinkers to benefit from treatment.

Posted by Mardi Byers-Gay on 23 Jun 08 11:44 AM EDT
E.M. Jellnick first charted the various signs and symptoms of alcohol use/abuse and addiction in 1952. Out of this study he determined "species" or types of alcohol using behavior which he identified using a Greek letter for each type: Alpha, Beta, Gamma, Delta, and Epsilon. This article seems to revisit Jellnick's suggestion that consumers of alcohol users are not as easily "pigeon-holed" as we might like.

Posted by Arnie Magy on 23 Jun 08 12:06 PM EDT
There is a point where we need to recognize that it is not our business to make personal choices for people. They way a person drinks is none of my business until it affects others.

Posted by Paul Farmer on 23 Jun 08 12:18 PM EDT
While I agree with the previous writer that it is not my job ot make personal choices for other people, it is my job to try to educate folks on the problems associated with the extensive use of alcohol. As Brian Serna commented, if this new catagory, hazardous drinking, is identified as a treatable condition possibly we can give more people the opportunity to evaluate what possible benefit they garner from drinking 18-24 drinks a week.

Posted by Dave on 23 Jun 08 02:00 PM EDT
The minimal requirement for all DSM diagnoses is that the issue is either causing discomfort or dysfunction or both. If we added an issue that was causing neither, we'd not only be adding a new diagnosis. We'd also be adding a new way of looking at issues that are the province of mental health workers. Just how would we get such people into treatment? If they are not feeling distress and so far there is no harm, why would they come to treatment and why would anyone pay for doing treatment. It seems like this is more a matter for public education than treatment unless and until the person themself wants to do something about their heavy drinking.

Posted by Rick ET on 23 Jun 08 03:08 PM EDT
The world of "treatment" has difficulty with diagnosis because of the minimal level of education required for certification. As mentioned by Mardi Byers-Gay the idea of differing types of alcoholics has been around along time but programs have resisted it because of having to broaden the views of the counselors providing the "treatment". The newest type system by Moss, Chen, and Yi of NIAAA addresses many of these concerns but treatment program owners want nothing to do with it because it smacks of academia. It is so sad!

Posted by Brian Serna on 23 Jun 08 04:37 PM EDT
The fact is that most persons in treatment programs are not there because they acknowledge harm or even risk. They are there because they there is an external stimulus compelling them to present for treatment. This can take the forms of employers, courts, spouses or parents. A problem then arises when an individual minimizes his/her use, and/or denies any problems or risk from their use. Then based on the client's self report, they do not meet diagnostic criteria and are given two choices. One, they continue treatment without access to resources that would pay for someone with a diagnosable disorder. Two, they do not attend treatment and will likely return once the problem is elevated to the extent that they are unable to mask or deny it.

Posted by Frank kelly on 23 Jun 08 07:55 PM EDT
I think this is the tip of the iceberg. Calling people addicts and alcoholic has been in my opion one the major reasons a lot os if not millions of users don't seek out help. Who want's to be labeled the rest of their lives to a condemnation of no valid proof of being a "so called alcoholic or addict" whoray for someone looking forward and seeing a bigger picture. Although this kind of forward thinking or change is not going to sit well with some of the current stakeholders who have made a whole industry out of rehab centers and recovery programs that don't work, but make a tremedous amount of money for the stakeholders.

Posted by Peter on 25 Jun 08 11:26 AM EDT
There was some speculation about the new version of the DSM looking at alcohol abuse/dependency (and now hazardous drinking) as a continuum. This makes a lot of sense, as it allows for a broader range of interpretation of the behaviors. As everyone knows, there are many instances where even the abuse diagnosis doesn't fit, and I feel even the new "hazardous drinking" classification - while it will be useful - still promulgates diagnostic pigeon-holing. But it seems we're getting closer to attaining clarity in this area.

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