Asians). High vulnerability is associated with preexisting schizophrenia or bipolar disor- der, as well as impulsivity (producing enhanced rates of all substance use disorders and gambling disorder), and a high risk specifically for alcohol use disorder is associated with a low level of response (low sensitivity) to alcohol. A number of gene variations may ac- count for low response to alcohol or modulate the dopamine reward systems; it is impor- tant to note, however, that any one gene variation is likely to explain only 1%—2% of the risk for these disorders.
Course modifiers. In general, high levels of impulsivity are associated with an earlier onset and more severe alcohol use disorder.
In most cultures, alcohol is the most frequently used intoxicating substance and contrib- utes to considerable morbidity and mortality. An estimated 3.8% of all global deaths and 4.6% of global disability—adjusted life-years are attributable to alcohol. In the United States, 80% of adults (age 18 years and older) have consumed alcohol at some time in their lives, and 65% are current drinkers (last 12 months). An estimated 3.6% of the world population (15—64 years old) has a current (12-month) alcohol use disorder, with a lower prevalence (1.1%) found in the African region, a higher rate (5.2%) found in the American region (North,
South, and Central America and the Caribbean), and the highest rate (10.9%) found in the
Eastern Europe region.
Polymorphisms of genes for the alcohol-metabolizing enzymes alcohol dehydroge- nase and aldehyde dehydrogenase are most often seen in Asians and affect the response to alcohol. When consuming alcohol, individuals with these gene variations can experience a ﬂushed face and palpitations, reactions that can be so severe as to limit or preclude future alcohol consumption and diminish the risk for alcohol use disorder. These gene variations are seen in as many as 40% of Japanese, Chinese, Korean, and related groups worldwide and are related to lower risks for the disorder.
Despite small variations regarding individual criterion items, the diagnostic criteria perform equally well across most race/ethnicity groups.
Males have higher rates of drinking and related disorders than females. However, because females generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach, they are likely to develop higher blood alcohol levels per drink than males. Females who drink heavily may also be more vulnerable than males to some of the physical consequences associated with alcohol, in- cluding liver disease.
results likely to be seen with regular heavier drinking. These measures do not establish a diagnosis of an alcohol-related disorder but can be useful in highlighting individuals for whom more information should be gathered. The most direct test available to measure a1- cohol consumption cross-sectionally is blood alcohol concentration, which can also be used to judge tolerance to alcohol. For example, an individual with a concentration of 150 mg of ethanol per deciliter (dL) of blood who does not show signs of intoxication can be pre- sumed to have acquired at least some degree of tolerance to alcohol. At 200 mg/dL, most nontolerant individuals demonstrate severe intoxication.
Regarding laboratory tests, one sensitive laboratory indicator of heavy drinking is a modest elevation or high-normal levels (>35 units) of gamma-glutamyltransferase (GGT).
This may be the only laboratory finding. At least 70% of individuals with a high GGT level are persistent heavy drinkers (i.e., consuming eight or more drinks daily on a regular basis).