Craving for alcohol is indicated by a strong desire to drink that makes it difficult to think of anything else and that often results in the onset of drinking. School and job per- formance may also suffer either from the aftereffects of drinking or from actual intoxica- tion at school or on the job; child care or household responsibilities may be neglected; and alcohol-related absences may occur from school or work. The individual may use alcohol in physically hazardous circumstances (e.g., driving an automobile, swimming, operating machinery while intoxicated). Finally, individuals with an alcohol use disorder may con- tinue to consume alcohol despite the knowledge that continued consumption poses sig- nificant physical (e.g., blackouts, liver disease), psychological (e.g., depression), social, or interpersonal problems (e.g., violent arguments with spouse while intoxicated, child abuse).
Alcohol use disorder is often associated with problems similar to those associated with other substances (e.g., cannabis; cocaine; heroin; amphetamines; sedatives, hypnotics, or anxiolytics). Alcohol may be used to alleviate the unwanted effects of these other substances or to substitute for them when they are not available. Symptoms of conduct problems, depression, anxiety, and insomnia frequently accompany heavy drinking and sometimes precede it.
Repeated intake of high doses of alcohol can affect nearly every organ system, espe- cially the gastrointestinal tract, cardiovascular system, and the central and peripheral ner— vous systems. Gastrointestinal effects include gastritis, stomach or duodenal ulcers, and, in about 15% of individuals who use alcohol heavily, liver cirrhosis and/ or pancreatitis.
There is also an increased rate of cancer of the esophagus, stomach, and other parts of the gastrointestinal tract. One of the most commonly associated conditions is low-grade hy- pertension. Cardiomyopathy and other myopathies are less common but occur at an in- creased rate among those who drink very heavily. These factors, along with marked increases in levels of triglycerides and low-density lipoprotein cholesterol, contribute to an elevated risk of heart disease. Peripheral neuropathy may be evidenced by muscular weakness, paresthesias, and decreased peripheral sensation. More persistent central ner- vous system effects include cognitive deficits, severe memory impairment, and degener- ative changes in the cerebellum. These effects are related to the direct effects of alcohol or of trauma and to vitamin deficiencies (particularly of the B vitamins, including thiamine).
One devastating central nervous system effect is the relatively rare alcohol-induced per- sisting amnestic disorder, or Wernicke-Korsakoff syndrome, in which the ability to encode new memory is severely impaired. This condition would now be described within the chap- cognitive disorder.
Alcohol use disorder is an important contributor to suicide risk during severe intoxi- cation and in the context of a temporary alcohol-induced depressive and bipolar disorder.
There is an increased rate of suicidal behavior as well as of completed suicide among in- dividuals with the disorder.
Alcohol use disorder is a common disorder. In the United States, the 12-month prevalence of alcohol use disorder is estimated to be 4.6% among 12- to 17-year-olds and 8.5% among adults age 18 years and older in the United States. Rates of the disorder are greater among adult men (12.4%) than among adult women (4.9%). Twelve-month prevalence of alcohol use disorder among adults decreases in middle age, being greatest among individuals 18- to 29-years-old (16.2%) and lowest among individuals age 65 years and older (1.5%).
Twelve-month prevalence varies markedly across race/ethnic subgroups of the US.
population. For 12- to 17-year-olds, rates are greatest among Hispanics (6.0%) and Native