Table 1Definitions of drinking disorders, patterns, and categories

Alcohol Consumption CategoryTermsDefinitionsPrevalence/population
“Excessive”Alcohol use disorders: Dependence: 3 or more of the following during a 1-year period:
1.

tolerance;

2.

withdrawal;

3.

intake larger amounts than intended;

4.

persistent desire or unsuccessful efforts to cut down;

5.

“a great deal” of time spent obtaining, using, or recovering from use of alcohol;

6.

social, occupational, or recreational activities reduced because of alcohol use;

7.

use continues despite knowledge of related problems. Specifier: Physiological dependence if either item 1 or 2 is present.

7.4% of general population meet criteria for abuse/alcoholism 2
Alcohol dependence Abuse: 1 or more of the following during a 1-year period:
1.

recurrent use results in failure to fulfill role obligations at work, school, or home;

2.

recurrent use in physically hazardous situations (e.g., driving a motor vehicle);

3.

recurrent legal problems related to use;

4.

continued use despite related persistent or recurrent social or interpersonal problems. 41

10% of current drinkers meet diagnostic criteria for dependence and another 7% for abuse 49
Alcohol abuse Alcoholism: “...is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic”. 42
Alcoholism Chronic Alcoholics: “...individuals whose life is centered around procuring and consuming alcohol and who, upon stopping drinking, suffer severe withdrawal symptoms.” 44
Chronic alcoholism Harmful drinking: >5 drinks/day (NHMRC [Aust.] recommendations, cited in Holman, et al. 32 ); “exhibit physical, social, or psychological harm, but may not meet criteria for dependence” 44
Harmful drinking
“At-risk”Problem drinking Problem drinkers: “typically have either experienced negative consequences of their drinking or drink in ways that place them at risk of such consequences; however, they usually do not drink steadily, do not show major withdrawal symptoms when they stop drinking, and sometimes drink with control, and their lives do not revolve around drinking” 43 55% of current adult drinkers binged (5 or more drinks on an occasion) in last year; 12% binged weekly or more; 16% binged in past month. 45
Hazardous drinking Hazardous drinking (a): AUDIT score >=8 46 32% of HS seniors and 39% of college students binged in last 2 weeks; 20% of current drinkers average over 2 drinks/day 45
At-risk or risky drinking Hazardous drinking (b): 3–4.9 drinks/day (NHMRC [Aust.] recommendations, cited in Holman, et al. 32 )Among pregnant women, 15–44, 15.3% used alcohol & 2.9% binged 45
Binge drinking At-risk drinking:
1.

>7 drinks/week for women, >14 drinks/week for men; or binge drinking (drinks per occasion >3 for women and > 4 for men) 38, 40

2.

>14 drinks/week for women, >21 drinks/week for men; or binge drinking (WHO guideline, in Saunders et al. 46 ); “at risk from exceeding daily, weekly, or per occasion thresholds” 44

Heavy or heavier drinking Binge drinking: 6 or more drinks/occasion; 47 5 or more drinks/occasion (BRFSS, cited in Holtzman et al. 48 ); 5 or more drinks/occasion in last 30 days 49
Heavy or heavier episodic drinking Heavier drinking: >2 drinks/day 50
Heavier episodic drinking: >4 drinks/occasion for men, >3 drinks/occasion for women 39, 40
“Responsible” or “appropriate”Light or lighter drinking Responsible drinking: >0 to 2.9 drinks/day (NHMRC [Aust.] recommendations, cited in Holman, et al. 32 )72% of female and 74% of male current drinkers aged 21 and older exceed NIAAA moderate drinking guidelines. 45
Moderate drinking Light drinking: 0.01 to 0.21 fl oz alcohol/day (1 to 13 drinks/month) 50, 51
Safe drinking levels Moderate drinking (a): Average consumption of ≤1 standard drink/day for women and for anyone over age 65; ≤2 standard drinks/day for men. 39
Low risk drinking guidelines Moderate drinking (b): ≤ 3 drinks/day and ≤12 drinks/week for women; ≤4 drinks/day and ≤16 drinks/week for men 38
Moderate drinking (c): 0.22 to 1.00 fl oz alcohol/day (4 to 14 drinks/week 50, 51
Low risk drinking: <2 drinks/day (Canadian Medical Association guideline, cited in Ashley et al 52 )
“Current Use”current useCurrent drinkers—at least 12 drinks in the preceding year; 2 at least 1 drink in last 30 days 49 Current drinkers—44% of Americans 18 and older; 45
Adolescent/young adult use—used in last month, ever use.12th grade ever use-81%; Last month use-20% 45 (ages 12–17); 59% (ages 18–25) 45

Note: In the U.S., a standard “drink” is typically defined as a half-ounce of alcohol, roughly the amount in 12-ounces of beer, 5-ounces of wine, or 1.5 ounces of distilled spirits. 41 Standard drink units in other countries are reported in a variety of volume and weight measures, including imperial ounces, grams, and milliliters (see Miller et al 197 for conversion factors).

From: 1, Background

Cover of Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use
Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use [Internet].
Systematic Evidence Reviews, No. 30.
Whitlock EP, Green CA, Polen MR, et al.

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