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ALCOHOL USE DISORDER (Risk Factors for AUD (Peer context: associating with…
ALCOHOL USE DISORDER
Guidelines
Moderate drinking
- Women: 10 drinks/week, no more than 2/day
- Men: 15 drinks/week, no more than 3/day
- On special occasions, no more than 3 for women, 4 for men
Heavy/binge drinking
- Women: 4/+ drinks on at least 1 occasion/month in past year
- Men: 5/+ drinks
- less than 25% of Ontario kids grades 7-12 met this criteria at least once in past month
- 30% Canadian students aged 15-19 met this criteria 12/+ times past year
- 41% Canadians aged 20-24 met this criteria 12/+ times past year
- People who start binge drinking in adolescence are 4x more likely to develop AUD later in life
Potential Health Impacts
Short-Term
- intoxication, delirium, disinhibition, psychosis, vision, risky behaviour
- decision-making, memory, anxiety depression
- injury, motor control
- alcohol poisoning
-
Long-Term
- decision-making, memory, anxiety, depression
- injury, motor control
- brain damage, stroke, mental health
- heart disease, hyptertension
- pancreatitis, stomach ulcers, fatty liver disease, hepatitis, cirrhosis
- fertility
- skin, muscles, hormones, immune system, stress system
- cancer, STIs, AUD
-
-
"Double Threat"
- adolescents are more vulnerable to engaging in risky alcohol-use behaviour
AND
- adolescents are more vulnerable to the neurotoxic effects of alcohol
DSM-5
DSM-5 Questions:
In the past year have you...
- had times when you ended up drinking more, or longer, than you intended?
- more than once wanted to cut down or stop drinking, or tried to, but couldn't?
- spent a lot of time drinking? or being sick or getting over the after-effects?
- wanted a drink so badly you couldn't think of anything else?
- found that drinking - or being sick from drinking - often interfered with taking care of home/family? or caused job/school troubles?
etc...
AUD Criteria
- 2+ symptoms = AUD
- mild: 2-3 symptoms
- moderate: 4-5 symptoms
- severe: 6+ symptoms
Epidemiology
- Lifetime: 18.1%
- 12-month: 3.2%
- Sex ratio: 2-3x higher in males
- Age of onset: ~26
- Higher rates in Aboriginal communities
- This is the most prevalnt mental illness (1/5)
- One of the mental disorders associated with greatest mortality
- Estimated costs of alcohol abuse: $14.6 billion total
Risk Factors for AUD
-
Family context: low parental monitoring, maltreatment
- low parental monitoring - strong predictor for adolescent alcohol & substance use
- maltreatment
Cultural context: e.g., religious prohibitions, cultural disenfranchisement
- protective or confer risk
- religious prohibitions - culture that prohibits alcohol could be protective
- cultural disenfranchisement - e.g., Indigenous context, colonization, increases likelihood of substance abuse (82.6% of Indigenous respondents to a survey said alcohol/drug abuse was their #1 challenge, likely as a result of cultural disenfranchisement)
Personal context:
- personality: impulsive decision-making (not just general impulsivity), high neuroticism (increases feelings of anxiety/depression, mood dysregulation can impair ability to make decisions)
- cognitive: alcohol expectancies (expectancies about the positive incentive value of alcohol that are stored as memories & influence future alcohol use, like an alcohol schema); hard time pulling on memories & experiences of -ve effects of alcohol
- low self-efficacy beliefs about being able to cope in high-risk situations
Genetic context:
- heritability estimate: .50-.60 (more than half of variance is due to genetic factors)
- genes → intermediate characteristics (endophenotypes) → drinking behaviour
- e.g., behavioural disinhibition: GABAergic & DAergic genes