THE COMPLEXITY OF ALCOHOL
ALCOHOL USE DISORDER: A YOUNG
PSYCHIATRIST’S PERSPECTIVE
AUTHOR Ali Farooqui, MD
A
lcohol has played a prominent
role in human cultures around
the world since the beginning
of recorded time. World leaders,
artists and professionals boast of
being champions of liquor. F. Scott
Fitzgerald eloquently stated, “First
you take a drink, then the drink takes a drink,
then the drink takes you.” The power to escape from reality is se-
ductive, and humankind has often sought solace and, all too often,
oblivion in the cup. Many cultures embraced the power of alcohol,
and some have even worshipped it – the cult of Dionysus - while
others condemned its consumption as evil, never to be taken. Amer-
ican history has also displayed these dichotomous views as shown
by the ratification of the 18 th constitutional amendment, followed
by its speedy reversal.
Despite our historical ambivalence, the culture of drinking is
deeply entrenched in our society. It is nevertheless impossible to
ignore the dangers of any potentially addictive mood and mind-al-
tering substance. Though physicians appreciated these dangers
thousands of years ago, it was not until 1849 in Sweden that alcohol’s
effects on the human mind and body were better defined, and the
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LOUISVILLE MEDICINE
term “alcoholism” was coined. This diagnosis was formalized in
medical practice in 1952 when the first Diagnostic and Statistical
Manual of Mental Disorders (DSM) was published.
Alcoholism was initially classified as a secondary reaction to per-
sonality disorders, specifically “sociopathic personality disturbance.”
Over the next half century, the terminology of alcohol abuse and the
classification of alcoholism has undergone numerous modifications,
and is now classified as Alcohol Use Disorder (AUD). It is also now
a primary diagnosis instead of merely an afterthought, a sequela of
a primary personality disorder. This new classification has varying
levels of severity (Table 1, page 27).
In the United States, 8.5% of adults and 4.6% of pediatric popu-
lation are estimated to suffer from alcohol use disorder. Pathological
drinking is not uniquely an American problem as the worldwide
prevalence approached 4%. This high prevalence has an unclear eti-
ology, but the impact of cultural norms cannot be ignored. Genetics
also play a pivotal role and is attributed to 40% to 60% of the risk
of developing AUD, with the rate being three to four times higher
in individuals with close relatives suffering from the disorder. The
pathological behavior inherent in the diagnostic criteria often has
a relapsing and remitting course. There are 11 specific areas of im-
pairment, the combination of which – if present within a 12-month