Volpicelli Joseph R, Menzies Percy
Institute of Addiction Medicine, Plymouth Meeting, PA, USA.
Assisted Recovery Centers of America, St Louis, MO, USA.
Subst Abuse. 2022 Jul 22;16:11782218221111832. doi: 10.1177/11782218221111832. eCollection 2022.
Greater than moderate alcohol use spans a continuum that includes high levels of total alcohol consumed per period (heavy drinking) as well as episodes of intense drinking (binges) and can give rise to alcohol use disorder (AUD) when associated with an inability to control alcohol use despite negative consequences. Although moderate drinking and AUD have standard, operable definitions in the United States (US), a significant "gray area" remains in which an individual may exceed recommended drinking guidelines but does not meet the criteria for AUD (hereafter referred to as unhealthy alcohol use). To address this need, we conducted a structured literature search to evaluate how this gray area is defined and assess its burden within the US. For purposes of this review, we will refer to this gray area as "unhealthy alcohol use." Although numerous terms are used to describe various unsafe drinking practices, our review did not find any studies in which the specific prevalence and/or burden of unhealthy alcohol use was evaluated. That is, we found no studies that focus exclusively on individuals who exceed moderate drinking guidelines but do not meet AUD criteria. Furthermore, we did not discover an established framework for identifying individuals with unhealthy alcohol use. The lack of a consistent framework for identifying unhealthy alcohol users has significant implications for patient management and disease burden assessment. Therefore, we propose the following framework in which unhealthy alcohol use comprises 2 distinct subpopulations: those at risk of experiencing alcohol-related consequences and those who have subthreshold problems associated with use. The former, termed "risky drinkers," are defined by exceeding recommended guidelines for moderate drinking (⩽1 or 2 drinks per day for women and men, respectively). People with subthreshold problems associated with use, defined as exhibiting exactly 1 AUD symptom, would be classified as "problematic drinkers" within this proposed framework. These definitions would help bring the core elements of unhealthy alcohol use into focus, which in turn would help identify and provide management strategies sooner to those affected and reduce the overall burden of unhealthy alcohol use.
超过适度饮酒的情况涵盖了一个连续区间，包括每个时期饮酒总量较高（重度饮酒）以及狂饮（暴饮）发作，当与尽管有负面后果却无法控制饮酒相关联时，可能会引发酒精使用障碍（AUD）。尽管在美国，适度饮酒和酒精使用障碍有标准的、可操作的定义，但仍存在一个显著的“灰色地带”，即个体可能超过推荐饮酒指南，但不符合酒精使用障碍的标准（以下简称不健康饮酒）。为满足这一需求，我们进行了一次结构化文献检索，以评估这个灰色地带是如何定义的，并评估其在美国的负担。在本综述中，我们将这个灰色地带称为“不健康饮酒”。尽管有许多术语用于描述各种不安全饮酒行为，但我们的综述未发现任何评估不健康饮酒具体患病率和/或负担的研究。也就是说，我们没有找到专门针对超过适度饮酒指南但不符合酒精使用障碍标准的个体的研究。此外，我们没有发现一个用于识别不健康饮酒个体的既定框架。缺乏一个一致的框架来识别不健康饮酒者对患者管理和疾病负担评估具有重大影响。因此，我们提出以下框架，其中不健康饮酒包括两个不同的亚群体：有经历与酒精相关后果风险的人群以及与饮酒相关的亚阈值问题人群。前者被称为“危险饮酒者”，定义为超过适度饮酒的推荐指南（女性和男性每天分别不超过1或2杯）。在这个提议的框架内，有与饮酒相关的亚阈值问题（定义为恰好表现出一种酒精使用障碍症状）的人将被归类为“问题饮酒者”。这些定义将有助于聚焦不健康饮酒的核心要素，进而有助于更快地识别并为受影响者提供管理策略，减轻不健康饮酒的总体负担。
