Hazardous drinking and alcohol use disorders.
James M MacKillopRoberta AgabioSarah W Feldstein EwingMarkus HeiligJohn F KellyLorenzo LeggioAnne Lingford-HughesAbraham A PalmerCharles D ParryLara RayJürgen RehmPublished in: Nature reviews. Disease primers (2022)
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
Keyphrases
- healthcare
- alcohol consumption
- public health
- mental health
- liver failure
- drug induced
- respiratory failure
- aortic dissection
- human health
- primary care
- sleep quality
- depressive symptoms
- health information
- quality improvement
- high throughput
- air pollution
- high resolution
- life cycle
- risk assessment
- multiple sclerosis
- obsessive compulsive disorder
- resting state
- functional connectivity
- intensive care unit
- emergency department
- early life
- fluorescent probe
- extracorporeal membrane oxygenation
- climate change
- acute respiratory distress syndrome
- health insurance
- stress induced
- blood brain barrier