Description of Alcohol Abuse
In today’s society, alcoholic beverages are a routine part of the social landscape for many in the population. This is particularly true for those in social environments with high visibility and societal influence, where alcohol frequently accompanies socializing (WHO, 2019). Since it is very common to have alcohol during times of socializing, it is easy to overlook or discount the health and social damage caused or contributed to by drinking. With that being said, “alcohol is a toxic and psychoactive substance with dependence producing propensities” (WHO, 2019). Alcohol is the most commonly used and abused substance worldwide and since it is legal, the access is easily available. Even though alcohol use is very common among college students, it is also prevalent among other ages as well. “On average, every person in the world aged 15 years or older drinks 6.2 L of pure alcohol per year and alcohol is the leading risk factor for premature mortality and disability among those aged 15 to 49 years, accounting for 10 percent of all deaths in this age group” (WHO, 2019). The risks of becoming an alcohol abuser can start just from drinking once at a college party, from getting divorced or even losing your job in your mid thirties.
Alcohol abuse is defined as the misuse of an alcoholic substance with a strong desire to consume and an impaired ability to stop; despite the negative consequences. According to the National Institute on Alcohol Abuse and Alcoholism, “heavy alcohol use is when one binge drinks on 5 or more days in one month and one standard drink consists of 12 ounces of regular beer, 5 ounces of wine, and 1.5 ounces of any kind of vodka” (National Institutes of Health, 2018). It is mindblowing to see these statistics because it has been evident that some people fill their glasses to the tippy top and consume way more alcohol in one sitting than the standards recommend. For example, abusers consume so much alcohol to the point where this habit turns into an addiction. They start to consume the substance every single day and continue to drink it all day long. Doing so, would make them consistently be overcome with that drunk feeling that they desire. After abusing alcohol every single day for months or years, this usage would than be called chronic.
If alcohol use has many harmful consequences just from using it one night, can you imagine the effects of consuming the beverage everyday for years upon years? Chronic abuse causes a huge decline to one’s health status in an abundance of ways. Alcohol abuse can affect a variety of things such as ones health, relationships with others, family dynamics, and overall finances. Not only does it have an impact locally among the individual, but also has an affect on the economy and on the health of populations globally. According to the World Health Organization, “Alcohol consumption contributes to 3 million deaths each year globally as well as to the disabilities and poor health of millions of people; this represents 1 in 20 deaths” (WHO, 2019).With that being said, alcohol abuse is an extremely significant problem in today’s world and there is a lot of history behind this topic.
History
Alcohol has been a part of human culture for many years now and was commonly made from fermented grain, fruit juice and honey. Fermented beverages existed in early Egyptian civilization, with evidence of an early alcoholic drink in China around 7000 B.C. (Foundation for a Drug Free World, 2018). While, In India, an alcoholic beverage called sura, distilled from rice, was in use between 3000 and 2000 B.C. Several Native American civilizations developed alcoholic beverages in pre-Columbian times, but was only used in ritualistic contexts. Alcohol, at this time, was called Spirits. (Foundation for a Drug Free World, 2018).
The idea of drinking recreationally and excessively was introduced by European settlers who plied indigenous Americans with alcohol as a way of weakening their resistance to unfair demands for land, resources, and women (Lautieri, A. et al, 2019). The historical record suggests that hundreds of distinct peoples across this large continent were suddenly exposed to alcohol after limited or no previous exposure. For eastern natives, this exposure would have occurred in the 16th century, whereas for some midwestern and western tribes, it could have been as late as the mid-19th century.Within the century after contact, the majority of these peoples, developed significant risks for socially and physically harmful alcohol use, which have largely persisted despite extraordinary efforts to control them ever since (Frank, J W. et al, 2000).
Drinking was pervasive among the early European colonists, and alcohol served practical purposes in their everyday lives. Alcohol was used as a substitute for drinking water (which was usually contaminated) and for medical purposes to fight fatigue, soothe indigestion, ward off fever, and relieve aches and pains. Then, with the increasing availability of hard liquor and increased local brewing and distillation, people began drinking more and in a less controlled context. Between 1800 and 1830, the annual alcohol consumption in the United States was estimated to be between 5 and 9.5 gallons, compared with 2.6 in 1978 (Frank, J W. et al, 2000).
At the beginning of the eighteenth century, the British parliament passed a law encouraging the use of grain for distilling spirits. Cheap spirits flooded the market and reached a peak in the mid-eighteenth century. In Britain, gin consumption reached 18 million gallons and alcoholism became widespread.The nineteenth century brought a change in attitudes and the temperance movement began promoting the moderate use of alcohol—which ultimately became a push for total prohibition. In 1920 the US passed a law prohibiting the manufacture, sale, import and export of intoxicating liquors. The illegal alcohol trade boomed and by 1933, the prohibition of alcohol was cancelled (Foundation of a Drug Free World, 2018).
Human beings have been dependent on alcohol in one form or another: from religious rituals to medicinal uses; as a source of energy and simply quenching thirst; from being used to relax to being used as a social lubricant; as an addition to meals and a complement to courtship and mating practices. For millions upon millions of people throughout history, alcohol has existed for enhancing the quality and pleasures of life (Lautieri, A. et al, 2019).
Today, an estimated 15 million Americans suffer from alcoholism and 40% of all car accident deaths in the US involve this substance (Foundation of a Drug Free World, 2018).
Current Status
According to the World Health Organization, an estimated 2.3 billion people are current drinkers. Alcohol is consumed by more than half of the population in three WHO regions – the Americas, Europe and the Western Pacific with Europe having the highest consumption rate in the world (WHO, 2018). Alcohol abuse is more common in high-income countries, which is also why it is a growing problem in the United States. So how much alcohol are people currently consuming? Well, the average daily consumption of people who drink alcohol is 33 grams of pure alcohol a day, roughly equivalent to 2 glasses (each of 150 ml) of wine, a large (750 ml) bottle of beer or two shots (each of 40 ml) of spirits (WHO, 2018). However, people that drink all day long probably triple or quadruple those numbers. Worldwide, 27% of all 15–19-year-olds are current drinkers. Rates of current drinking are highest among 15–19-year-olds in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%) (WHO, 2018). The Global consumption of alcohol is predicted to increase over the next 10 years, particularly in the South-East Asia, Western Pacific Regions and the Region of the Americas. Overall, alcohol abuse is a current growing problem both locally and globally that has been identified, but not eradicated. Public health measures need to be implemented and the population needs to be motivated in order for the slightest dent to be made regarding this issue.
Immediate Issues & Long-term Issues
The harmful use of alcohol is a serious health burden, and it affects virtually all individuals on an international scale. Health problems from dangerous alcohol use arise in the form of acute and chronic conditions (WHO,2019). Some short term consequences of alcohol use would be injury, accidents, violence, & sudden death, whereas some long-term issues would be alcohol dependence, stroke, liver damage, & different cancers. Chronic alcohol abuse also has an affect on memory. One study showed that long term memory was still impaired in a past chronic alcohol abuser even after 7 years of being alcohol free (Brandt, J, 1983). This indicates that permanent damage was done. Unfortunately, alcohol-related deaths occur very frequently. “Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions” (WHO, 2018).
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According to The National Institute on Alcohol Abuse and Alcoholism: “The scope and variety of these problems are attributable to differences in the amount, duration, and patterns of alcohol consumption; differences in genetic vulnerability to particular alcohol-related consequences; and differences in economic, social, and other environmental factors.. Some people develop the symptoms of alcohol abuse after only months of heavy drinking, whereas other alcoholics may drink heavily for years before developing symptoms. Alcohol problems, both those of individuals and those that affect society at large, continue to impose staggering social and economic burdens. In addition to negatively affecting health, a wide range of social ills including domestic violence, child abuse, fires and other accidents, and other crimes against individuals such as rape, robbery, and assault have all been linked to alcohol misuse. An estimated 20 to 40 percent of patients in large urban hospitals are there because of illnesses that have been caused or made worse by their drinking. This means that out of every 100 patients in such hospitals, almost half may be there because of their alcohol use. In spite of the severity of the alcohol-related problems, many people do not yet understand that alcohol problems can yield to scientifically-based medical and psychosocial intervention in the same way as other health conditions are responsive to prevention and treatment” (National Institutes of Health, n.d).
Alcohol abuse also has an impact on many other aspects of life. For example, in 2010, alcohol misuse cost the United States $249.0 billion which strongly affected the economy. Also, it was discovered that more than 10 percent of U.S. children live with a parent with alcohol problems, which strongly affects their family dynamic and possibly the children’s mental health (National Institutes of Health, 2018). This supports how powerful the impact of alcohol actually is and how the short and long term effects could be prevented just from not drinking.
Educational Needs of Population
Educating the population on the health issues and harmful consequences of alcohol abuse is extremely important. The only way this issue will ever get better is if we all come together to educate one another. People of all ages need to become more aware of how dangerous alcohol can really be. Education could be done in schools either from the teacher or even have police officers come in to speak. I know from experience that when I was in School they had a DARE program and officers would come in and teach kids about why they should stay away from drugs and alcohol. Education can also be done at health fairs, people can hang fliers around the neighborhood, or even educate in hospitals. Everyone needs to work together to educate one another and if they see someone drinking and about to drive they should speak up to prevent that person from doing it. Another way to educate would be to have someone who is an alcohol abuser with liver disease or cancer go and speak to schools or neighborhoods, so they can see in person what abusing alcohol really does and get a chance to listen to their story. It is also extremely important to make sure that teachers are educated on substance abuse in order for them to properly educate the students. For example, there was a study done that “examines not only the prevalence of substance abuse in one rural, Canadian high school, but also how teachers understand teaching and learning in relation to substance abuse. Over one third of students reported that they had used marijuana (37%) and alcohol (38%) in the last seven days, a rate considerably higher than typical Canadian averages. Pedagogical implications were informed by three main themes that emerged from staff interviews. Several teachers normalized substance abuse in adolescence, others coped silently 'under the radar,' and a few called for specialized support from other human services. Further, in-school approaches require that the entire staff be involved to enhance awareness of substance abuse, interprofessional collaboration, and a sense of interdependence”(Salm, T. et al, 2011). This study was really important to realize that teachers need to also be strongly educated and be involved. They either thought it was normal for the students to be doing that or they knew it was wrong, but still stayed quiet about it. All teachers need to be involved and schools should be more involved in putting programs together and having speakers come in. The use of substances starts younger and younger as the generations pass, so it needs to be controlled as early as possible.
Since alcohol is a legal substance, it is advertised in many places. Alcoholic advertisements are on tv commercials, billboards, social media, and even in tv shows or movies that many people watch. Alcohol is also extremely easy to access and not too expensive.“Proven, cost-effective actions include increasing taxes on alcoholic drinks, bans or restrictions on alcohol advertising, and restricting the physical availability of alcohol” (WHO, 2018). Some countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts. The majority of countries have some type of restriction on beer advertising, with total bans most common for television and radio but less common for the internet and social media (WHO, 2018). This is a huge problem considering the majority of the population is constantly on social media.
“We would like to see Member States implement creative solutions that will save lives, such as taxing alcohol and restricting advertising. We must do more to cut demand and reach the target set by governments of a 10% relative reduction in consumption of alcohol globally between 2010 and 2025” (WHO, 2018). The government should worry less about making money and more about public health. Making alcohol less accessible and more expensive could steer people away from buying it. They should also try to put a show on television about why alcohol is harmful or maybe a commercial about an alcohol abuser just like they do with smoking. These interventions would provide education and begin to increase public health.
After researching, there was a new intervention by the World Health Organization that really stood out and it is called SAFER. It is the newest WHO-led roadmap to support governments in taking practical steps to accelerate progress on health, beat noncommunicable diseases through addressing the harmful use of alcohol, and achieve development targets (WHO, 2019). “We have seen too little progress since the endorsement of the ‘Global strategy to reduce the harmful use of alcohol’ by the World Health Assembly eight years ago. But SAFER brings new impetus for action” (WHO, 2019). So what does SAFER consist of ? Well, SAFER provides 5 strategic actions that are prioritized for implementation to promote health and development which are to: strengthen restrictions on alcohol availability, advance and enforce drink driving countermeasures, facilitate access to screening, brief interventions, and treatment, enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion, & raise prices on alcohol through excise taxes and pricing policies (WHO, 2019). Because alcohol is so commonly used, people do not realize how much of a public health threat it actually is. These strategies pretty much sum up everything that needs to be worked on and gives guidance to governments worldwide on how to save lives. “The greatest impact will be achieved by implementing all the SAFER interventions in full” (WHO, 2019).
Role Of Nurse
Primary care includes providing patients with guidelines and information for maintaining good health as well as providing the screening, diagnosis, intervention, and treatment of basic health problems, including alcohol abuse and dependence (Naegle, M, 1994). With that being said, nurses play a crucial role in the primary care setting. They assess client needs; formulate and deliver care to individuals and families; and often are responsible for detecting, addressing, and referring patients who exhibit alcohol, tobacco, and other drug-related problems (Naegle, M, 1994). Primary care activities related to alcohol abuse center on the early prevention and intervention of problems and on the identification of problems and referral to specialty care. This technique is usually described as the levels of prevention. 1) primary prevention would be educating patients about the harmful effects of alcohol abuse, 2) secondary prevention would be screenings and early identification of alcohol abuse and 3) tertiary prevention would consist of treatment like rehabs and medications to help decrease the desire to drink. Such an emphasis on prevention provides opportunities for general nurses to assume more formal roles in providing primary care (Naegle, M. 1994). Registered nurses and the Advanced practice nurses can play two different roles is dealing with patients with alcohol abuse. For nurse practitioners, the role extends beyond primary care to include secondary care of patients with alcohol abuse and dependence (primary care referring to prevention and health maintenance and secondary care to diagnosis and care of acute illnesses) (Naegle, M. 1994). A primary care nurse addressing alcohol-related problems must have received adequate education and training to obtain routine alcohol and other drug histories; implement primary prevention strategies, including anticipatory guidance and alcohol abuse education; assess a possible problem with alcohol; formulate a diagnosis of abuse from an analysis of patient assessments and data collection; conduct appropriate nursing interventions; identify acute alcohol-related illness and refer patients to physicians or addictions nursing specialists; and continue care in the forms of followup, monitoring, health maintenance, or health care support during recovery (Naegle, M, 1994)
Future Implications
Research has shown that 37% of the 155 responding countries do not provide access to postgraduate training programmes for professionals working within treatment of substance use disorders, and 40% of the 147 responding countries do not provide access for those working in prevention of substance use (WHO, 2018). This goes to show that in many countries, after one’s schooling has been completed,they do not receive any further educational refreshers afterwards. This is a very scary thought especially for healthcare providers considering they are taking care of the lives of other people. They should be receiving plenty of educational refreshers.
Defining precisely who is at risk for alcohol problems and assessing the risks versus the benefits of alcohol use are important to designing effective interventions to reduce alcohol problems and providing accurate public health information (National Institutes of Health, n.d). However, if members of the healthcare team are not having extra educational seminars on these topics, then they will not be able to properly assess patients or properly educate them. Since nurses play a prominent role in primary care, they regularly encounter and attend people with alcohol abuse and dependence problems. For that reason, it is vital that education about alcohol abuse and related problems, becomes an integral element of basic nursing curricula. Despite how important being knowledgeable about this topic is, basic knowledge about alcohol abuse and its related problems has not been included in general nursing education in any consistent manner. Indeed, significant gaps exist in the content of nursing curricula aimed at educating nurses about substance abuse (Naegle, M, 1994). Long-term effects of alcoholism and appropriate nursing care for this condition often were included in professional nursing curricula developed in the 1940's. However, Nursing schools averaged only 1 to 5 hours on alcohol abuse education, a disproportionately small amount given its far-reaching health implications. Content related to alcohol abuse and dependence was presented primarily in courses on psychiatric or medical nursing, as associated with long-term effects and medical complications (Naegle, M, 1994). This shows that they focus very little time on substance abuse in nursing schools and then strongly lack education related to this topic as a post grad.
Nurses are one of the largest groups of healthcare professionals sharing in patient care responsibilities, including caring for those who use and abuse psychoactive substances. With that being said, a study was done to evaluate the theoretical-practical knowledge acquired by nurses in undergraduate and postgraduate studies and their perceptions about alcohol users (Pillon, S. C. et al, 2005). The study involved a bunch of nurses and a survey that included questions about sociodemographic characteristics; a nurses' attitudes and beliefs scale; and a questionnaire to identify formal nursing education on the use of alcohol and its consequences (Pillon, S. C. et al, 2005). The results showed that 70% of the participants had received little or no information on physical, family and social problems related to alcohol use; 87% had received little or no information on high risk related to specific segments of the population; 95% had received little or no information on nursing procedures for alcohol-abuse patients. In conclusion, formal education regarding the use of alcohol and its consequences is limited, especially with regard to offering adequate care and management for patients who have problems with or are addicted to alcohol (Pillon, S. C. et al, 2005). The main future implication for all healthcare providers is education. Education is a huge part of a nursing role and is constantly being done all day long. Hospitals need to make sure that their nurses are being educated and refreshed on up to date practices, signs and symptoms of things etc. Nurses would be able to make a huge difference in contributing to decreasing the alcohol abuse problem if they were able to confidently speak to their patients about it and discuss the risks, and consequences, etc.
Summary
Overall, alcohol is the most widely used and abused substance across the globe. The abuse of alcohol is a problem that continues to grow as the years go by. Since alcohol is such a common substance to have just sitting in the fridge or to have any kind of social event, it is usually hard for people to realize the negative consequences that come along with consuming it. How could something legal and so common be so bad for someone? That is what people have a hard time coming to terms with. With that being said, According to the 2015 NSDUH, approximately 1.3 million people18(about 3.3 percent19) ages 12–20 (3.6 percent of males and 3.0 percent of females19) reported heavy alcohol use in the past month (National Institutes of Health, 2018). Teachers, nurses, doctors, parents, the government and just people in general need to come together and educate one another about the importance of not abusing a substance this toxic. It can ruin families, health,mental status, and even cause death. Alcohol’s addictive characteristics when used on a daily basis can be a very scary thing. The general public of all ages needs to be educated,as well as healthcare providers, police officers and teachers. This is a global problem that is far from being eradicated, but it is starting to become recognized and learned about.
The World Health Organization came up with a global strategy to help reduce harmful use of alcohol which states: The ten areas for national action are:leadership, awareness and commitment; health services' response; community action; drink-driving policies and countermeasures; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of drinking and alcohol intoxication; reducing the public health impact of illicit alcohol and informally produced alcohol; monitoring and surveillance (WHO, 2019). They also came up with the safer program that lists five interventions to implement that would assist in saving lives . Overall the main goal would be to increase public health and well being. In order to help achieve this goal, we could educate on harmful consequences, reduce the availability of alcohol in stores, make it more expensive, and come together as a nation in order to help decrease this issue.
References
- Brandt, J. (1983). Cognitive Loss and Recovery in Long-term Alcohol Abusers. Journal of General Psychiatry,40(4), 435. doi:10.1001/archpsyc.1983.01790040089012
- Frank, J. W., Moore, R. S., & Ames, G. M. (2000). Historical and cultural roots of drinking problems among American Indians. American journal of public health, 90(3), 344–351. doi:10.2105/ajph.90.3.344
- Foundation for a Drug-Free World.(2018). A Brief History of Alcohol & Alcoholic Beverages - Drug-Free World. Retrieved from: www.drugfreeworld.org/drugfacts/alcohol/a-short-history.html.
- Lautieri, A., Thomas, S., & Stein, S. (2019, June 13). The History of Alcohol Abuse and Treatment. Retrieved July 26, 2019, from https://riveroakstreatment.com/alcohol-addiction/history/#alcohol-abuse-in-american-history
- Naegle, M. A. (1994). The need for alcohol abuse-related education in nursing curricula. Alcohol Health & Research World, 18(2), 154. Retrieved from http://search.ebscohost.com.ezaccess.libraries.psu.edu/login.aspx?direct=true&db=a2h&AN=9502037643&site=ehost-live&scope=site
- Pillon, S. C., & Laranjeira, R. R. (2005). Formal education and nurses attitudes towards alcohol and alcoholism in a Brazilian sample. Sao Paulo Medical Journal,123(4), 175-180. doi:10.1590/s1516-31802005000400004
- Salm, T., PhD., Sevigny, P., PhD., Mulholland, V., PhD., & Greenberg, H., M.S.W. (2011).
- Prevalence and pedagogy: Understanding substance abuse in schools.Journal of Alcohol and Drug Education, 55(1), 70-92. Retrieved from http://ezaccess.libraries.psu.edu/login?url=https://search-proquest-com.ezaccess.libraries.psu.edu/docview/867434720?accountid=13158
- The National Institute on Alcohol Abuse and Alcoholism. Alcohol Facts and Statistics. (2018, August 12). Retrieved July 26, 2019, from: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
- The National Institute on Alcohol Abuse and Alcoholism. (n.d). Alcoholism: Natural History and Background. Retrieved from: https://pubs.niaaa.nih.gov/publications/healthdisparities/alcoholism1.htm
- The World Health Organization. (2019). Alcohol. Retrieved from: https://www.who.int/health-topics/alcohol#tab=overview
- The World Health Organization. (2018, September 21). Harmful use of alcohol kills more than 3 million people each year, most of them men. Retrieved from https://www.who.int/news-room/detail/21-09-2018-harmful-use-of-alcohol-kills-more-than-3-million-people-each-year-most-of-them-men
- The World Health Organization. Human resources. (2018, December 27). Retrieved from https://www.who.int/gho/substance_abuse/human_resources/en/
- The World Health Organization. (2019). Management of Substance Abuse. Retrieved from: https://www.who.int/substance_abuse/facts/en/
- The World Health Organization. (2019, May 10). WHO launches SAFER alcohol control initiative to prevent and reduce alcohol-related death and disability. Retrieved from https://www.who.int/substance_abuse/safer/launch/en/
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