Hazardous alcohol use: Its delineation as a subthreshold disorder, and approaches to its diagnosis and management

The last 20 years have seen a significant paradigm shift in how we view alc ohol misuse. The dichotomous model of "alcoholism" and "normal drinking" ha s now been replaced by the concept of a spectrum of disorders. In this new framework, "hazardous alcohol use" is defined as a repeated pattern of drin king that confers the risk of harmful consequences. It is a typical example of a subthreshold disorder. Where actual physical or psychological harm or social problems have occurred, the terms "harmful alcohol use" and "alcoho l abuse," respectively, are applied. These conditions would typically be co nsidered to be above the clinical threshold. The most severe disorder, alco hol dependence, is a psychobiological syndrome with often severe physical, psychological, and social sequelae. This article describes how the concept of hazardous alcohol use originated, and reviews the intervention technique s that have been developed to induce and assist hazardous drinkers to reduc e their consumption to nonhazardous levels. The findings from a series of W orld Health Organization (WHO) collaborative studies on brief interventions for hazardous alcohol use are described. This work has resulted in the dev elopment of the Alcohol Use Disorders Identification Test (AUDIT) screening instrument, which can detect over 90% of hazardous drinkers in a range of settings, and the demonstration that 5 minutes' structured advice can reduc e hazardous consumption by 30%. The later phases of this program of work ha ve examined strategies to promote the dissemination of brief interventions for hazardous alcohol use out primary health care, and the nationwide, syst ematic, and sustained utilization of these interventions. Copyright (C) 200 0 by W.B. Saunders Company.