This review covers interventions in hazardous and harmful alcohol users aged 18 years and older being treated in primary care or in emergency departments. In defining hazardous and harmful alcohol consumption, we have used the WHO categorisation of alcohol-use disorders. Dependent drinkers (who have more serious alcohol misuse problems than harmful or hazardous drinkers) are not covered by this review. It is important to note that threshold levels of hazardous and harmful consumption often vary by country and culture. Hazardous alcohol consumption is defined as a pattern of alcohol consumption that increases the individual's risk of alcohol-related harm, but is not currently causing alcohol-related harm. The quantity and frequency of alcohol consumption that constitutes hazardous consumption is usually specified using threshold levels of consumption. In the UK, these levels are specified as: in excess of 14 standard drinks for women and 21 standard drinks for men in any week, where a standard drink constitutes 10 mL by volume or 8 g by weight of pure ethanol. Harmful alcohol consumption is a pattern of consumption likely to have already led to alcohol-related harm. In the ICD-10, alcohol consumption is defined as harmful if: there is clear evidence that alcohol is responsible for physical or psychological harm; the nature of the harm is identifiable; alcohol consumption has persisted for at least 1 month over the previous 12 months; and the individual does not meet the criteria for alcohol dependence. Harmful alcohol consumption is also conceptualised in terms of a pattern of alcohol consumption in excess of specified limits, which currently stands in the UK as 35 standard drinks for women and 50 standard drinks for men in any week. Hazardous and harmful alcohol users are unlikely to seek treatment specifically for alcohol-related problems, but they may come to the attention of health services through opportunistic screening for alcohol use, or, in the case of people with harmful levels of alcohol consumption, because they exhibit alcohol-related harm at presentation. Alcohol-related harm may be acute (such as alcohol-related accidents, alcohol poisoning, or acute pancreatitis), and may also be chronic (such as hypertension, cirrhosis, depression and anxiety, fetal alcohol syndrome, and fetal alcohol effects). ...read more.
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