Harmful drinking

The department of health in the UK recommends that adult men should not regularly drink more than four units of alcohol per day and women no more than three units (this definition implies the need for alcohol free or lower alcohol consumption days) (3)

Above 50 units of alcohol per day in men and 35 units in women is regarded as 'definitely harmful' while those drinking more than eight units per day in men and six units in women are regarded as 'binge drinkers' (3)

The spectrum of alcohol use includes:

• abstinence
• low risk - AUDIT score <=7
  • although no amount of alcohol consumption can be called "safe", the risk of harm to person is less than if consumption is below levels specified in the "increasing risk"
• increasing risk (hazardous) - AUDIT score 8-15
  • regular consumption of more than 2 or 3 units a day (women) and more than 3 or 4 units a day (men)
• higher risk (harmful) - AUDIT score 16-19
  • regular consumption of more than 6 units daily (women) or more than 8 units daily (men), or more than 35 units weekly (women) or more than 50 units weekly (men
• dependence - AUDIT score >=20
  • as defined by ICD-10 (international classification of diseases, 10th revision) (1)

Harmful drinking is defined as a pattern of alcohol consumption causing health problems directly related to alcohol (probably at somewhat higher levels than in hazardous drinking).

• it could include psychological problems such as depression, alcohol-related accidents or physical illness such as acute pancreatitis
• in the long term, harmful drinkers may go on to develop high blood pressure, cirrhosis, heart disease and some types of cancer, such as mouth, liver, bowel or breast cancer (1)

The term was introduced in ICD-10 and replaced 'non-dependent use' as a diagnostic term. The ICD-10 Classification of Mental and Behavioural Disorders definition:
"a pattern of psychoactive substance use that is causing damage to health. The damage may be physical (e.g. hepatitis) or mental (e.g. depressive episodes secondary to heavy alcohol intake). Harmful use commonly, but not invariably, has adverse social consequences; social consequences in themselves, however, are not sufficient to justify a diagnosis of harmful use."

The closest equivalent in other diagnostic systems (e.g, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, in its fourth edition [DSM-IV]) is 'alcohol abuse', which usually includes social consequences (3)

Reference:

• (1) World Health Organization (WHO). Global status report on alcohol and health 2014
• (2) Day E, Copello A, Hull M. Assessment and management of alcohol use disorders. BMJ. 2015;350:h715
• (3) National Institute for Health and Clinical Excellence (NICE) 2011. Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence