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Hazardous drinking and alcohol use disorders

Abstract

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.

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Fig. 1: Alcohol consumption and prevalence of alcohol use disorders.
Fig. 2: Harms associated with alcohol use.
Fig. 3: Major pathways in alcohol metabolism.
Fig. 4: A contemporary overview of the neurobiology of alcohol use disorders.

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Acknowledgements

J.M. is supported by the Peter Boris Chair in Addictions Research, a Tier 1 Canada Research Chair in Translational Addiction Research, and grants from the Canadian Institutes of Health Research, Health Canada, and the National Institutes of Health (NIH; R01AA024930, R01AA025911, R21 AA027679, R01AA025849). S.W.F.E. is supported by NIH grant K24AA026876. M.H. is supported by the Swedish Research Council (2013-07434, 2019-01138) and is a Clinical Scholar supported by the Knut and Alice Wallenberg Foundation. J.F.K. is supported by NIH grants K24AA022136 and R01AA025849 L.L. is a US federal employee at the National Institutes of Health, and is supported by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. C.D.P. is supported by the South African Medical Research Council. A.A.P. is supported by NIH grants P50DA037844, R01AA02628 and R01AA029688. L.R. is supported by NIH grant K24AA025704. The views expressed herein are those of the authors and do not reflect the official policy or position of the funding sources.

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Contributions

Introduction (J.M., A.A.P. and M.H.); Epidemiology (J.M., C.D.P. and J.R.); Mechanisms/pathophysiology (J.M., A.L.-H., A.A.P. and M.H.); Diagnosis, screening and prevention (J.M., A.L.-H., L.L., R.A., S.W.F.E., J.R. and M.H.); Management (J.M., A.L.-H., L.L., R.A., S.W.F.E., L.R., J.F.K. and M.H.); Quality of life (J.M., A.A.P. and M.H.); Outlook (J.M., A.A.P. and M.H.); Overview of Primer (J.M.).

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Correspondence to James MacKillop.

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J.M. is a principal and senior scientist in BEAM Diagnostics, Inc. and a consultant to Clairvoyant Therapeutics, Inc.; no associated products or services are discussed in the article. Outside his federal employment, L.L. receives an honorarium from the UK Medical Council on Alcoholism (Editor-in-Chief for Alcohol and Alcoholism) and royalties from Routledge for a textbook. A.A.P. is on the Scientific Advisory Board of Vivid Genomics and is listed as an inventor on US patent US20160038559A1. M.H. is a member of the scientific advisory council of the Swedish Medical Products Agency, and Scientific Advisor to the Board of Health and Social Welfare; his views expressed here do not represent those of these agencies; M.H. has received consulting fees, research support or other compensation from Indivior, Camurus, Molteni, BrainsWay, Aelis Farma, Lundbeck and Janssen Pharmaceuticals. A.L.-H. has received honoraria paid into her Institutional funds for speaking and chairing engagements from Lundbeck, Lundbeck Institute UK, Janssen-Cilag, Pfizer and Servier; has received honoraria to deliver training and education for the British Association for Psychopharmacology; has received research grants or support from Lundbeck and GSK, and unrestricted funding from Alcarelle for a PhD; has been consulted by but received no monies from Dobrin; and is a member of a group producing UK Alcohol Clinical Guidelines, UK Government (Office for Health Improvement and Disparities, Department of Health and Social Care). R.A., S.W.F.E., J.F.K., C.D.P., L.R. and J.R. declare no competing interests.

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MacKillop, J., Agabio, R., Feldstein Ewing, S.W. et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers 8, 80 (2022). https://doi.org/10.1038/s41572-022-00406-1

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