Should we promote alcohol problems as a continuum? Implications for policy and practice

Abstract

The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criteria of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.

Keywords:

• Continuum
• alcohol use disorder
• alcohol prevention
• alcohol problems
• recovery
• non-abstinent recovery

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Including but not limited to a wide range of health conditions, dependence, injury, harm to others, and increased risk of these harms, even if not yet experienced.

2 We therefore refer to AUD where it reflects an operationalized model of alcohol problems in the context of treatment or policy (e.g. DSM-5) or research (e.g. as a measure or experimental depiction of alcohol problems in accordance with a particular model).

3 Harmful drinkers were identified as scoring 8 or more for women or 9 or more for men on the AUDIT-C.

4 For example, an ‘Alcohol Use Continuum’ could be a possible shorthand for communicating the IOM’s alcohol problems perspective in a way that explicitly emphasizes the continuum nature of use and harms without being susceptible to potential implicit binary associations with words such as ‘problem’ or ‘disorder.’

Additional information

Funding

This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism (K08AA030301 PI: Boness; R01AA022328 PI: Witkiewitz).