Alcohol Use Disorders (123) How can we define and measure alcohol use disorders? (4)

6 March, 2024

"May the tree not make us lose sight of the forest”

Thank you very much Neil for the effort to review the definitions that describe the “different” alcohol use disorders. [ ]

I agree with your conclusion that the terminology is “quite confusing,” and that does not contribute to a better understanding of when health professionals have to act.

Due to "professional deformation", although I am not a psychiatrist, I am inclined to favor the use of the APA [American Psychiatric Association] criteria, because it allows us to identify a wide range of problems linked to alcohol consumption.

It is also in line with my conviction that we must not only try to help those who have the “most serious disorders,” but to do so we must reduce the population average alcohol consumption.

If we really want to reduce problems linked to alcohol at the population level, we must apply policies that reduce total consumption. Which will obviously reduce alcohol sales... and therefore will be strongly resisted by the alcohol industry, which only wants us to focus on the "heavy drinker."

Otherwise, we would be seeing only the tree, and not the forest.

I am sharing the following fragment from the 3rd edition of Babor's book Alcohol: No Ordinary Commodity, which summarizes what I am trying to say:

Why is per capita alcohol consumption important?

Relationship between APC [alcohol per capita consumption] and prevalence of heavy drinkers. There is a fairly consistent pattern of substantial effects of average alcohol consumption on population health and social harm rates.

Therefore, an increase in this average tends to be accompanied by an increase in population mortality and, in particular, mortality from specific causes in which alcohol usually plays an important role and also in violence rates.

Across all studies, there is no single definition of “heavy drinking” and various levels of drinking have been used to distinguish “heavy drinkers” from other drinkers.

However, whatever the criteria for "excessive drinking", there is strong evidence of a close connection between the APC per drinker and the prevalence of excessive alcohol consumption, that is, the higher the level of consumption, the greater the proportion of heavy drinkers.

When the average consumption changes, the consumption at low, medium and high levels also changes.

Changes in the APC per drinker can typically be described as collective changes in which the entire distribution of drinkers “tends to move up and down the consumption scale.”

I hope this can contribute to our understanding of what should be the focus for the healthcare professionals to intervene.

Kind regards,


Dr. Eduardo Bianco

Director, Addiction Training Program (ATP)



HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT