Alcohol Use Disorders (125) How can we define and measure alcohol use disorders? (5)

6 March, 2024

[re: ]

Dear Neil

Many thanks for this. I think you are correct – “Is it feasible to reach a point where everything is clear? From my perspective, this seems unlikely.” There are many reasons for this, but it is mainly because different organisations DO focus on different issues – for example, some may focus on physical health and harms to health, others may focus on social problems, some on criminal justice consequences, etc.

Some of these definitions are throwbacks to a much older conceptualisation, where there was a simple binary distinction between being ‘an alcoholic’ and not being one (eg WebMD: 'Alcohol use disorder (AUD) is a chronic illness in which you can’t stop or control your drinking even though it’s hurting your social life, your job, or your health.'

Others are much more inline with current thinking, which is that alcohol-related problems exist on a continuum, from Mild through Moderate through to Severe, or from Hazardous (or Risky) drinking through to Harmful drinking through to Dependent drinking.

You suggest that “Perhaps, for the individual health worker, there is a case for abandoning terminology that is not useful and instead focus on the number of units of alcohol consumed per week, together with a narrative description of the harms attributable to alcohol consumption in each case?” I certainly would agree with this – and indeed, in my book ‘Counselling for Alcohol Problems’ [SAGE Publications Ltd; Third edition (18 Jan. 2011)] I have an entire chapter devoted to ‘Understanding Alcohol Problems’, which looks at how it is best to describe and think about alcohol problems. However, the idea of issue of “focus(sing) on the number of units of alcohol consumed per week” runs not the problems you have raised and discussed previously – there is no consensus over what a ‘Unit’ of alcohol (or a ‘standard drink’) consists of, nor over what is an amount which might be considered ‘problematic’.

For me, the issue is whether a person’s drinking is causing harm or problems to anyone – to the person drinking, or to others (eg their family or friends), or to wider society. So it is NOT about some fixed amount of alcohol consumed, it is about the consequences of the consumption. As I write in that chapter,

“My own definition of an alcohol problem is very simple: if someone’s drinking causes problems for him or her, or for someone else, in any area of their lives, then that drinking is problematic. If someone’s drinking causes problems with his or her health, finances, the law, work, friends or relationships, then that drinking is problematic; if it causes problems for husbands, wives, children, parents, bosses, or subordinates, then that drinking is problematic.

There are many implications of such a simple definition. It means that whether or not someone has a drinking problem is not determined by fixed quantities of alcohol, or fixed timings, but instead is a matter of negotiation by the individual with him or herself, family, friends, work place, and society as a whole.

The idea of negotiation within context may be illustrated with a few examples:

* Within a marital context, it might be the case of a person who drinks one pint of beer a week but is married to a confirmed teetotaller: the one pint may cause problems, and will need to be negotiated within the marital context.

* Within an employment context, someone might drink half a bottle of wine during a business lunch, or might visit the pub at lunch-time with colleagues. In some contexts, such drinking has been negotiated as acceptable behaviour; yet the same drinking may cause severe problems within an industry which has introduced an alcohol-at-work policy which forbids drinking during the working day.

* Within the social context, fifty years ago someone’s ability to drive after drinking was determined by their ability to walk a straight line; now, someone’s ability to drive after drinking has been re-negotiated by society such that it is determined by their blood-alcohol level, and if it exceeds a certain amount (and they are detected by the police!) they are automatically deemed unfit to drive, and will have their licence revoked.

Someone has an alcohol problem if their drinking causes them or anyone else a problem.”.

I hope that this is useful.

Best wishes, Richard Velleman

Professor Richard Velleman <>

Emeritus Professor of Mental Health Research, University of Bath

Co-Director, Addictions and related Research Group, Sangath Community Health NGO, Goa, India

Trustee and Treasurer, AFINet (Addiction and the Family International Network)

HIFA profile: Richard Velleman is Emeritus Professor/ C-Director, Addictions and related Research Group. Organisation: Sangath, Goa, India/University of Bath, UK. Professional interests: Addiction; families; mental health. Email address: r.d.b.velleman AT