Prevalence and nature of alcoholism in a total population

Abstract

The claim that alcohol causes somatic and mental abnormalities which often can be termed sicknesses is indisputable; that so many persons are involved that alcoholism is a mass sickness is also obvious. It is remarkable that the epidemiology of alcoholism is still but slightly known considering the enormous damage alcohol causes to the individual and to society. - Frequency figures from different studies vary widely. This is due, to a great extent, to the different definitions of alcoholism in use. - We have employed a purely medical definition and applied it to a total population, that of Lundby, a geographical area with 2 612 inhabitants, of whom 950 are men over 20 years of age (see Hagnell, 1966). More than 99% of these 950 were personally interviewed, and additional information obtained for almost all of them. 2. 0% of the men were chronic alcoholics, 3. 4% alcohol addicts and 4. 9% alcohol abusers. Two thirds of the alcoholics were unknown to the Temperance Boards. - More than half (28 out of 51) of the advanced alcoholics (alcohol addicts and chronic alcoholics) were unknown to the Temperance Boards. We have, then, a large proportion of “hidden” alcoholics. Four per cent of all men (and 10% of those in age group 20–29) were in the Temperance Boards' register but were not alcoholics in the medical sense. Various parallel phenomena, sequelae or other factors related to alcoholism, are used by the Temperance Boards as criteria indicating alcoholism. It is necessary to be cautious in accepting these criteria, since they cover a much wider group than does the strictly medical definition. - Even if cultural factors have considerable influence they can hardly explain the very great imbalance of the sexes. In this context it may be significant that neuroses and mental insufficiences are much commoner among women. Certain personality characteristics (predominance of subsolids), psychopathy and psychosomatic diseases (e. g. peptic ulcer), and occupations associated with higher morbidity (e. g. skilled industrial work) are variables which are found among both alcoholics and persons with mental insufficiency. - The epidemiology of alcoholism must be more thoroughly studied if the etiology and natural history are to be established. One possibility is to follow the population used in the present study, which, in 1947 and 1957, was described in detail in terms of personality, psychological, medical, psychiatric and social data. The prognoses of those who had previously been considered alcoholics would then be ascertained. At the same time those who had newly become alcohol sick could be compared with those who had not. In the web of causations which lie behind alcoholism such comparisons can give information about important background factors.