What should be the legal age for drinking?

Information & Evidence

Historically medical conditions with uncontrollable craving for alcohol were termed as Dipsomania and later alcoholism. Dipsomania was coined by German physician C.W. Hufeland in 1819. Alcoholism was first used by Magnus Huss in 1849 to describe the adverse effects of alcohol and what he considered to be a chronic, relapsing disease. The term “alcoholism” referred to compulsive and uncontrolled consumption of alcohol which has an adverse effect on a person such as health problems and strained personal relationships. Since this term was poorly defined, its usage was discouraged by a World Health Organization expert committee in 1979. The present day classification systems prefer to use terms like alcohol abuse and alcohol dependence instead of alcoholism. ‘Alcohol use’ refers to repeated use of alcohol despite adverse effects, while ‘alcohol dependence’ refers to repeated alcohol use despite adverse effects characterized by tolerance, withdrawal and compulsion or uncontrollable urge to drink.

Alcohol-use disorders are common in both developed and developing countries being more among men than women. Alcohol dependence may result due to genetic factors (family history of alcohol use and genes influencing metabolism of alcohol) as well as other factors such as younger age of initiating drinking, childhood trauma, lack of peer and family support. Alcohol primarily stimulates the GABAA receptor thus resulting in central nervous system depression. Repeated consumption of alcohol in large quantities makes these receptors desensitized and reduced in number leading to tolerance and physical dependence.

Persons can be screened for alcohol dependence using screening questionnaires like Alcohol Use Disorders Identification Test (AUDIT), CAGE questionnaire and Michigan Alcohol Screening Test (MAST) (add link). However, a diagnosis of alcohol dependence can be made using the criteria provided by International Classification of Diseases (ICD-10) or Diagnostic Statistical Manual of Mental Disorders (DSM-IV).

Treatment goals for most clinicians is abstinence though a few may favor teaching how to control drinking. An important factor to consider in deciding treatment options is the motivation level of the person. While low risk drinkers may benefit from simple advice, harmful or hazardous users can benefit from brief intervention (usually linked with the screening tool). Dependent users need a treatment approach combining elements of pharmacotherapy, detoxification and psychosocial interventions.



Saddock, B.J. & Saddock, V.A. Kaplan and Saddock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. New Delhi: Wolters Kluwer/Lippincott, 2006.  

Schuckit, M.A. Alcohol use disorders. Lancet, 373: 492-501, 2009.