Impacts of Alcoholism in Public Health , a Systematic Review

Paula Pessoa Pinheiro1,2,3, Dara Almeida Maurício de Alencar1,2,3, João Vitor Cândido Pimentel1,2,3, Paulo Victor Ataliba Morais1,2,3, Cícero Roberto Pinheiro Grangeiro Júnior1,2,3, Ana Lívia Alencar Coelho1,2,3, Luiza beatriz bezerra Falcão1,2,3, Cláudio Gleidiston Lima da Silva1,2, Maria do Socorro Vieira dos Santos1,2,3, Sonilde Saraiva Januário4, Edglê Pedro de Sousa Filho4, Uilna Natércia Soares Feitosa4, Emídio Antonio de Araújo Neto4, Modesto Leite Rolim Neto1,2,3,4 1 Federal University of Cariri, Divine Savior Street, 284, Center, Barbalha, Ceara, Brazil. 2 Scientific Writing Lab (LABESCI) –Federal University of Cariri (UFCA). 3 Suicidology Research group –Federal University of Ceará (UFC)/National Council for Scientific and Technological Development (CNPq). 4 Post Graduation Program in Health Sciences –Faculty of Medicine of ABC, Santo André, São Paulo, Brazil.


Introduction
Alcohol is a psychoactive substance with dependence-producing properties.It has been part of a multitude of cultures since many centuries.For this moment, around 2 billion people worldwide consume alcoholic beverages.More than 76 million people suffer from alcohol use disorders (AUD) [1].These data turn the alcohol consumption in the one ]of the most important global risk factors for the burden of disease [2,3,4,49].Because of its important prevalence in different countries and its potential harmful effects, several studies have confirmed innumerable individual and social damages, such as those that burden the public health.
There have been several efforts to estimate alcohol-attributable deaths and years of life lost due to premature mortality [5,6,7,8,49].As example of individual damages, there is the exacerbating or contributing to a multitude of health and social problems, including physical and psychological illness; interpersonal conflicts; violence and legal problems; unemployment; poverty; deleterious reproductive outcomes; disability; and premature death [9].This was ratified by Rehm et al, 2013, who found that Alcohol Use Disorders (AUD) were shown to be responsible for a sizable portion of mortality and the burden of disease in the United States, a finding similar to recent European studies with slightly different methodology [10,11,49].
In front of these expressive data that require a comprehensive prevention strategy, this study is based on the question: how far does alcohol consumption impacts the public health?To answer that, it was performed a systematic review aiming to analyze the influence of possible individual vulnerability factors -such as age, gender and socioeconomic status -and societal vulnerability factors -culture and drinking context, for example -in morbidity and mortality of the phenomenon of alcohol consumption and abuse, besides of the importance of some pharmacological or not pharmacological treatment, such as psychological assistance [12] or electroacupuncture [13].

Methods
It was performed a qualitative systematic review of articles about alcoholism and its aspects about public health.It was conducted a search in the literature through the online Scopus database, by limiting itself to articles published between 2010 to 2014.The reason to limit the search between 2010 and 2014 was because the last five years most countries were more watchful for those problems collaterally to the alcohol abuse.It was also limited to the 5 journals with more publications on the subject.The following descriptors were used, in English, for searching in Scopus: (1) "Alcoholism'' (Medical Subject Headings [MESH, in English]); (2) "Public Health'' (MESH term).
The analysis of the article followed eligibility criterion previously determined.It was adopted the following inclusion criterions: (1) Original articles with accessibility to the full text online; (2) Studies pertaining how alcoholism affects the public health; (3) Articles written in english.The exclusion criterions were: (1) Not about alcoholism and public health; (2) Case report; (3) Review; (4) Metaanalysis; (5) Note; (6) Abstract or full text not available; (7) No relevance.
Each article was read in its entirety, and the information was entered in a spreadsheet that included authors, year of publication, the study sample description, main findings, and databases.to better analyze the data, the next stage was divided into classes according to the topic addressed in each article.it is noteworthy that an article can be in more than one class, depending on the perspective of its author.The classes were: The Youth Alcohol Abuse, Socioeconomics impacts of use of alcohol, The evolution of alcohol abuse, Alcohol and other drugs, The Physiological effects

Figures and Tables
The Figure 1 illustrates the five journals that more published articles matching the descriptors "alcoholism" and "public health", since 2010.Subjects with alcohol dependence were more often daily smokers.Many associations observed in the mental dimensions of SF-36 were found to be confounded by depression and also by alcohol dependence.
[2014] [88] Lapham, GT et al Alcohol Clin Exp Res 344,994 outpatients of Veterans Health Administration with a pair of annual alcohol screens in which the initial screen was negative for alcohol misuse 5.4% of women and 6.0% of men screened positive a year later.In both women and men, the probability of converting to a positive subsequent was highest in the youngest women (11,2%) and men (17,2%).

Alcohol Clin Exp Res
The Wave 1 NESARC, conducted in 2001 to 2002, surveyed a representative sample (n = 43,093, response rate = 81.0%) of the adult (18 years of age and older) population of the United States.
In the United States in 2005, 65,000 deaths, 1,152,000 years of life lost due to premature mortality, 2,443,000 years of life lost due to disability, and 3,595,000 disability-adjusted life years lost were associated with AUD. [2014] [89]   For the most part, findings regarding Socio-Economic Status (SES) and drinking in higher income countries were as expected.However, women of higher SES in low and middle income countries appear at higher risk of engaging in RSOD.
[ Twelve-step participants were more likely to be male than nonparticipants.They had higher AOD severity at baseline, and also were more likely to use tobacco and to have been diagnosed with ADHD.The average length of stay for the index AOD treatment was more than twice as long ( Here we have additionally determined that the patterns of periadolescent body weight gain remained strongly gender-specific in a statistically significant manner for both control and ethanol-treated mice. [ Prevalence of past 12-month co-occurring alcohol use disorders (AUDabuse or dependence) and major depressive episode (MDE) was 1.2%, corresponding to about 2.4 million adults ages 18 and older.Among males with alcohol dependence,comorbid MDE was associated with a greater number of days drinking at home alone.Among females and males with alcohol abuse and dependence, comorbid MDE was associated with higher prevalence of drinking to enhance depressed mood.Comorbid MDE was also associated with lower levels of some drinking behaviors among those with alcohol abuse. [

Eur J Public Health
Participants were 1500 Swedes commissioned by SoRAD, Stockholm university, through a monthly telephone survey.This article has analysed the temporal relationship between alcohol consumption and alcoholrelated hospitalizations in Sweden during the period 2002-07.
Changes in alcohol consumption in Sweden was associated with changes in male and female alcohol-related hospitalizations also in analyses based on gender-specific consumption measures.There was no clear evidence that the population level association between alcohol and harm differed between men and women. Vol

Discussion
The Youth Alcohol Abuse Despite of the fact that adolescence is characterized by maturation and synaptic remodeling of brain regions implicated in reward and decisionmaking processes including the limbic system, the prefrontal cortex, and the hippocampus [14,15,17], the youth alcohol abuse still remains as a major public health problem that underlies the third leading lifestyle-related cause of death generally preventable among adolescents in the United States [16,46].Due to the malleable and vulnerable nature of the adolescent brain, and specifically the mesolimbic dopamine system, alcohol may cause substantial disruption of normal development, as well as neurological damage, which may then translate into long-term negative behavioral consequences such as the increased risk-taking behavior [17].In addition, alcohol consumption during adolescence is a strong risk factor for developing alcohol-related health problems later in life [18,46], once studies have shown that frequent heavy episode drinking (HED) in adolescence can predict adult heavy drinking [19,20,144].
One of these problems is showed in a recent analysis demonstrating that adolescent alcohol intake produces enduring and maladaptive risk preference in adulthood [17], with harmful consequences like negative effects on health, social and family relations, educational attainment and employment prospects [21,47].Besides of this, there are findings strongly suggesting that consuming more alcohol is associated with higher odds of engaging in criminal activity and being the victim of a predatory crime [22].As example of these injurious activities that occur in many universities campi around the US, there is those caused by other students' drinking, interruption of sleep and study, verbal harassment, being assaulted, and a general degradation of the on-campus environment [23,24,25,26,27,78].It is showed, too, that the probabilities of being a victim of predatory crime for females who are weekly or more frequent drinkers are higher than those for males, which could reflect the fact that females, especially those who drink frequently, are more likely to be victims of various crimes [22].Analyses have shown that the majority of problems may occur in relation to heavy drinking occasions, and that the number of people with heavy drinking occasions is larger among low-moderate consumers than among heavy consumers [28,29,30,144].
Another major concern about the high consumption of alcohol is the increased probability to consume alcohol and to drive later, because drugged and drunk driving together accounted for 14% of US drivers/motorcyclists involved in fatal crashes in 2008 [31,146].Thus, national data indicate that nearly one-quarter of college students have driven while under the influence of alcohol in the past 30 days [32,33,39].It is suggested that those who drive after drinking report greater demand for alcohol independent of drinking level.Theoretical and laboratory research on behavioral economics suggests that elevated/inelastic demand reflects a stronger and more persistent motivation to consume alcohol [34,35,36,37].In line with the behavioral economic framework, this results suggest that elevated demand is associated with specific decisions to drive after drinking [37].Nevertheless, recent evidence indicates that there has been a decline in youth involvement in alcohol-related traffic fatalities [38,39], largely attributable to declines in youthful drinking, minimum legal drinking ages, zero tolerance laws, and programs that seek to motivate youth to refrain from drinking and driving [39].
Still, the alcohol consume is associated with other substances, such as marijuana and energy drinks (EDs).Both using alcohol to increase the effects of another drug and because the respondent reported being hooked showed significantly stronger relationship with frequency use than all other alcohol use reasons [40].In the case of EDs, the increase in its consume has raised concerns about their impact on health of consumers owing to the risk of caffeine intoxication.Research indicates that the excessive consumption of EDs may have detrimental health effects in susceptible subjects [41,42,43,44,45,46].Another conclusion is that alcohol-mixed energy drinks (AmED) consumption appears to be associated, to some extent, with the use of illicit drugs, and seems to indicate that AmED, as well as ED consumption, is another expression of a highrisk behavior lifestyle [46].For simultaneous alcohol and marijuana (SAM) use, adolescents who engage in frequent alcohol use are most likely to engage in frequent SAM use [40].It was also found that the risk for any SAM use exhibit both "expected" risk characteristics as well as characteristics indicative of higher socioeconomic standing and socially active lifestyles (higher grades, higher evenings out).Importantly, the results from these studies also indicate that SAM use is not limited to social contexts [40].
Related to that, there is substantial evidence that addictive health behaviors, such as smoking, opiate use and alcohol dependency, are associated with time perspective [47] and, as example of this fact, in a sample of students studying at a university in Northern England, those students who had greater future time perspective, and considered the future outcomes of their actions more, were less likely to have an AUDIT (Alcohol Use Disorder Identification Test) score indicative of hazardous alcohol consumption [47].There are, still, findings suggesting that the effect of EtOH exposure on decision making and risk preference is limited to the adolescent period.An alternative explanation is that adolescent EtOH intake accelerates a natural progression to greater risk-taking behavior in adulthood [17].

Socioeconomics impacts of use of alcohol
Alcoholic beverages have been used since the beginning of recorded history [48].Alcohol consumption has negative effects on society because of alcohol-related mortality and morbidity [48], decreasing users' health and related people's safety and comfort.For example, the numbers of deaths associated with AUD were considerable: we estimated that approximately 53, 000 male deaths and 12, 000 female deaths in the United States in 2005 were associated with AUD [49].In France, out of 535000 deaths in 2009, 49000 were attributable to alcohol: 36500 among men and 12500 among women, which represent 13 and 5%, respectively, of total deaths [50].Studies conclude that persons of higher socioeconomic status (SES) have lower mortality and morbidity as well as more favorable health behaviors than those of lower status [51,143].The estimation of alcohol-attributable mortality provides a useful indicator for developing national public health strategies [50].It has been argued that the amount of alcohol consumed in a country is related to its economic development [52,143].
The social patterning of alcohol consumption is not universal and varies by region, gender and by choice of alcohol measure [53].Numerous studies have also show that many different forms of alcoholrelated harm tend to rise as per capita consumption increase [54,55,56,57,142].Prevalence of AUD in the U.S. population by sex and age, divided into the categories of AD and alcohol abuse based on NESARC data, showed consistent and expected patterns.Men in all age categories had a higher prevalence than women, prevalence in both sexes decreased with age, and AD was more prevalent than alcohol abuse, except in the youngest age category [49].Important sex differences are apparent in alcohol-related traffic risk behaviors.Although the gender gap with AUD in the general population is closing [58,59,39] men appear more likely to drive under the influence of alcohol and drive after drinking any alcohol, while have been mixed findings on riding with an intoxicated driver (RWID) [60,61,62,63,39].
Epidemiological studies have pointed out that moderate drinking is associated with reduce risk of mortality from heart disease and stroke [64,65,1].Thus, higher alcohol prices or taxes could limit alcohol affordability and the potential beneficial effects of alcohol consumption related to heart disease and stroke [1].Even at the lowest dose of 13g per day, where alcohol is associated with a reduced risk of cholelithiasis, ischemic heart disease, ischemic stroke and type 2 diabetes, the overall effect is detrimental [50].In the other hand, education level is negatively correlated with excessive alcohol consumption.In addition, a positive correlation between alcohol consumption and being a smoker was demonstrated [48].Also, alcohol was involved more frequently in violent and public disorder crimes than in property crimes [22].
Furthermore, alcohol consumption is a major cause of premature death [50].A social stress model considers prenatal alcohol use as the result of individual stress mitigated by social networks, social competencies, and psychosocial resources [66,67,82]].Elderly Europeans use to drink less if compared with younger adults.However, alcoholrelated deaths among elderly adults have increased markedly over the past 10 years [68,70].The recommended 'safe' drinking limits, namely, 21 units for men and 14 units for women per week and no more than two drinks per day [69,70], incorporated in most European countries, are not suitable for elderly people because of age-related changes in metabolism, advancing ill health and increase sensitivity to the effects of alcohol [70].And, even if it is slow to transition from a first dose episode to an episode of AUD, studies have revealed that symptoms of these disorders may occur early in an individual's drinking career [71].Beside this simultaneous alcohol and marijuana (SAM) use has been significantly and positively associated with social consequences, alcohol dependence and depression, binge drinking, and other health problems [72,73,74,75,40].
Adolescent alcohol and other drug (AOD) use puts a heavy economic burden on the health care system [76].Moreover, it is known that adolescents entering AOD treatment were more than twice as likely to visit the emergency room (ER), three times as likely to have a primary care visit, and four times as likely to be hospitalized in the year prior to treatment than non-AOD using controls [77,76].Adolescents who engage in frequent alcohol use are most likely to engage in frequent simultaneous alcohol and marijuana use [40].In addition, the costs of obesity, tobacco, and alcohol and found a similar results, with the exception that the costs of obesity were far higher than either tobacco and alcohol, because of a much higher prevalence of obesity in the United States [48].
Specifically, as alcohol use progresses, clinical features of AUD may manifest, which in turn promotes sustained drinking and the transition to more frequent and persistent alcohol use [71].High-risk drinking among college students is associated with a variety of harmful consequences [78].These included unintentional injury resulting from drinking and driving and other causes, physical and sexual assault, health problems, unsafe and unplanned sexual activity, sexual harassment, impaired sleep and study time, and interpersonal problems [79,80,78].
Greater numbers of alcohol outlets in a community may be a sign of loosened normative constraints against violence, promote problem drinking among at-risk couples, and provide environments where groups of persons at risk for intimate partner violence (IPV) may form and mutually reinforce IPV-related attitudes, norms, and problem behaviours [81,145].Intimate partner violence, a serious indicator of unhappy and unsatisfactory partner relationships, was significantly correlated with prenatal drinking [82].Although women are as likely as men to engage in physically aggressive behavior toward their partner, they are more likely than men to be injured as a result of IPV [83,84,85,145].Pregnant women who drink are at risk for fetal alcohol spectrum disorders (FASDs) and are targets in the prenatal care settings for selective prevention [66,82].
In fact, alcohol problems continue to present a major challenge to medicine, social peace, and public health, in part because population-based public health approaches have been neglected in favor of approaches centered on the individual which tend to be more palliative than preventative [86,48].Obtaining a clear understanding of the type of clinical features that begin to emerge soon after drinking commences, therefore, would be useful for designing strategies to help control drinking and prevent the escalation of AUD [87,71].Primary prevention programs for prenatal alcohol use could consider combined interventions to strengthen families and educate and empower women to respect and manage their lives [82].The longer an individual has the opportunity to use alcohol, the more likely it is that they will able to progress from experiencing clinical features of AUD to developing a full-blown disorder.This information may be useful for professionals who are responsible for planning early intervention strategies to reduce the escalation of alcohol-related problems among early-career drinkers [71].

Personal causes and consequences of alcohol abuse
Centers for Disease Control and Prevention (CDC) indicate that excessive drinking is responsible for approximately 79, 000 deaths annually in the United States and that binge drinking accounts for more than half of these deaths [9].New-onset alcohol users (NOAUs) -drinkers who started to drink alcohol within 24 months -frequently experienced problems relating to self-reported tolerance, spending a great deal of time recovering from the effects of alcohol and unsuccessful attempts at cutting down on drinking [71].To better understand this event, Lapham and colleagues worked with AUDIT-C (Alcohol Use Disorders Identification Test -Consumption) to find that the probability of converting to a positive screen varied widely based on age, gender, and initial negative screen score (range 2.1 to 38.9%) [88].In particular, older patients and those with the lowest scores on their initial negative screen were least likely to convert to a positive subsequent screen on AUDIT-C [88], despite the fact that episodic heavy drinking is frequent among middle-aged and older adults [89].Besides, it was demonstrated that those with an AUDIT score of 20 or more are not only more likely to have functional impairment but also that psychiatric morbidities are more common in this group [90].Unemployment and divorce are stressful life events and alcohol is used by some individuals to reduce tension while undergoing them, and the accumulation (number of events or longer duration of exposure) may increase the risk of excessive drinking [53], indicating that these two are important events that leads to a high alcohol consume framework.A third important dependence reason for alcohol abuse was verified in many European countries, where excessive drinking in men varies by level of education and income, with the least educated and those earning lower income being at higher risk [53].A similar outcome were found in USA, where, compared with moderate drinkers who were episodic heavy drinkers, regular moderate drinkers were significantly higher on SES (Socioeconomic Status) [89].
There is a plausible reciprocal process that connects drinking frequency and alcohol use disorders [71].The episodes of heavy drinking concentrate alcohol's toxicity and are linked to mortality through diverse disease and behavioral pathways [91,89].Those men who typically consumed 6 or more bottles of beer per drinking occasion had substantially increased total mortality compared with men who typically consumed < 3 bottles of beer per drinking occasion [89] and moderate drinkers who were episodic heavy drinkers in comparison with regular moderate drinkers showed 3 times more likely to be problem drinkers at baseline and more than 2 times increase in the odds of total mortality during the 20-year period [89].Advances in alcohol research have shown that patterns and average quantity of alcohol use may influence the outcomes of alcoholrelated diseases and conditions [9].
Once alcohol is related with the exacerbating or contributing to a multitude of health and social problems, including physical and psychological illness; interpersonal conflicts; violence and legal problems; unemployment; poverty; deleterious reproductive outcomes; disability; and premature death [9], the longer an individual has the opportunity to use alcohol, the more likely it is that they will progress from experiencing clinical features of AUD to developing a full-blown disorder [71].

Alcohol and other drugs
One of the main problems related to alcohol consumption is its use with other drugs, such as marijuana or tobacco.Available studies indicate the most common form of simultaneous drug use involves alcohol and marijuana [92,93,73,74,75,40], whilst tobacco smoking continues, worldwide, to be the most harmful health behavior associated with premature disease and death [94,95,89].Another substance highly mixed with alcohol are energy drinks, which has raised concerns about their impact on health of consumers owing to the risk of caffeine intoxication.Research indicates that the excessive consumption of EDs may have detrimental health effects in susceptible subjects [41,42,43,44,45,46].
Epidemiological studies have shown the high frequency of the co-occurrence of alcohol use and smoking in the general population [96,97,98], however, Coste et al (2014), in a study that related smoking and health related quality of life (HRQoL), haven't found any significant interaction of depression and alcohol dependence with smoking status on HRQoL scores [98].
Terry-McElrath et al (2013) found that while both alcohol and marijuana use frequency positively associated with the likelihood of frequent SAM (simultaneous alcohol and marijuana) use, alcohol use frequency had a significantly stronger association than marijuana use frequency [40].Withal, another study showed that Canadian college students who reported drinking AmEDs (alcohol-mixed energy drinks), were significantly inclined to cigarette smoking, heavy drinking, and marijuana use [99,46], suggesting that AmED, as well as ED (energy drinks) consumption, is another expression of a high-risk behavior lifestyle [46], such as marijuana and alcohol use.
The main concern about the AmEDs use is that most adolescents demonstrated they are not aware about the caffeine content of EDs, as Flotta et al (2014) found out that only 13% believe EDs is similar to drinking coffee -once research indicates that the excessive consumption of EDs may have detrimental health effects in susceptible subjects [41,42,43,44,45,46].Also, studies showed that mEDs can reduce the subjective perception of alcohol intoxication but not significantly reduced alcohol-related objective motor coordination and visual reaction time [100,101,46], which can relate to the fact that adolescents drinking EDs have a statistically significant involvement in substance use and behaviors that contribute to unintentional injuries [46].
One of the reasons found to the associated use of alcohol and other drug, especially marijuana, was alcohol use to increase the effects of another drug and because the respondent reported being hooked.Other aspects are that students with higher truancy records and higher substance use (especially alcohol use) have the strongest risk for frequent SAM use [40].

The Physiological effects of Alcohol Abuse
There are numerous researches studying individuals throughout the life span that have shown hippocampal anomalies associated with alcohol consumption [102].Results from a recent longitudinal brain imaging study of male P rats (from P88 to 578) have revealed that free-choice ethanol consumption attenuated the growth and expansion of brain structures, including the corpus callosum and hippocampus [103].In the case of the hippocampus, these changes may relate to the inhibition of neurogenesis established to take place in this structure [102].Anatomical MRI studies in persons with more severe forms of alcoholism use disorders (AUD), such as alcohol dependence, commonly demonstrate decreased striatal, amygdala and hippocampal volumes [104,105,106,102], an effect which reverses with prolonged abstinence.
Besides of these effects in hippocampus, one study has addressed alterations in young-adult binge drinkers (BD) grey matter volume, focusing on cortical thickness.Female binge drinkers (BD) had thicker left frontal cortices whereas male binge drinkers (BD) had thinner left frontal cortices compared to gender matched controls [107,102].The existing literature also indicates that females often consume more ethanol and/or respond differently to ethanol than their male counterparts [103], although only small differences in mass measurements of the brain, the cerebellum, and the corpus callosum were seen either as a result of age (from P70 to 225), gender, or ethanol treatment.
Focusing on other important regions of the nervous system, previous studies have shown that chronic alcohol exposures induce the accumulation of DFosB within the subregions of the striatum and the prefrontal cortex (PFC), which involves activation of endogenous opioid systems [13].Human imaging studies have also confirmed that alcohol induces changes in the ventral striatum.Oral administration of alcohol in humans results in robust ventral striatal blood oxygen level dependent activity, and positron emission tomography imaging shows that alcohol consumption causes endogenous dopamine and opioid release in the nucleus accumbens [102].It was shown that chronic ethanol self-administration induced pronounced accumulation of DFosB in the NAc (Nucleus Accumbens) core and the DLS (dorsolateral stratum), but not in the NAc shell and the DMS (dorsomedial stratum).There is, still, significant decrease in connectivity between the frontal-temporal-basal ganglia and cerebellar components during the alcohol condition [108].Such connections are consistent with our FNC findings that indicate disrupted connectivity between frontal-temporalbasal ganglia and cerebellum during alcohol intoxication [108].

Treatment of Alcoholism
Alcohol treatment usually is neglected and this fact can affect the society directly.Awhile some individuals wish for the right treatment, other ones have not money to afford it or just do not want this kind of intervention.A consistent finding from many general population epidemiological surveys in the US and other countries is that a large majority of individuals with substance use disorders (SUD) do not receive treatment for these problems [109,110,111,112,113,139].For many countries the importance given to this drug is not as big as expected, but the treatment must be a major factor to reduce the number of alcohol abusers.
There are some treatment that are not pharmacological.They are interesting to reduce the alcohol addiction.Attendance in Alcoholics Anonymous (AA) is associated with reduced drinking and improved psychosocial functioning in individuals with alcohol use disorders (AUDs) [114,115,12].
Besides, Marlon P. Mundt et al study presented a 12-step program efficacy as a psychological support.In this research, adolescents may be replacing their previous AOD-using networks [116,117,118,79].Change in social networks may positively influence adolescents' health behaviors, leading them to seek health care more quickly than they might otherwise [119,120,121,76].There is also substantial evidence that brief interventions (BIs) can have a significant impact on problem drinking [122,140,86,48,123,140].These BIs are control initiatives such as taxation, limiting access, and drinking and driving laws.Confirming this fact, there is extensive evidence that BIs can reduce drinking for primary care patients who screen positive [124,125,126,88].
Moreover, there are innovative researches which seek to be helpful to alcohol addiction treatment.Thus, acupuncture has been regarded widely as an effective mean for some medical conditions, including nausea, pain [127,13] and drug abuse [128,13].Compared with the currently available pharmacological interventions, a clear advantage of acupuncture therapy is that it has the potential to help drug abusers stay away from drugs without major adverse side effects [13].Previous clinical and preclinical studies have shown that acupuncture or acupuncture combined with electrical stimulation (electroacupuncture, EA) is an effective treatment for alcohol withdrawal syndrome and alcohol abuse [129,130,131,132,133,134,13].
Another perspective in the assistance of alcohol damage reduction is the use of vitamin E. The study of Long, L. et al have shown that vitamin E effectively prevents ethanol-induced neural death and ROS formation and blocks ethanol-induced morphological changes and cognitive damages [135].
Therefore, it is realized that actually the alcohol treatment is not only associated with pharmacological treatment, but also to psychological assistance, electroacupuncture, BIs and it is still possible to prevent neuronal damages with vitamin E.

Alcohol and psychological disorders
There is a high association between heavy-drinking (HD) and psychological disorders or HD and the exacerbation of these conditions.Some studies using clinical samples showed that the co-occurrence of alcoholism and depression (C-ALDP) is associated with worse alcohol-related outcomes, and this relationship appears to be stronger in males than females [136,141].However, the findings of Beijer, U. and Andréasson, S. with homeless population showed that younger homeless women (18-36-years-old at the baseline) had a higher risk for alcohol disorders than homeless men [137].
The research of Schuckit et al., 1997 about alcohol use disorders (AUD) had conclusions that among those with an AUD, comorbid depression is associated with an earlier onset of alcohol dependence, higher rates of lifetime drug dependence [138,141].Besides, in the same study already realized by Beijer, U. and Andréasson, S. the prevalence of schizophrenia in combination with alcohol and drug use disorders was nearly three times higher among the homeless women than among homeless men [137].
Thus, a contrast is attested in these findings because there is not a agreement about which gender is most affected for alcohol abuse correlated with results in psychological disorders.

Conclusion
It is possible to realize the problems that alcohol causes in society, like bringing losses with the excess public spending on treatment and prevention of this drug.Besides, the studies made clear that the human being as a collective is impaired when this substance is misused.The data that showing close relationship between early youth death attributed to alcohol are worrying.In this sense, the alcohol in the youth allows higher risk behavior between teens, how risky sexual conduct and involving the criminal activities.These behaviors occur more frequently among adolescents, who are still developing judgment and decision-making skills and may be limited in their ability to accurately assess risks [22].
The findings listed in this review showed that the prevalence of the alcohol use in the population can be decreased with increase in prices of alcoholic beverages, including them high taxes aiming at to decrease accessibility to this drug.Also, the number of binge drinkers decreases by increasing the general education of a country, because as higher the truancy, bigger the number of drinkers.Education campaigns in schools and workplace, media campaigns, and efforts to enhance recognition and motivation for treatment-seeking in primary care and mental health care settings can potentially improve the perception of need for treatment among individuals with substance use disorders [139].
Therefore, if we reduce the use of this substance, the consume of others drugs, risky behaviors and psychological illness will decrease too.Unfortunately, alcohol problems continue to present a major challenge to medicine.The health sciences should promote better adherence of states and universities to campaign against alcohol.We need more studies and more incentives to reduce the existence of the negligence.
Where Doctors exchange clinical experiences, review their cases and share clinical knowledge.You can also access lots of medical publications for free.Join Now! http://medicalia.org/

Comment on this article:
International Archives of Medicine is an open access journal publishing articles encompassing all aspects of medical science and clinical practice.IAM is considered a megajournal with independent sections on all areas of medicine.IAM is a really international journal with authors and board members from all around the world.The journal is widely indexed and classified Q1 in category Medicine.

Figure 1 :
Figure 1: The five magazines used and their importance in the last 16 years.

Table 1 .
Each included article and the main findings of them.

Figure 2 :
Figure 2: Flowchart to get in the final included articles for this present systematic review.
19) analytic sample comprised 1194 individuals (47.7% male, 72.8% white) who participated in at least one assessment in Years 2 through 4, and were ages 19-22 at the time of those assessments.Year 1 data were not used due to overlap with high school experiences.Most (80.3%) were still enrolled at the same university by Year 4.One in six (17% wt ) 19-year-olds with access to a car drove drugged in the past year; prevalence remained stable through age 22. Drugged driving was more prevalent among males ( p < .001)andwhites( p < .01).Riding with a drugged driver varied by race and sex (overall prevalence 28% wt at age19), was stable from age 19 to 21, and decreased by age 22 ( p < .05).Annually, half of drugged drivers also drove drunk (ranges between 47% and 60%).Both drugged and drunk driving were independently associated with increased risk for alcohol dependence, holding constant age, sex, and race.
12,71% of the Wave 1 sample).Wave 3 was collected in 2001 and 2002 and included15,190respondents (all original Wave 1 respondents who could be contacted and re-interviewed) between 18 and 26 years of age.The fourth in-home interview was conducted in 2007 and 2008.Our findings strongly suggest that, ceteris paribus, consuming more alcohol is associated with higher odds of engaging in criminal activity and being the victim of a predatory crime, all of which result in staggering costs to society[2011]12Blonigen, DM et al.Addiction 628 individuals (47% women) with AUDs who had an initial contact with the alcohol intervention system recruited based on no previous history of substance abuse treatment.Individuals were assessed at baseline, and 1, 8 and 16 years later.Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping and greater social support and self-efficacy at year 1, and better coping and greater social support at year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all year 1 outcomes and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger).Decreased impulsivity appears to mediate reductions in alcohol-related problems over 8 years in people attending Alcoholics Anonymous.The civilian noninstitutionalized population participating of National Epidemiologic Survey, 18 years of age and older, living in the United States and the District of Columbia.For Wave 1 (W1) of the NESARC, face-to-face interviews were conducted with 43,093 participants .The final sample was 52.1% female; with respect to age, 21.8% of the participants were 18-20 years old, 30.9% were 30-44 years old, 31.1% were 45-64 years old, and 16.2% were 65 years or older; with respect to race/ethnicity, 70.9% of the participants were White, 11.1% were Black,11.6%were Hispanic, 4.4% were Asianor Pacific Islander; and 2.1% were Native American.

Table 2 .
Significant information about the performance of each research included, like the type of study and its duration.Contains Data From A Study, Conducted From 2001 To 2006, Directed To All 18 Schools And 79 Classes In 6 Central Districts (Out Of 18) In Stockholm, Sweden.The Study Population Included Seventh Grade Students (N= 1923) In 2001 (Age 13 Years).In 2001, 84% (N= 1610)Participated.Study B, From 2008, Includes Data From Two Surveys, Each Comprising Over 3000 Pupils, Of Nationally Representative, And Randomly Selected Samples Of School Classes From The Whole Of Sweden Of Adolescents Aged 15 Years And 17 Years.At The Start Of The Experiments, Taconic Farm, Ny) Were Individually Housed In Ventilated Cages, In A Climate-Controlled Room (20-22Uc), Kept On A 12-H Light/Dark Cycle (Lights Off At 6 P.M.).The Animals Were First Acclimatized To The Homecage Environment For One Week, And Were Trained To Voluntarily Drink Ethanol Under The Intermittent Access Two-Bottle Choice Drinking Procedure.Through 4, And Were Ages 19-22 At The Time Of Those Assessments.Year 1 Data Were Not Used Due To Overlap With High School Experiences.Most (80.3%)Were Still Enrolled At The Same University By Year 4.