What defines an alcoholic?
Diagnosing alcohol use disorder is not as straight forward as looking at how much a person drink. In American Physician, Hebert et al. (2016) describes alcohol use disorder as a “problematic pattern of alcohol use leading to clinically significant impairment or distress”, before listing 11 possible symptoms (see Criteria for the Diagnosis of Alcohol Use Disorder). Out of the list of criteria, consisting of statements covering alcohol craving, tolerance and more, only two to three of the following eleven symptoms needs to be met in the last 12 months in order to set a diagnosis. Still, with this seemingly clear diagnosis process, a lot of alcoholics go untreated. The stigma of the disease can contribute to the fact that a diagnosis and treatment often is delayed by an average of 18 years, according to Gullo et al. (2017).
Another delaying factor of the diagnosis is the link between alcoholism and mental health issues.
Heavy drinking associated with alcoholism can coexist with, contribute to, or result from several different psychiatric syndromes. As a result, alcoholism can complicate or mimic practically any psychiatric syndrome seen in the mental health setting, at times making it difficult to accurately diagnose the nature of the psychiatric complaints. (Shivani et al., 2002)
The fact that we don’t always know what comes first, the alcohol problems or the mental illness also makes it harder create a suitable treatment plan. It is therefore imperative to get to the core of the problem to create the best treatment plan on an individual level in order to prevent relapse.
The strong influence film has, especially on the younger part of society, is also something that can be used as an advantage. When looking to the research done on cigarettes and the influence smoking in films has had on children and teens throughout the years, one can draw parallels. Research from Shmueli et al. (2010) found “a direct link between viewing smoking scenes and immediate subsequent smoking behavior”, which is similar to the research presented on alcohol use in film. Charlesworth and Glantz in 2006 created a study looking at how to reduce the impact smoking in film had on adolescence and they found that “Viewing antismoke advertisements before viewing movie smoking seems to blunt the stimulating effects of movie smoking on adolescent smoking”. Creating a warning before showing a film positively depicting alcohol is something to look further into when looking for a solution to alcohol in film.
How do films relate to alcohol misuse?
The film industry has a big responsibility when it comes to the impact they have on children and young adults. Films portraying alcohol as a prerequisite to having fun together with friends or the cure to heartache may be a lot less innocent than it appears on the screen. A study created by Hanewinkel et al. (2007) looked at the exposure to alcohol in American films and how that affected German adolescents.
Movie alcohol exposure was directly associated with alcohol use WPK (without parental knowledge) and binge drinking, after controlling for multiple covariates including sociodemographics, personality characteristics and social influences.
This was one of several related studies created on European adolescents with similar results. There has also been a study (Koordeman et al., 2011) looking at the direct effects of alcohol and how, especially men, tend to imitate the actors on the screen by taking a sip of alcohol at the same time as the actor in the scene. All these correlations are important to look further into, especially for the people within the film industry.
Have you ever noticed how often people drink alcohol in films? And has that ever tempted you to have a beer, a glass of wine or maybe a cocktail? Research from Dal Cin et al. (2008) revealed that 83 % of the top 100 U.S. box office films each year from 1998-2002 depicted some form of alcohol use, and there is no reason to believe this trend is declining. A more recent study (Muldoon, 2020) shows that from 1996 to 2017 there was a 96 % increase in branded alcohol appearing in the top 100 films of the year. How does this influence us when watching these films?
Alcoholism or alcohol use disorder, which is the medical diagnosis, is a lot more common than it appears in society, also among adolescences and young adults. Around 3 out of every 20 people suffer from alcohol misuse (Stetka, 2018) and alcohol is the second most used psychoactive substance, after caffeine. The fact that alcoholism is a brain disease is important knowledge when looking for the best treatment, and its link to mental health is an important topic to look further into. “Around 1 in 4 individuals with SMI (Severe mental illness) also have an SUD (Substance use disorder).” (NIDA, 2020). This clear link between alcohol use disorder and other mental illnesses may prove the susceptibility people with mental illness have to turn to alcohol in order to temporarily escape their disease. Are films taking part in promoting alcohol as a cure? And how does frequent use of alcohol in films affect young adults?
Conclusion
After looking at the dangers of exposure of alcohol among children and young adults it is clear that there is the need for a change when it comes to the positive exposure of alcohol in films. Product placement for alcoholic beverages in films have increased rapidly in American film productions over the years (American Academy of Pediatrics, 2017) and the problem the exposure creates might therefore be increasing as well. By bringing this issue to light one can start to look at preventative measures as well as looking for change in the film industry itself by making the production companies aware of the impact they have, especially on adolescence. Also, bringing up the negative effects of alcohol in films might be a way to fight the stigma surrounding the disease, as well as painting a more nuanced picture of the effects of alcohol.
Criteria for the Diagnosis of
Alcohol Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or
distress, as manifested by at least two of the following, occurring within a 12-month period:
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol,
use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of he same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol.
b. Alcohol (or a closely related substance, such as a benzodiazepine)
is taken to relieve or avoid withdrawal symptoms.
Diagnostic and Statistical Manual of Mental Disorders.
5th ed. Washington, DC: American Psychiatric Association; 2013:490–491.
Who is exposed to alcoholism?
There are countless studies on who is more likely to get addicted to alcohol. As previously mentioned, mental health is linked to alcohol use disorder, which might be because:
Ethanol acts to depress brain function, very much in the style of an anesthetic. Ethanol at low blood concentrations releases behaviours that are otherwise inhibited and usually produces feelings of relaxation and good mood which may facilitate socializing. (Banerjee, 2014)
Here Banerjee explains the positive effect alcohol can have on the user and to someone suffering from a mental illness relaxation, mood boosters and a way to escape reality becomes a tempting alternative. Self-medication is a known problem among people struggling with mental health issues and alcohol is one of the most common methods used to escape unwanted emotions.
Heritability is also something that has been studied and linked to alcoholism for a long time. Verhulst et al. (2014) created a study on twins and adoption cases looking at the genetic and environmental risk factors for alcohol use disorder. They found that alcohol use disorder is approximately 50 % heritable, while the link to environmental factors were more difficult to determine precisely. In research from Meque et al. (2019) they examined the environmental influence more closely:
In earlier years, maternal drinking predicted early adult AUD while parental monitoring and school engagement were protective. Both peer and parental influences waned in adulthood.
Here they found that among adolescence being surrounded by alcohol and peer pressure the drinking habits could be influenced, while these impulses become less influential as they grow older. This study then proves clear link between the environment creating a glorified image of alcohol and alcohol use disorder in young adults. It is therefore imperative to actively protect the youth from a glorified image of alcohol in order to protect them from addiction.
