Problem drinking and alcohol problems. Widening the circle of covariation

This chapter reviews research pertaining to two basic premises regarding problem drinking: that a conceptual clarification is necessary, one which makes an explicit distinction between drinking behavior and alcohol-related problems or adverse consequences, and that an adequate theory of problem drinking must extend beyond the alcohol-specific theories to a broad matrix of biological, behavioral, psychological, and social variables. Both cross-sectional and longitudinal studies of drinking in nonclinical populations show that levels of alcohol consumption are only moderately related to alcohol-related adverse consequences, and that a broad array of variables mediate the extent to which normal-population drinkers will be vulnerable to alcohol problems. Factors contributing to differential vulnerability to alcohol problems include the concurrent use of other drugs, engaging in other problem behaviors, personality characteristics such as impulsivity, prior depression, and a lack of social conformity or conventionality, the lack of a protective family environment, stress, and being female. A model of problem drinking consisting of overlapping, but distinct sets of predictors for drinking behavior and alcohol-related adverse consequences is proposed.