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Alcohol misuse
  1. W JOAN ROBSON, Consultant in Paediatric A&E Medicine (now retired)
  1. Royal Liverpool Children's Hospital, Alder Hey
  2. Eaton Road, Liverpool L12 2AP, UK

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Every society has a socially acceptable drug. In Europe this is alcohol.1 In 1994–96 a Health Survey for England2 found that 29.2% of the adult male population and 14.5% of the adult female population drank alcohol over the recommended limits. For many this pattern will have started in adolescence, which is a time for experimentation with high risk behaviours. From the age of 5 years children in England and Wales can legally drink alcohol. The misuse of alcohol in children must be considered in this context.


The definition of the age range ofchildren varies. The Children Act of 1989 relates to children and young persons up to the age of 18 years. This is the age after which alcohol may be purchased in all circumstances in the UK, therefore the age limit for children referred to in this annotation is 18 years.

The Health Advisory Service review of services for young people in Britain3 acknowledged the difficult distinction between use and misuse of drugs, including alcohol. The authors suggesteddrug use referred to experimentation.Misuse was defined as use that is “harmful”, in line with the World Health Organisation definition4: dependent use or use of substances that is part of a wider spectrum of problematic behaviour. In the USA and in some other countries the term use has been superseded by abuse, reflecting the ideological view that any use constitutes abuse. Harrison et al argue that although this may reflect public disapproval of the use of alcohol and other drugs, it blurs the distinctions necessary for clinicians and researchers.5 DSM-IV6 is used for operational definitions and severity criteria for diagnoses of alcohol related problems in adults; however, concern has been expressed about its clinical validity in children.7

A unit of alcohol …

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