A Note on Terminology
These Guidelines do not use any specific terminology to define the levels of drinking in relation to the Australian Guidelines to Reduce Health Risks from Drinking Alcohol (NHMRC 2020). Definitions of alcohol-related harm and risk levels, and some traditional terms describing levels and patterns of drinking, are also included in the appendix (and in Chapter 4).Where necessary, we indicate that the levels are either within or in excess of the current Guidelines. Alcohol consumption is described in terms of Australian standard drinks each containing 10g alcohol (see Appendix).
Similarly, we often use ‘unhealthy alcohol use’ (an umbrella that includes hazardous or risky alcohol use, problems due to alcohol, and alcohol dependence). Specific diagnostic terms are problematic; there are two major approaches to diagnosis (International Classification of Diseases [ICD] and Diagnostic and Statistical Classification [DSM]), that offer both areas of agreement and of difference. There are significant limitations in both, such as the absence of assessment of consumption level which is a both a predictor of harm and goal of treatment (Rehm, 2019).2 Where reference is made in these Guidelines to a specific body of research, then the correct diagnostic term for that piece of research is used. Elsewhere, we prefer alcohol dependence as this term is recognised within ICD-10 which forms the basis for Australian health service coding and consequently most Australian health service data. In practice, few clinicians use these terms formally by checking diagnostic criteria and counting that each patient meets the diagnostic requirements.
We have avoided stigmatising labels wherever possible, but this is problematic. An alcohol problem, a diagnosis of this disorder, and the terms used to describe the disorder are all stigmatised entities. The term ‘unhealthy alcohol use’ is over inclusive for most purposes of these treatment guidelines. We avoid using the term alcoholic, where possible, and prefer terms such as alcohol-related liver disease.
We use the term patient rather than client or consumer to refer to the person seeking treatment for a drinking problem. Some evidence shows that users of treatment services themselves prefer this term and we preferred consistency and simplicity. We acknowledge this issue is problematic and that many health professionals prefer not to use this term.