Ⅰ. Introduction

Alcohol dependence refers to a complex genetic predisposition that has become one of the most important global diagnostic health issues in both the young and old, which has been associated with deleterious and unequivocal health consequences including heart disease, cancer, accidents, suicide, notably shorter life spans, hepatitis, cirrhosis, pancreatitis, gastritis, ulcers, fractures and peripheral neuropathy (Dawson, 2000, p.72; Hahn, Woolf-King, & Muyindike, 2011, p.172; Mayfield, Harris, & Schuckit, 2008, p.275). The clinical diagnoses of alcohol dependence are identified warning signs, such as chemical tolerance, physical withdrawal, impaired control, and unsuccessful attempts to reduce drinking behavior (Hingson & Zha, 2009, p.1478). The International Classification of Diseases and Health Problems, tenth revision (ICD-10) also describes this dependence as a “multitude of behavioral, cognitive, and physiological manifestations; a tenacious and progressive pattern to insensitivity, excessive drinking despite harmful consequences and/or higher priorities given to alcohol use than other activities and obligations” (Esser et al., 2014, p.4; WHO, 2011). Aggregate studies have considered alcohol dependence a serious public health concern that contributes to 1.8 million deaths annually around the globe and a major cause of comorbidity; its biggest contributor being alcohol-drinking patterns (Agrawal et al, 2009, p.2047; Swahn, Ali, Palmier, Sikazwe, & Mayeya, 2011, p.1; Swahn, Palmier, & Kasirye, 2013, p.1).

A drinking volume defined as excessive consumption is associated with morbidity and mortality-related alcohol dependence (Dawson, 2000, p.72; WHO, 2010) and myriad other health and social complications including an onset of HIV infections, Sexually Transmitted Diseases (STDs) and unintended pregnancies (Dawson, 2011, p.144; Naimi, Lipscomb, Brewer, & Gilbert, 2003, p.1136; Schneider, Neuman, Chersich, & Parry, 2012, p.1; Shield, Parry, & Rehm, 2013, p.155; Testino, 2011, p.314; Testino & Borro, 2010, p.322). Worldwide, harmful drinking, which leads to alcohol dependence, has been linked to more than 60 non-communicable diseases (NCDs) and injuries, and claiming 2.5 million deaths annually (WHO, 2011).

Numerous public health scientific journals and statistical materials indicate that high-risk drinking, in all probability, has reached epidemic proportions in South Korea and China, though no research evidence were shown so far to relate its formal relationship with alcohol dependence. The WHO (2011) describes the harmful use of alcohol as “a physical or mental addiction that may lead to alcohol dependence – also known as alcoholism or alcohol dependence syndrome.” Alcohol dependence is classified within the Alcohol Use Disorder (AUD) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and carried over to the DSM-V (WHO, 2014). In 2013, alcohol abuse and alcohol dependence were defined as a single, but distinctly addressed disorder (American Psychiatric Association, 2013; Tang et al., 2013, p.270).

A main concern from this rests largely on the burden of alcohol consumption in South Korea and China. Despite the knowledge of global alcohol consumption irregularities, research to date is largely limited to mortality and alcohol-related chronic illnesses (Han et al., 2015, p.316; Ryu, Crespi, & Maxwell, 2013, p.183). Some researchers show higher peculiar apprehension levels of alcohol dependence dynamics in South Korea compared to other countries (Kang, Kim, Cho, & Park, 2014, p.1; Min, et al., 2008, p.1). Although elevated health-related results of alcohol dependence prevail in both South Korea and China, this has not been made a priority. The prevalence of alcohol dependence as a health problem precursor is underrated (Min et al., 2008,p.1), and there seems to be no estimate on the prevalence of alcohol dependence for ages 15 and above using the RAPS4, a screening instrument that Cherpitel (2000), found as surpassing other ED screening instruments for alcohol dependence at both sensitivity and specificity levels. The objective of our study includes assessing alcohol dependence in South Korea and China using the RAPS4.

Ⅱ. Background

Ⅲ. Materials and Methods

Ⅳ. Results

Ⅴ. Discussion

Many studies have identified an intrinsic relationship between alcohol consumption and alcohol dependence. Drinking initiated at early ages is not only associated with alcohol-induced brain damage and neurocognitive deficits, but may also increase the risk of progression to AUDs (Hingson, Heeren, & Winter, 2006, p.743). Bierut et al. (2002, p.208), and Mayfield et al. (2008, p.817), suggest that alcohol dependence is a manifestation of underlying traits and genetic inclination. Whereas most reviewed research tends to focus on comparing South Korea to the US or some other developed country, our analysis has focused on a global-regional comparison with China, which, along with South Korea, are two among the main alcohol consumption countries. South Korea and China have a similar and contemporary tenet of alcohol consumption, for men in particular, that includes drinking at mealtime, supposedly to enhance social relations with friends and business companions, advance good associations between supervisors and employees, relieve stress, or initiate a blissful and friendly mood for adults (Jiang et al., 2015, p.e190; Han et al., 2015, p.316; Millwood et al., 2013, p.817).This calls for an infrastructure dynamic strong enough to establish a change in the drinking paradigm. In trying to understand the adverse health effects of alcohol abuse and dependence on humans from earlier and recent studies, limited data is available on Asian populations (Kang et al., 2014, p.1)

Our study has examined the prevalence of alcohol dependence using the RAPS4 among respondents visiting EDs in South Korea and China. Of note, 13.7% of the total sample, 17.5% Koreans and 10.8% Chinese were shown to be alcohol dependent. The non-alcohol dependence component may be judicially attributed to alcohol abuse categories. That 17.5% prevalence of alcohol dependence in South Korea was higher than the WHO (2004) South Korea rural population rate results (11.7%). Similarly, China’s alcohol dependence was 10.8%, also exceeding their 5.2% WHO (2004) delimited provincial survey results. Findings are suggestive that alcohol dependence has not been studied as extensively as it should be for both China and the South Korea. Moreover, the alcohol dependence research reports in both countries are from restricted areas with sporadic international associations. In China, previous studies examined alcohol dependence on a small scale within some areas in the country and never nationally or internationally. Furthermore, community-based treatment and legitimately accepted medication for alcohol dependence may not be available (Tang et al., 2013, p.273). The data samples were almost similar in both ROK and China.

The WHO (2004) reported at least 12.8% males to 3.7% females in South Korea and 9.2% males to 0.6% females in China with prevalence of alcohol dependence. In this study, alcohol dependence male to female ratios were significantly higher among Koreans (4.9%) than their Chinese counterparts (2.6%). Consistent with gender differentials on alcohol dependence, this study has been shown to yield greater odds of alcohol dependence among men than in women (4.9% and 2.6%, respectively), in both nations. Traditionally, alcohol drinking in South Korea is largely male-driven, with consumption rates of about 18L a year compared with only 1L for women, and approximate estimations of 22% men and 1% women lifetime rates of alcohol dependence in rural settlements (WHO, 2004). In China, Li et al. (2011) reported widespread magnitudes of harmful drinking at 62.7% for men and 51.0% for women. Further, previous research has shown that Asians tend to report lower levels of alcohol consumption (Mahoney, Graham, Cottrell & Kim, 2012, p.469).

Also of note is the plausibility that the rising economy in both South Korea and China may have increased alcohol consumption levels among women (Kim, & Kim, 2008, p.1078; Tang et al., 2013, p.271). Unlimited societal alcohol drinking among women in the ROK reached 59.5% in 2001; paralleling women employment levels (Lee et al., 2010, p.297; Ryu et al., 2013, p.189; Mahoney et al., 2012, p.469).

Our study could be used to suggest a reorientation of the approach of policy makers towards alcohol dependence. This is a public health issue ever increasing in importance, and thorough measures should be taken to address it. South Korea and China should adopt more rigorous policy measures, such as those at the European commission (Babor et al., 2010, p.771; Rehm, Shield, Gmel, Rehm, & Frick, 2013, p.89; WHO, 2012). The lack of information, peer-reviewed research and awareness initiatives would be potential challenges.

As a solution to the lack of information and extensive research on alcohol dependence, it is imperative for the governments of both countries to develop, support, and maintain a common evidence-based alcohol dependence commission. This should assist in obtaining comparable information on alcohol consumption, especially for the younger age brackets; further, evident definitions on alcohol consumption dependence, drinking patterns, cultural influences, added ingredients, social and health effects of alcohol, and the impact of alcohol consumption in productivity and socio-economic development. This information, when gathered, can be used as a basis to inform, educate, and raise awareness on the impact of alcohol dependence, and on appropriate consumption patterns. Broad and carefully implemented health and life-skills education programs, beginning in early childhood and ideally continued throughout adolescence, can raise awareness and have an impact on risk behaviour (Botvin, Griffin, & Murphy, 2010, p.289; Griffin & Botvin, 2010, p.505). Such interventions should address both risk factors related to alcohol and developmental periods of risk,particularly adolescence, and protective factors reflected in changes of lifestyle and behaviour.

Ⅵ. Conclusion

We have clearly shown a rising trend of alcohol dependence in both South Korea and China compared to the WHO studies in 2004. Conclusively, alcohol dependence male to female ratios are significantly higher among Koreans than their Chinese counterparts. Further research is recommended for RAPS4 analysis in settings other than where our data was collected, thus adding to this growing body of knowledge. In China, AUDs have been identified, but not extensively studied. Further studies addressing alcohol dependence as a nationwide phenomenon are needed. Overall, both countries need to implement the WHO’s global strategic approach designed to alleviate alcohol-related problems.