Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions

Purpose: There has been a lack of comprehensive reviews targeting specific aspects of functioning and the difficulties faced by persons with alcohol dependence. The aim of the present review was to systematically compile the existing literature on activity limitations and participation restrictions as defined in the International Classification of Functioning, Disability and Health (ICF) in the context of alcohol dependence. Methods: A database search (MEDLINE and PsychINFO) was performed for studies published in English (2005-2012), examining the activity limitations and participation restrictions in alcohol dependence. Using a standardised protocol, information about the studies' characteristics and data on activity limitations and participation restrictions, their evolution, onset, determinants and associations with other variables were extracted from the studies under review. Results: A total of 211 difficulties in activities and participation in persons with alcohol dependence were extracted from 125 papers. The spectrum of studies was wide, and their overall quality was good. A common reason for the exclusion of studies was an inconclusive definition of alcohol dependence. Issues with interpersonal interactions, economic and professional life, dealing with aggression and legal problems were the most frequently reported difficulties. Problems with high-risk behaviours and in seeking appropriate treatment were also common. The most frequent determinants of the onset and evolution of the identified difficulties were factors pertaining to the course of alcohol dependence. These difficulties were rarely the studies' focus; therefore, the data on their underlying causes and courses were limited. Conclusions: The results confirm that alcohol dependence profoundly affects the family and social network of the afflicted person. The treatment of alcohol dependence can contribute to the alleviation of these associated difficulties. The ICF offers a new perspective on evaluating the wide range of difficulties encountered in the context of alcohol dependence.