Problems related to alcohol use: a cross-cultural perspective.

The assessment, diagnosis, and classification of mental disorders are embedded in social and cultural norms. In view of their Anglo-Saxon origins, the prevailing diagnostic criteria and instruments for their assessment have a strong Western influence. Yet they are used internationally with the implied assumption of their cross-cultural applicability. The WHO Cross-Cultural Applicability Research (CAR) study was designed to test this assumption as it applies to disorders relating to the use of alcohol and drugs. This multi-disciplinary research project was conducted in nine countries having different patterns of alcohol and drug use. The results suggest that, even though some similarities exist with respect to the definition of problematic use of alcohol in these ethnically diverse societies, very substantial differences also exist. A number of core concepts underpinning diagnosis of disorders relating to the use of alcohol have no equivalence in the local languages of the various cultures, while some others lacked cultural applicability because of their relative 'distance' from cultural and ethnic norms of drinking. This distance often relates to the difficulties of adapting descriptors of drinking norms in a 'wet' culture to one that is decidedly 'dry'.