The burden and cost of alcohol problems are high, but their full personal, social and economic impact has yet to be accurately estimated.

The aim of this systematic review is to compile existing data from literature (2005-10) on psychosocial difficulties (psd:s) related to alcohol dependence. We focus here on social consequences defined as restrictions of activities and participation according to the International Classification of Functioning, Disability and Health (ICF).

As part of PARADISE (Psychosocial fActors Relevant to BrAin DISorders in Europe), an EU funded project under the Seventh Framework Programme, a database search of MEDLINE and PSYCHINFO was conducted using a defined strategy. Identified literature was checked against predefined eligibility criteria. Using a standardized protocol, information was extracted from full papers about study characteristics and results, psd:s, their evolution, and determinants of onset.

Of the 260 papers included, 137 dealt with limitations in activities and participation. The most frequent social consequences were difficulties in interpersonal relationships, employment and looking after one's health. The most significant determinants of these difficulties were related to the course and severity of alcohol dependence and lack of social support.

General social functioning was measured in 25 papers. Improvement of social functioning was associated with treatment interventions that had a positive impact on the brain disorder (abstinence or reduced drinking).

Limitations of activities and participation are frequently reported in alcohol dependence. Interventions targeting alleviation of the underlying condition can contribute to reduction of these difficulties.