WORLD: Do you have a problem with alcohol?

. BOSTON, MA / Harvard Medical School / HealthBeat/ December 17, 2008 ‘Tis the season for celebration. And from holiday egg nog to New Year’s champagne, alcohol is often involved. The majority of Americans drink, and many drink regularly without suffering harmful consequences. Still, alcohol problems are common. So where is the line between social drinking and problem drinking? Can someone who never misses a day of work be dependent on alcohol? Does drinking every day or drinking a certain amount indicate a problem? How can you tell if you or a loved one has a problem with alcohol? Here’s the bottom line: if your pattern of drinking creates difficulty for you personally, socially, or at work, then your drinking pattern is either hazardous or harmful to your health and you should seek immediate medical assessment to determine the best treatment options for you. Remember that problematic drinking patterns can develop in anyone — women and men of all ages and from every walk of life may be vulnerable to alcohol-related problems, and their lives may be impaired in many different ways, some more visible than others. There is no “typical course” to developing a drinking problem, which is why it’s sometimes difficult to recognize problem drinking patterns in yourself or others — even close friends and family members. Clinical experts have developed two brief assessments to screen for problem drinking patterns: the CAGE questionnaire and the AUDIT. _____________________________________________ Screening tests to identify problem drinkers Health care professionals have developed several screening tests that can help assess whether you, or someone close to you, might have a drinking problem. Among these are the CAGE and AUDIT tests. If either of these test results suggests that you have an alcohol problem, contact your doctor, a psychotherapist, a substance abuse rehabilitation program, or a self-help group. The CAGE test Physicians and therapists frequently use the following four-question test, which is most useful in identifying more severe alcohol problems. Despite its apparent simplicity, this test can provide valuable information. It’s called the CAGE test because the first letters of a key word in each question spell “cage.” 1. Have you ever felt you should Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty or bad about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves, get rid of a hangover, or as an Eye opener? If you responded “yes” to any one of these questions, you may have a drinking problem. If you responded “yes” to more than one question, it’s highly likely that a problem exists. AUDIT The World Health Organization developed the following screening tool, called AUDIT (Alcohol Use Disorders Identification Test), to help physicians identify harmful or hazardous drinking patterns in their patients. 1. How often do you have a drink containing alcohol? 0 = never 1 = monthly or less 2 = 2–4 times a month 3 = 2–3 times a week 4 = 4 or more times a week 2. How many drinks containing alcohol do you have on a typical day when you are drinking? 0 = none 1 = 1–2 2 = 3–4 3 = 5–6 4 = 7–9 5 = 10 or more 3. How often do you have six or more drinks on one occasion? 0 = never 1 = less than monthly 2 = monthly 3 = weekly 4 = daily or almost daily 4. How often during the past year have you found that you were unable to stop drinking once you had started? 0 = never 1 = less than monthly 2 = monthly 3 = weekly 4 = daily or almost daily 5. How often during the past year have you failed to do what was normally expected of you because of drinking? 0 = never 1 = less than monthly 2 = monthly 3 = weekly 4 = daily or almost daily 6. How often during the past year have you needed a first drink in the morning to get going after a heavy drinking session? 0 = never 1 = less than monthly 2 = monthly 3 = weekly 4 = daily or almost daily 7. How often during the past year have you had a feeling of guilt or remorse after drinking? 0 = never 1 = less than monthly 2 = monthly 3 = weekly 4 = daily or almost daily 8. How often during the past year have you been unable to remember the night before because you had been drinking? 0 = never 1 = less than monthly 2 = monthly 3 = weekly 4 = daily or almost daily 9. Have you or someone else been injured as the result of your drinking? 0 = never 2 = yes, but not in the past year 4 = yes, in the past year 10. Has a relative, doctor, friend, or health professional been concerned about your drinking or suggested you cut down? 0 = never 2 = yes, but not in the past year 4 = yes, in the past year Scoring Add up the numbers for each response to get your total score. A score of 8 or more suggests that you may have a drinking problem and indicates the need for more in-depth assessment. _________________________________________ What is moderate or “safe” drinking? The 2005 edition of the U.S. government’s Dietary Guidelines for Americans defines moderate drinking as up to two standard drinks per day for men and no more than one drink per day for women. Women have lower limits because they absorb more alcohol into the bloodstream, resulting in higher blood alcohol levels and more rapid intoxication. Also, the National Institute on Alcohol Abuse and Alcoholism recommends that men ages 65 and older have no more than one drink per day because metabolism slows with age. What’s a standard drink? PROBLEM DRINKING (alcohol abuse or dependence) affects 18.2 million people in the United States alone—nearly one in every 13 adults and teens ages 12 and over. Millions more Americans engage in risky drinking behaviors, such as driving under the influence or being intoxicated while having direct responsibility for another person’s well-being. Alcohol misuse sharply raises the risk of illness or death from numerous health problems, including liver disease, heart disease, and some types of cancer. It also has a profound detrimental impact on society, playing a major role in many violent crimes, accidents, and suicides. Fortunately, the past decade has seen significant advances in the detection and treatment of alcohol-related disorders, all of which are detailed in this report. They include a greater understanding of the pivotal role of genes in alcohol dependence and how these might be used to screen people at risk; new medications to treat alcohol use disorders; the first major study defining the most effective behavioral treatments for alcohol dependence; and insights into alcohol use and abuse among women, who are at greater risk than men of suffering alcohol’s harmful health effects. Prepared by the editors of Harvard Health Publications in collaboration with Hilary Smith Connery, Ph.D., M.D., Psychiatrist in charge, Alcohol and Drug Abuse Treatment Program and Instructor at Harvard Medical School; 49 pages. (updated: 2008) FEATURED CONTENT: * The consequences of alcohol abuse and dependence * Who is at risk? * Smoking and alcohol: A risky combination * Women and alcohol * Drinking and older adults * Alcohol use among teens and young adults * A 7-part plan toward recovery * When a loved one is a problem drinker Reprinted from Alcohol Use and Abuse, a Special Health Report from Harvard Medical School Copyright © 2008 by Harvard University.