When Is Alcohol a Problem?

Irene Berman-Levine, PhD, RD
July 16, 2004

This is the seventh extract from Dr Irene Berman-Levine's book, "Dr Irene's Nutrition Tidbits". You can order the book, which is packed with easily digested research news, tips, menus, and recipes, for US$16 by clicking here . Robert Griffith, Editor.

Introduction

In an earlier article, I addressed the possibility that increased stress, whether from the threat of terrorism or the stress of everyday life, may result in binge eating or drinking. These symptoms may be early warnings that you or loved ones might need help in coming to terms with stressful events. You may also be dealing with someone who had a problem with alcohol even before these events. In the United States, at least 700,000 Americans receive treatment for this disease every day. It is estimated that over 18 million people abuse alcohol to the point that their personal relationships, work impact health are impaired. This means many people, even before the recent increase in stressful events, are walking around with a serious alcohol problem.

Detecting an alcohol problem may be difficult. Individuals with a past history of binge eating or drinking are often experts at hiding their behavior. Even when confronted, denial is often encountered. This article provides information to help identify if alcohol is a problem. Early intervention and a strong support system may make a major difference in someone's life.

Just a drink or two . . .

Certainly recent events may seem to warrant a drink or two to cope. Alcohol is probably not a problem if a person takes one or two drinks and moves on to a normal routine.¹ However, if the individual who took that drink has a previous history of alcohol abuse and was using abstinence as a means of control, those one or two drinks can present a big problem. Someone who also may be in trouble is a person who continues to use alcohol as a coping mechanism. Someone might consider themselves a "light" drinker, but if they have more than one drink a day (for women) or two drinks a day (for men), their alcohol intake is considered excessive. If a woman is pregnant, even one drink is considered too many. And women are even more vulnerable to alcohol than men.

The costs of alcoholism

There are not only physical and social impacts of alcohol, but economic ones as well. Alcohol-related absenteeism and poor job performance in the United States is estimated at $148 billion annually. Most of the cost is incurred by the impact of the hangover on work performance. After all, who can work efficiently or be socially kind when suffering from the symptoms of a hangover. Symptoms may include headache, tremors, nausea, diarrhea, fatigue, less clarity in thought or decreased physical coordination. People with hangovers may pose substantial risk to themselves and others despite having a normal blood alcohol level.

Seniors and alcohol

Alcohol intake of seniors is also of concern. Adults age aged 60 or older tend to be overlooked in discussions of substance abuse, resulting in thousands of older adults who need treatment and do not receive it. For more information, read the US Department of Health and Human Services report entitled Substance Abuse Among Older Adults (see link below). This report estimates that 40% of seniors who are at risk do not recognize or seek services for substance abuse on their own. This high figure provides even more evidence of the importance of a family member, staff of a senior center, or friend intervening when they feel an alcohol problem exists. Frequently, these individuals are in the best positioned to detect those behavioral changes that signal a possible problem.

Screening for an alcohol problem

Two types of alcoholism-screening instruments are available. The first type involves a person recognizing the problem themselves through a self-screen or being interviewed by someone else. The second type of screening involves health professionals ordering laboratory tests that can detect body changes associated with excessive alcohol consumption. The interview is the most practical for the average person.

The CAGE screen is one of the easiest screens for alcohol problems. CAGE is an acronym which stands for the key words in the questions asked (see below). The CAGE can be self-the administered or done through an interview. It asks for overt yes-no questions and requires approximately one minute to complete. If an individual answer yes on two of the four questions, research estimates that this will identify 75% of individuals with serious alcohol problems.

    C -- Have you ever thought you should Cut Down on your drinking?
    A -- Have you ever felt Annoyed by others' criticism of your drinking?
    G -- Have you ever felt Guilty about your drinking?
    E -- Do you have a morning Eye Opener?

There are many other screening tests. A review of some of them can be found in the second link below. The main point is to recognize a potential problem, but you do not have to be the one to do the screening. If you feel at all uncomfortable in this role, but suspect an alcohol problem, seek guidance from health professionals with experience in handling these issues. They can administer their screen of choice and steer the individual, if necessary, to a treatment program. There are many treatment options, including Alcoholics Anonymous, brief intervention therapy, motivational enhancement therapy, couples therapy, dual-addiction treatment, and medication therapy.

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Source

• I Berman-Levine PhD, RD. "Welcome to Dr Irene's Nutrition Tidbits" 2002 Nutrition Program Planning Inc., PO Box 60748, Harrisburg, PA 17106-0748, USA

Footnotes
1. What counts as a drink? 12 ounces of regular beer (150 calories), or 5 ounces of wine (100 calories), or 1.5 ounces of 80-proof distilled spirit (100 calories).

Related Links
Substance Abuse Among Older Adults
Screening Tests for Alcoholism in Seniors

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