3. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Mod drink NIAAA Men,≤2 drinks / day Women, ≤1 drink/day >65 ys, ≤1 drink/day Category Organization Definition
4. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire At-risk drinking NIAAA Men, >14 drinks/week or >4 drinks/ occasion Women, >7 drinks/week or >3 drinks/occasion Category Organization Definition
5. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Hazardous drinking WHO At risk for adverse consequences from alcohol Harmful drinking WHO Alcohol causing physical or psychological harm Category Organization Definition
6. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Alcohol abuse (DSM-IV) APA 1 or more of the following events in a 12-month period: • Recurrent use resulting in failure to fulfill major role obligations • Recurrent use in hazardous situations • Recurrent alcohol-related legal problems • Continued use despite social or interpersonal problems caused or exacerbated by alcohol use Category Organization Definition
7. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Alcohol dependance (DSM-IV) APA 3 or more of the following events in a 12-month period: • Tolerance (increased amounts to achieve effect or diminished effect from same amount) • Withdrawal • Great deal of time spent obtaining alcohol, using it, or recovering from its effects • Important activities given up or reduced because of alcohol • Drinking more or longer than intended • Persistent desire or unsuccessful efforts to cut down or control alcohol use • Use continued despite knowledge of having a psychological problem caused or exacerbated by alcohol Category Organization Definition
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22. CONSEQUENCES OF CHRONIC ALCOHOL MISUSE : The CAGE Questionnaire Acute intoxication Emotional & behavioural disturbance Medical problems: hypoglycaemia, aspiration of vomit, respiratory depression Complicating other medical problems Accidents&injuries sustained in fights Withdrawal phenomena Psychological symptoms: restlessness, anxiety, panic attacks Autonomic symptoms: tachycardia, sweating, pupil dilation, nausea, vomiting Delirium tremens: agitation, hallucinations, illusions, delusions Seizures
23. MEDICAL CONSEQUENCES : The CAGE Questionnaire Neurological Peripheral neuropathy Cerebellar degeneration Cerebral haemorrhage Dementia Hepatic Fatty change,hepatiti, & cirrhosis, Liver cancer Gastrointestinal Oesophagitis, gastritis Pancreatitis Oesophageal cancer Mallory-Weiss syndrome Malabsorption Oesophageal varices Respiratory Pulmonary TB ,Pneumonia
31. What Determines Alcohol Dependency? 1. Tolerance 2. Withdrawal 3. Significant time spent obtaining/using alcohol, or recovering from its effects 4. Reducing or giving up important activities because of alcohol 5. Drinking more or longer than intended 6. Persistent desire or unsuccessful efforts to cut down or control use 7. Continued use despite problems caused or exacerbated by alcohol Those with alcohol dependency suffer clinically significant impairment or distress in the presence of three or more of the following: Source: Saitz R. Unhealthy Alcohol Use. NEJM. 2005;352:596-607.
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34. The AUDIT Test Includes 10 Questions with Multiple Choice Answers Scaled 0 to 4 How often do you have a drink containing alcohol? How many drinks do you have in one day? How often do you have six or more drinks? How often during the past year were you unable to stop drinking? How often during the past year have you failed to do what was normally expected from you? Has a relative, friend, doctor, or health care worker been concerned and suggested you cut down? Score of 8 or more AUDIT Unhealthy Use Sources: Saitz R. Unhealthy Alcohol Use. NEJM. 2005;352:596-607. Fiellin DA, Reid MC, O’Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med . 2000;160:1977-1989. Cited in Saitz R.
(Title Appears) Unhealthy alcohol use is a significant public health problem in the United States and around the world. (Blue Text Box Appears) Annually in the United States, there are (1 st Bullet Appears) 85,000 alcohol-related deaths, as well as (2 nd Bullet Appears) substantial disability from the medical, psychological and trauma-related effects of alcohol use. 1,2,3 Despite this, drinking alcohol is somewhat common in our culture, and unhealthy use often gets ignored or goes undetected. (Text Box Appears) The spectrum of alcohol behaviors in our country extends from abstinence to dependency. ( Pyramid & Bottom Text Appears) Approximately 30 percent of Americans are abstinent, (Line & 2 nd From Bottom Text Appears) 30 percent are low-risk alcohol users, (Line & 2 nd From Top Text Appears) 30 percent are risky with their alcohol use, and (Line, Arrow & Top Text Appears) 10 percent are abusive or dependent. 1
(Title & 1 st Blue Text Box Appear) Risky use is defined as (1 st & 2 nd Text Lines Appear) more than 7 drinks per week, or 3 per occasion, in women, and (Line, 3 rd & 4 th Text Lines Appear) more than 14 drinks per week, or four per occasion, in men, with (5 th Text Line Appears) no alcohol related consequences – at least not yet. 1 According to a study in the New England Journal of Medicine, those suffering from (2 nd Blue Text Box Appears) alcohol abuse have experienced (6 th Text Line Appears) recurrences of the following situations in the last 12 months: (1 st LH Bullet Appears) failure to fulfill major role obligations, (2 nd LH Bullet Appears) alcohol use in hazardous situations, (1 st RH Bullet Appears) alcohol-related legal problems, or (2 nd RH Bullet Appears) social or interpersonal problems resultant from alcohol.
(Title & Blue Text Box Appears) Those with alcohol dependency suffer “clinically significant impairment or distress in the presence of three or more of the following: (Bullet #1 & Picture Appear) tolerance; (Bullet #2 Appears) withdrawal; (Bullet #3 Appears) a great deal of time spent obtaining alcohol, using alcohol, or recovering from its effects; (Bullet #4 Appears) reducing or giving up important activities because of alcohol; (Bullet #5 Appears) drinking more or longer than intended; (Bullet #6 Appears) a persistent desire or unsuccessful efforts to cut down or control use; (Bullet #7 Appears) continued use despite having a physical or psychological problem caused or exacerbated by alcohol.” 1
(Title Appears) While moderate use of alcohol may have (1 st LH Text Box Appears) mild health benefits -- namely, (2 nd LH Text Line Appears) some protection from ischemic heart disease and (3 rd LH Text Line Appears) stroke -- the effects of moderate use impact people differently based on (1 st LH Text Line Appears) their age, sex, genetics, and other factors. The benefit of a reduced risk of heart disease and stroke is often counterbalanced by the wide range of (1 st RH Text Box Appears) harmful effects, (1 st RH Text Line Appears) including liver disease, (2 nd RH Text Line Appears) pancreatitis, (3 rd RH Text Line Appears) motor vehicle accidents, (4 th RH Text Line Appears) gun-related trauma, (5 th RH Text Line Appears) hypertension, (6 th RH Text Line Appears) hemorrhagic stroke, and (7 th RH Text Line Appears) cancer of the esophagus, larynx and mouth. (Blue Text Box, LH Text Box, & 1 st LH Text Line Appear) For men under age 34 and (2 nd LH Text Line Appears) women under age 45, those who do not drink alcohol at all have the lowest death rates. (RH Text Box & 1 st RH Text Line Appear) For men 35 or older, those who have five or fewer drinks a week have the lowest death rates. (2 nd RH Text Line Appears) For women over 45, those who take two or fewer drinks per week live the longest. 1
(Title Appears) How does one know if their alcohol use is unhealthy? Two tests in particular are useful for self-evaluation and clinical screening – they’re known as CAGE and AUDIT. 4 ( Blue Text Box Appears) CAGE asks four questions: (Bullet #1 Appears) Have you ever felt you should cut down on your drinking? (Bullet #2 Appears) Have people annoyed you by criticizing your drinking? (Bullet #3 Appears) Have you ever felt bad or guilty about your drinking? (Bullet #4 Appears) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (Bottom blue text box and Text Line Appear) One or two affirmative answers indicates a high likelihood of unhealthy alcohol use.
(Title Appears) The AUDIT test includes 10 questions with multiple choice answers scaled 0 to 4. For example, the first question – (1 st blue text box and 1 st text line Appears) “How often do you have a drink containing alcohol?” -- provides the following answers and scores: never (0), monthly or less (1), 2 to 4 times a month (2), 2 to 3 times a week (3), 4 or more times a week (4). Some of the other questions are: (2 nd Text Line Appears) How many drinks of alcohol do you have on a typical day when you are drinking? (3rd Text Line Appears) How often do you have six or more drinks on one occasion? (4 th Text Line Appears) How often during the past year have you found you were not able to stop drinking once you had started? (5th Text Line Appears) How often during the past year have you failed to do what was normally expected from you because of drinking? (6th Text Line Appears) Has a relative, friend, doctor or other health worker been concerned about your drinking or suggested you cut down? (2 nd Blue Text Box Appears and bottom line of text appear) After answering all 10 questions, a score of 8 or more is associated with a high likelihood of unhealthy alcohol use. 1
(Title, Text Box Outline & 1 st Bold Text Line Appears) Prevention of long-term disability from unhealthy alcohol use in a patient or loved one requires (LH Bullet Appears) intervention, (Middle Bullet Appears) tailored treatment plans, and (RH Bullet Appears) supportive follow-up. To get involved and address a suspected problem, here are nine steps to follow: (Bullet #1 Appears) 1) Gather information. Ask -- “What do you think about your drinking?” (Bullet #2 Appears) 2) Express concern. (Bullet #3 Appears) 3) Provide specific feedback, like, “Alcohol use is very common, but fewer than 1 in 10 people your age drink the amount you’re drinking.” (Bullet #4 Appears) 4) Express empathy -- “Quitting is difficult, but you are a strong person.” (Bullet #5 Appears) 5) Offer help -- “Would you like more information on how to cut down?” (Bullet #6 Appears) 6) Know local referral options -- “There are many resources. Here are two contacts that can help.” (Bullet #7 Appears) 7) Reinforce self-worth -- “Please think about your drinking because there are many people who care deeply about you.” (Bullet #8 Appears) 8) Assist with a plan -- “Let me help you make an appointment with an expert.” (Bullet #9 Appears) 9) Follow-up -- “Let’s schedule time to get together on a regular basis to monitor your success.” 7.8  The most unhealthy thing about unhealthy alcohol use is that we allow it to remain largely undetected and unaddressed. Â
(Title, Text Box Outline & 1 st Bold Text Line Appears) Prevention of long-term disability from unhealthy alcohol use in a patient or loved one requires (LH Bullet Appears) intervention, (Middle Bullet Appears) tailored treatment plans, and (RH Bullet Appears) supportive follow-up. To get involved and address a suspected problem, here are nine steps to follow: (Bullet #1 Appears) 1) Gather information. Ask -- “What do you think about your drinking?” (Bullet #2 Appears) 2) Express concern. (Bullet #3 Appears) 3) Provide specific feedback, like, “Alcohol use is very common, but fewer than 1 in 10 people your age drink the amount you’re drinking.” (Bullet #4 Appears) 4) Express empathy -- “Quitting is difficult, but you are a strong person.” (Bullet #5 Appears) 5) Offer help -- “Would you like more information on how to cut down?” (Bullet #6 Appears) 6) Know local referral options -- “There are many resources. Here are two contacts that can help.” (Bullet #7 Appears) 7) Reinforce self-worth -- “Please think about your drinking because there are many people who care deeply about you.” (Bullet #8 Appears) 8) Assist with a plan -- “Let me help you make an appointment with an expert.” (Bullet #9 Appears) 9) Follow-up -- “Let’s schedule time to get together on a regular basis to monitor your success.” 7.8  The most unhealthy thing about unhealthy alcohol use is that we allow it to remain largely undetected and unaddressed. Â