19. 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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22. 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.
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Editor's Notes
(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 (1st Bullet Appears) 85,000 alcohol-related deaths, as well as (2nd 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 & 2nd From Bottom Text Appears) 30 percent are low-risk alcohol users, (Line & 2nd 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 & 1st Blue Text Box Appear) Risky use is defined as (1st & 2nd Text Lines Appear) more than 7 drinks per week, or 3 per occasion, in women, and (Line, 3rd & 4th Text Lines Appear) more than 14 drinks per week, or four per occasion, in men, with (5th 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 (2nd Blue Text Box Appears) alcohol abuse have experienced (6th Text Line Appears) recurrences of the following situations in the last 12 months: (1st LH Bullet Appears) failure to fulfill major role obligations, (2nd LH Bullet Appears) alcohol use in hazardous situations, (1st RH Bullet Appears) alcohol-related legal problems, or (2nd 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 (1st LH Text Box Appears) mild health benefits -- namely, (2nd LH Text Line Appears) some protection from ischemic heart disease and (3rd LH Text Line Appears) stroke -- the effects of moderate use impact people differently based on (1st 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 (1st RH Text Box Appears) harmful effects, (1st RH Text Line Appears) including liver disease, (2nd RH Text Line Appears) pancreatitis, (3rd RH Text Line Appears) motor vehicle accidents, (4th RH Text Line Appears) gun-related trauma, (5th RH Text Line Appears) hypertension, (6th RH Text Line Appears) hemorrhagic stroke, and (7th RH Text Line Appears) cancer of the esophagus, larynx and mouth. (Blue Text Box, LH Text Box, & 1st LH Text Line Appear) For men under age 34 and (2nd LH Text Line Appears) women under age 45, those who do not drink alcohol at all have the lowest death rates. (RH Text Box & 1st RH Text Line Appear) For men 35 or older, those who have five or fewer drinks a week have the lowest death rates. (2nd 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 – (1st blue text box and 1st 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: (2nd 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? (4th 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? (2nd 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 & 1st 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
(Title, Text Box Outline & 1st 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 problem: ,[object Object],[object Object],[object Object],The CAGE Questionnaire](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)