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Alcohol Use and Abuse Health Article

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Alcohol Use and Abuse

If you occasionally enjoy a glass of wine with dinner, a cold beer on a hot summer afternoon, or a few sips of champagne to celebrate an important event, you know that alcohol can be a pleasurable addition to your life. But for a significant number of people, alcohol does nothing but detract from their lives — jeopardizing their physical and mental health, safety, relationships, and overall well-being.

In fact, severe problems with alcohol, such as alcohol dependence or abuse, afflict nearly 1 in every 16 adults in the United States today — some 17.6 million women and men. And millions more Americans, ranging from preteens to seniors, engage in risky drinking. In addition to causing immediate problems, risky drinking is often a slippery slope leading to heavier drinking and its serious, long-term consequences.

For the person with the drinking problem, alcohol abuse significantly raises the risk of liver disease, heart disease, some types of cancer, and a host of other serious conditions. It also has a profound impact on society, playing a major role in many violent crimes, accidents, and suicides. Indeed, more than 100,000 Americans — an average of about 274 people every day — die annually from alcohol-related causes.

Fortunately, significant progress has been made in the understanding of, and treatments for, alcohol-use disorders. These advances, which are discussed in this report, include the following:

the first major study defining the most effective treatments for alcohol dependence
insights into alcohol use and abuse among women, who are at greater risk than men of suffering alcohol's harmful effects (see "Women and alcohol")
a greater understanding of the pivotal role of genes in alcohol dependence and how these might be used to screen people at risk (see "Genes and alcoholism")
medications for treating alcohol abuse and dependency
medications to help quit smoking, which is closely linked to alcohol dependence and poses its own serious health risks (see "Medications to help you quit").

A Japanese adage says, "First the man takes the drink, then the drink takes the drink, then the drink takes the man." But, as you will read in this report, if you understand the risks and signs of alcohol abuse — and seek help if you are heading for trouble — you may be able to walk a different path.

What is an alcohol problem?

The majority of Americans drink, and many drink regularly without consequence. 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?

One common image of someone with an alcohol problem is that of a man in his 30s or 40s who takes his first drink early in the day. Often he can't remember what he does while intoxicated. He may pass out. He wakes with a hangover to start the cycle over again. His work life is a mess, and he neglects his family. He can't get through a day without taking a drink.

But this picture only occasionally reflects the facts. Women and men of all ages and from every walk of life are vulnerable to alcohol problems, and their lives are affected in many different ways. Alcohol problems don't develop along one typical course, which is why it can be difficult to recognize them in yourself or in others, even close friends and family members. (One way to find out is to take the CAGE test; see "Are you a problem drinker?")

Are you a problem drinker?

Health care professionals have developed several screening tests that can help assess whether you, or someone close to you, might have a drinking problem. The AUDIT and the CAGE tests are often used.

If either of these tests indicates that you have an alcohol problem, contact your doctor, a psychotherapist, a substance abuse rehabilitation program, or a self-help group (see "Resources").

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 letter of a key word in each question spells "cage."

Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty or bad about your drinking?
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.

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
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
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
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
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
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
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
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
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
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.