Alcohol Use Disorder – New Name, Old Problem

Opiate addiction has been in the spotlight recently. We’ve all seen the statistics.  New cases of HIV are popping up daily in seemingly small, sleepy little towns all over the country. While addiction to pain pills and heroin is a life-threatening illness, alcohol misuse is actually more devastating in terms of the number of deaths related to it.  According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 88,000 people die from alcohol related causes yearly. It is the fourth leading preventable cause of death in the US (National Center for Statistics and Analysis, 2015). In 2014, alcohol-impaired driving accounted for 31% of overall driving fatalities (Stahre, M.  in Preventing Chronic Disease, 2014).  Alcohol misuse takes a toll on health as well.  Global statistics reveal that it is the first leading risk factor for premature death in people between 15 and 49.  In the 20-35 year age group, 25 percent of total deaths are attributable to alcohol misuse (World Health Organization 2015).

The current diagnostic label for problematic drinking is alcohol use disorder. How do you know whether you have an alcohol use disorder?  The bottom line is that if you wonder whether you have a problem, you probably do. There are several screening tools that clinicians use to diagnose problem drinking, and I’ll include one at the end of this blog. However, ask yourself whether anyone has expressed concern about your drinking, whether you need a drink to get going in the morning, whether alcohol has caused you to lose a job or a relationship, or contributed to a health problem. These are all red flags that could indicate that you have a problem.

There are some guidelines about what constitutes moderate and problem drinking.  According to NIAAA, moderate alcohol consumption is defined as up to one drink per day for women and 2 drinks per day for men.   Binge drinking is defined by the Substance Abuse Mental Health Services Administration (SAMHSA) as drinking 5 or more drinks on the same occasion at least one day out of the last 30 days.  SAMHSA defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.  However, in order to really understand these guidelines, it is important to understand how a standard drink is measured. A standard drink is 12 fl. oz. of regular beer, 8-9 oz. of malt liquor, 5 fl. oz. of table wine, or a 1.5 oz. shot of 80 proof spirits (whiskey, gin, vodka, rum, etc.). So if you drink a 24 oz. tall boy, you really have had two standard drinks.

It is true that moderate levels of alcohol have been shown to be beneficial. For example, moderate alcohol consumption decreases risk of heart disease and ischemic stroke (stroke due to blocked arteries and reduced blood flow to brain), and diabetes.  But again, these studies are talking about MODERATE drinking as measured by the STANDARD drink.

I mentioned a lot of statistics in the first paragraph. However, I was most surprised by the statistics regarding treatment. Only about 8.9 percent of adults who needed treatment (9.8 percent of men and 7.4 percent of women) received it. This could have been due to refusal to get treatment, lack of available treatment, or lack of financial resources to get treatment. It’s a rather abysmal statistic, however you look at it.  There is still stigma about admitting to an alcohol problem. I believe it is decreasing.  There are new treatments available that have a better track record as far as treating alcohol use disorder.   Talk to your primary care doctor.  For more information, check out the following:

www.niaaa.nih.gov

www.samhsa.gov

Check out the AUDIT. If you score 8 or above, you may be a problem drinker.

AUDIT

Can’t I just take a pill?

I hear this question from my patients so often, though they may not ask it that directly. But I know what they mean.  They want to quickly feel better, and they believe that medication is the fastest route there.  Medication certainly has benefits, no question about it. Antidepressants can begin to get people moving again, up and off the couch, feeling less sad. However, the answer to the above question is really “Sorry, but no. You can’t just take a pill.” Medication may start the process of recovery, but when it comes to long-term health and prevention of relapse, it takes more than a pill.

Medicine has often reinforced the idea that patients are passive participants while the doctor makes the decisions and performs the treatment. That really does a disservice to patients and even to physicians. We are more and more aware that lifestyle has a strong influence on many medical problems including diabetes, hypertension, heart disease.  Certainly genetic factors play a role as well, but we can’t control our genetic background. We can control lifestyle.  I believe that it is time for patients (and I consider myself one as well) to take an active role in their health care and overall wellbeing.

Exercise is a good example of a lifestyle change that can make a big difference in many aspects of health. I often see eyes rolling and hear big sighs when I mention this. Yes, it is work. But you don’t have to go to a gym. It doesn’t have to be an hour a day. It can be a couple of 15 or 20 minute slots of time. It doesn’t have to be consecutive. Maybe it’s biking or gardening or walking. Actually walking is one of the best exercises for maintaining bone health in women because it is weight-bearing.

There is solid evidence that exercise can improve cognition. There is a lot of research going in psychiatry right now about the role of inflammation in disorders such as schizophrenia.  Moderate exercise appears to reduce inflammation in the brain (Knochel, C, et. al. in Prog Neurobiol, 2012). Several papers have shown that exercise has the potential to slow progression of Alzheimer’s Disease. Improvements in cognition after exercise have been reported in Huntington’s disease, multiple sclerosis, and Parkinson’s disease. If you would like further information about this research, please contact me.

Finding the motivation to begin an exercise program is the hardest part. Once you’ve started, you begin to see the benefits. That makes it easier to continue. Here are some tips for getting started.

  1. It’s always easier when you have company. Find someone to join you.  Knowing that the other person will be there waiting keeps you accountable.
  2. Think outside of the box. Exercise doesn’t have to be in the gym. Try to figure out what you really like to do. Don’t push yourself to do something that you hate. Remember that gardening can be a form of exercise. We’re not talking about setting the world on fire here. We’re just talking about increasing activity.
  3. Start slowly if you aren’t used to exercising. Overdoing it the first few times is one of the biggest reasons that people quit. It’s a set-up for failure.
  4. If all else fails, maybe you need a reward. Promise yourself a ticket to a play or a new exercise outfit if you stick with it for a period of time.

You are the captain of the ship. Start sailing!!