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Program Tries to Identify Problem Drinkers Before Problems Start

Most people who drink alcohol are not alcoholics and never will be. But the National Institute on Alcohol Abuse and Alcoholism knows all too well that millions of Americans drink in amounts or patterns that put them at risk of developing a dependence on alcohol and having to face the attendant medical, legal and social problems.

Based on a 2001-02 nationwide survey of 43,000 adults conducted by the National Institutes of Health, the alcohol institute estimates that 30 percent of people 18 and older drink at levels that raise their risk of alcoholism. And since helping those people identify themselves before they get into trouble with alcohol is easier than treating alcoholism, the institute has begun a groundbreaking preventive program called Rethinking Drinking.

The program includes a 16-page booklet for the public (“Rethinking Drinking: Alcohol and Your Health”), a product set for clinicians with a 34-page booklet (“Helping Patients Who Drink Too Much: A Clinician’s Guide”) and an interactive Web site for people who drink,, complete with quizzes, calculators and other tools.

The materials can be downloaded from the Web site or ordered by phone at 301-443-3860. Together, they represent a sea change in the approach to alcohol abuse: identify and treat risky drinking patterns before anything bad happens.

Making Adjustments

“This is a wellness project, patterned on the risk-reduction concept used to prevent other chronic diseases like heart disease and diabetes,” Dr. Mark Willenbring, the main architect (with Maureen Gardner) of the program, said in an interview. “As with lowering cholesterol or high blood pressure to prevent heart disease, the idea is early identification of risky drinking patterns and early intervention instead of waiting until the person is chronically ill.”

Dr. Willenbring, who directs the institute’s Division of Treatment and Recovery Research, added: “Once they know who they are, most people at risk of becoming alcohol abusers can cut down on their alcohol consumption and reduce their risk. We know that many heavy drinkers are able to change on their own.”

For those who already drink at abusive levels, the new program can help them acknowledge their problem and seek treatment earlier, before they suffer irreversible medical and social problems like liver or brain disease, legal difficulties, job loss or divorce.

The beauty of Rethinking Drinking is that it can be used in the privacy of the home or in a doctor’s office, sparing people the embarrassment and stigma that often accompany public acknowledgment of a problem with alcohol and entering a treatment program.

“A single session with a physician — just five minutes of advice — can have lasting effects on reducing a person’s drinking,” Dr. Willenbring said. Yet many primary care doctors don’t know how to identify a potential drinking problem in their patients or what to do if they suspect a problem may develop.

“More than 90 percent of alcohol treatment programs offer group counseling or Alcoholics Anonymous,” Dr. Willenbring noted. “This is not a medical model. Doctors are not involved.”

The Rethinking Drinking materials can also be used in other settings, like college campuses, workplaces and churches, and in the criminal justice system. A student who repeatedly wakes up hung over without knowing what he did the night before might consult the program and modify his behavior. Someone who is cited for driving while intoxicated might be referred to the program and prompted to take better control of his or her drinking before a disaster occurs.

Helpful Guidelines

Many drinkers have mistaken notions of what constitutes “a drink” and are often unaware of just how much alcohol they consume at any one time, Dr. Willenbring said.

Rethinking Drinking provides these equivalents of one drink: 12 ounces of regular beer = 8 to 9 ounces of malt liquor = 5 ounces of table wine = 1.5 ounces of 80-proof hard liquor. Thus, one bottle of wine equals five drinks. Forty ounces of malt liquor or a half-pint of hard liquor equals four and a half drinks. Also, many light beers have nearly as much alcohol as regular beer, and a single mixed drink can contain three or more standard drinks.

The institute defines low-risk drinking, for men, as consuming no more than 4 drinks on any day and no more than 14 drinks a week. For women, the limit is three drinks on any day and no more than seven drinks a week. Drinking more than these amounts in a day or during a week is considered at-risk or heavy drinking.

Even within these limits, some people can have problems with alcohol, especially those with health problems and people over 65. Older men and women are advised to consume no more than three drinks a day and seven a week.

“Even moderate levels of drinking (up to two drinks per day for men or one for women) can be too much in some circumstances,” the program states. And people in these circumstances should avoid alcohol altogether:

¶Women who are pregnant or trying to become pregnant (a safe level of alcohol for the developing fetus has not been established).

¶People planning to drive or operate dangerous machinery.

¶Those taking medications that interact with alcohol.

¶People with health problems made worse by alcohol.

Identifying Symptoms

The institute emphasizes that people who believe they have “a high tolerance” for alcohol — that is, they can drink a lot without acting or feeling inebriated — are not protected from developing alcoholism and alcohol-induced health problems. Quite the contrary.

The new program helps drinkers determine whether they are ready to change their drinking habits, identify personal benefits of making a change and recognize possible roadblocks and ways around them. It also provides nine strategies for cutting down on drinking, including learning how to pace yourself and keep track of how much you are drinking.

Dr. Willenbring listed five early symptoms that indicate a drinker already is an alcohol abuser or is at risk:

1. Repeatedly drinking more than self-set limits.

2. Having a persistent desire to quit or cut down.

3. Drinking and driving.

4. Spending too much time drinking.

5. Having hangovers or a sleep disorder.

“Alcoholism isn’t what it used to be,” Dr. Willenbring said. “What we used to know about it came from studying the very severe end of the spectrum — those with a chronic illness who reach rock bottom.”

It is now known that many people have limited episodes of alcohol dependence, and if these are recognized and dealt with early on, many alcohol-related problems can be avoided.

This is the second of two columns on recognizing alcohol abuse. Last week: the high-functioning alcoholic.
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