Thursday is National Alcohol Screening Day

Assess your drinking risk with this easy test.

The more you drink, the less likely you are to accurately perceive the risks of heavy drinking, according to a survey by Screening for Mental Health (SMH), a Boston-area non-profit group.  The phone survey of 1,000 adults in the U.S. indicated that 7 out of 10 respondents would consult a health care provider if they “thought they might have a problem with alcohol,” but that only 50% of responders with the highest number of at-risk drinking episodes per year said they would seek medical help.

Phone surveys can be notoriously unreliable when it comes to questions about the personal use of drugs and alcohol. However, the point being made here is clear: There are ways to screen high-risk drinkers, who aren’t always the best judge of their own behavior. For National Alcohol Screening Day on Thursday, April 11, SMH offers www.HowDoYouScore.org, where you can take a quick quiz to see how you measure up. More than a thousand community organizations, colleges, and military bases will be taking part. The screening, which is geared toward younger drinkers, is free, anonymous, and online—just the way college students like it. The event, held in April in conjunction with Alcohol Awareness Month, netted more than 40,000 online anonymous screenings last year.

In another finding from the survey, 20% of respondents said that drinking heavily is a “phase many kids go through,” which is certainly true and a suspiciously rare choice in this survey. It’s unlikely that people are eager to approve of young people drinking heavily, even as a “phase.” Nonetheless, we know that kids who begin drinking before age 15 are far more likely to drink alcoholically as adults. And at-risk drinking correlates strongly with age: Most of the mayhem is committed by men under age 35. No surprise there.

“Despite public opinion, at-risk drinking increases your chances of developing alcohol use disorders—such as alcoholism—as well as other physical and mental health problems," said Douglas G. Jacobs, M.D., associate clinical professor of psychiatry at Harvard Medical School and medical director of SMH, in a prepared statement. “In the U.S., about 18 million people have an alcohol use disorder. The screenings allow individuals to assess their drinking habits and have an opportunity to connect with local support resources.”

And while we are on the subject of, and in the month of, alcohol awareness, here are some earlier posts on ethyl alcohol and you:

7 Myths the Alcohol Industry Wants You to Believe

The Truth About Weight Loss Surgery and Alcohol

Mixing up the Medicine: What Alcohol Doesn’t Go With

Alcoholic Deception

Dude, where’s my metaconsciousness?

John Berryman and the Poetry of “Irresistible Descent”

“The penal colony’s prime scribe.”

“Will power is nothing. Morals is nothing. Lord, this is illness.”
—John Berryman, 1971

A year before he committed suicide by jumping off a Minneapolis bridge in 1972, Pulitzer Prize-winning poet John Berryman had been in alcohol rehab three times, and had published a rambling, curious, unfinished book about his treatment experiences. Recovery is a time capsule. If you think we have little to offer addicts by way of treatment these days, consider the picture in the 60s and 70s. In Recovery, treatment consists almost entirely of Freudian group analysis, and while there is regular talk of alcoholism as a disease, AA style, there is no evidence that it was actually dealt with in this way, after detoxification.

Best known for “Dream Songs,” Berryman taught at the University of Minnesota, and was known as a dedicated if irascible professor. Scientist Alan Severence, Berryman’s stand-in persona in the book, comes into rehab hard and recalcitrant, despite his previous failures: “Screw all these humorless bastards sitting around congratulating themselves on being sober, what’s so wonderful about being sober? Great Christ, most of the world is sober, and look at it!” And he is suffering from “the even deeper delusion that my science and art depended on my drinking, or at least were connected with it, could not be attacked directly. Too far down.”

Berryman was a difficult man, and knew it. He quotes F. Scott Fitzgerald: “When drunk, I make them pay and pay and pay and pay.”

Alcoholics, writes Berryman, are “rigid, childish, intolerant, programmatic. They have to live furtive lives. Your only chance is to come out in the open.” Berryman catches the flavor of group interaction after too many hours, too much frustration, and too much craving. One inpatient lashes out: “You’re lying when you say you do not do anything about your anger. You get bombed. It is called medicating the feelings, pal. Every inappropriate drinker does it. Cause and effect. Visible to a child. Not visible to you.”

Berryman was a shrewd observer, a singular writer, and, after all, a poet. He is extraordinary on the subject of alcoholic dissociation: “I found myself wondering whether I would turn off right towards the University and the bus home or whether I would just continue right on to the Circle and up right one block to the main bar I use there, and have a few. Wondering. My whole fate depending on pure chance…. as if one were not even one’s own actor but only a spectator.”

Berryman puts it all together in a horrific capsule description of the “irresistible descent, for the person incomprehensibly determined.”

Relief drinking occasional then constant, increase in alcohol tolerance, first blackouts, surreptitious drinking, growing dependence, urgency of FIRST drinks, guilt spreading, unable to bear discussion of the problem, blackout crescendo, failure of ability to stop along with others (the evening really begins after you leave the party)… grandiose and aggressive behavior, remorse without respite, controls fail, resolutions fail, decline of other interests, avoidance of wife and friends and colleagues, work troubles, irrational resentments, inability to eat, erosion of the ordinary will, tremor and sweating… injuries, moral deterioration, impaired and delusional thinking, low bars and witless cronies….

Berryman had no illusions about his failed attempt to hide behind the mask of a social drinker: “It seems to be loss of control. Unpredictability. That’s all. A social drinker knows when he can stop. Also, in a general way, his life-style does not arrange itself around the chemical, as ours does. For instance, he does not go on the wagon…”

In the end, he was "pleading the universal case of hope for abnormal drinkers, for all despairing and deluded sufferers fighting for their sanity in a world not much less insane itself and similarly half-bent on self-destruction…”

As the head nurse in the facility tells the group: “You are all suffering from the lack of self-confidence… often so powerful that it leads to consideration of suicide, a plan which if adopted will leave you really invulnerable, quite safe at last.”

And as Saul Bellow wrote in the introduction to Recovery: “At last there was no more. Reinforcements failed to arrive. Forces were not joined. The cycle of resolution, reform and relapse had become a bad joke which could not continue.” Berryman agreed. Toward the end, he wrote: “I certainly don’t think I’ll last much longer.”

“There’s hope until you’re dead,” a woman tells him during his final stay in rehab. Sadly, that hope ended a few months later.


Photo posted by Tom Sutpen for the series: Poets are both clean and warm

The Truth About Weight Loss Surgery and Alcohol

Bariatrics and booze don’t always mix.

For many people with obesity, bariatric surgery has proven to be a lifesaver. But for a subset of post-operative patients, the price for losing five pounds every time you step on the scale turns out to be an increased appetite for alcohol.

In a study of almost 2,000 patients who underwent surgery for severe obesity, the patients had either gastric bypass surgery (RYGB) in which a portion of the stomach and small intestine are removed, or gastric banding, a process by which an adjustable “lap band” is tightened around the entrance to the stomach. Those who opted for gastric bypass showed an increase in alcohol consumption two years after surgery, according to a recent study by Wendy C. King and coworkers in the Journal of the American Medical Association.

The notion that weight loss surgery, known as bariatric surgery, was related to increased use of alcohol had been an anecdotal staple among patients with obesity for years. Oprah Winfrey based one of her daytime television shows on the rumor back in 2006. Dr. King and a diverse group of associates concluded last month at the American Society for Metabolic and Bariatric Surgery annual meeting that “a significantly higher prevalence of alcohol use disorder” was associated with the second year following gastric bypass surgery. (During the first postoperative year, patients are strongly advised not to drink at all.)

Moreover, some of the patients who showed high-risk alcohol intake had not been problem drinkers before surgery. Some had not been drinkers at all. But the effects of gastric bypass, coupled with permission to drink a year after surgery, lead to an increase in alcohol abuse and alcoholism. While the overall increase was relatively modest, patients who had gastric bypass surgery were twice as likely to drink heavily than patients who underwent the lap band procedure.

“It’s a great study,” says Dr. Stephanie Sogg, staff psychologist at the Massachusetts General Hospital Weight Center and assistant professor in the Department of Psychiatry at Harvard Medical School, who was not associated with the study group. In an interview for this article, Sogg called the distinction between surgeries “an extremely important finding. They saw changes in alcohol use patterns with gastric bypass, but not with gastric banding. That’s exactly what we would expect.”

The findings make biochemical sense: “Gastric bypass surgery bypasses a part of the stomach that secretes alcohol dehydrogenase,”—a primary enzyme of alcohol metabolization, says Sogg. “And in gastric bypass, the alcohol is not coming into contact with the first part of the intestine, the duodenum. That’s going to cause some changes in the way the body processes alcohol that aren’t true of gastric banding. If this were a case of people who are addicted to food having to change their eating and thus becoming addicted to alcohol, we would expect to see the same changes whether the person had gastric bypass or gastric banding.”

It would be natural to assume that people with prior drinking problems would have the most trouble with alcohol control postoperatively. But things are rarely that simple in medicine. “Previous alcohol history sets up people for risk of relapse, but there’s a significant subset of people having trouble with alcohol who never drank at all,” says Dr. Sogg. “That’s where the real story is.”

Dr. David B. Sarwer, associate professor of psychology and director of clinical services for the Center for Weight and Eating Disorders at the University of Pennsylvania, called the King study “the most definitive evidence to date on the prevalence of alcohol use disorders in persons who undergo bariatric surgery.” In an email exchange, Sarwer said: “Individuals with a history of alcohol or substance abuse are informed that the stress of the dietary and behavioral requirements of bariatric surgery, like all major life stressors, could threaten their sobriety or abstinence. However, we simply do not know enough about the use of alcohol and other substances after surgery to predict this with a great degree of certainty.”

Dr. Sogg agrees. For the bariatric surgery population, the pharmacokinetics of alcohol changes. They become more sensitized to its effects—a little now goes a long way. The main problem, she says, is that “we’re not good yet at predicting exactly whom it’s going to happen to.”

But she has some thoughts about vulnerable subsets. “Some people with obesity have poor coping skills,” she says. “And now alcohol is so much more potent and reinforcing for them that alcohol becomes the coping strategy. When this biological change with alcohol happens, they may be the ones who are at higher risk of responding to that change by developing problems with alcohol.”

Warning patients about alcohol risks of weigh-loss surgery is becoming more common, says Dr. Sogg. “It doesn't change my decision-making about whether somebody should or shouldn't have surgery. But we can evaluate people's coping skills before surgery and point out to them that it is important for them to develop other ways of dealing with negative emotions besides eating." 

She also thinks that “people who have a history of actually becoming abstinent after drug or alcohol dependence may be better equipped for surgery. They will be less likely to put themselves in the path of alcohol use, and they have experience at making major successful long-term behavior changes. Basically, we should not consider past encounters with substance abuse as contraindications for surgery. But we should be carefully evaluating whether people are currently using substances at the time of surgery.”

In the end, she said, “I tell every one of my patients before surgery that they need to be aware of the risks of problem drinking after surgery, monitor their alcohol intake, and come back to us immediately at the first sign of any concerns about their drinking.”

King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, Courcoulas AP, Pories WJ, & Yanovski SZ (2012). Prevalence of Alcohol Use Disorders Before and After Bariatric SurgeryAlcohol Use Disorders and Bariatric Surgery. JAMA : the journal of the American Medical Association, 1-10 PMID: 22710289

 Photo credit: http://www.treatment4addiction.com/

7 Myths the Alcohol Industry Wants You to Believe

Staying on message in the liquor biz. 

“Our national drug is alcohol,” wrote William S. Burroughs. “We tend to regard the use of any other drug with special horror.” This emotional loophole in the psyche has been skillfully manipulated by the alcohol and tobacco industries ever since modern advertising was invented.

 Recently, the European Alcohol Policy Alliance, known as EuroCare, put together a brochure addressing the common messages the liquor industry attempts to drive home through its heavy spending on advertising. The messages are not just designed to sell product, but also to influence alcohol policy at the political level as well. (Eurocare is a network of more than 50 voluntary non-governmental organizations working on the prevention and reduction of alcohol-related harm in 20 European countries.) According to the group, the “industry”—the alcohol and tobacco companies—“has traditionally worked closely together, sharing information and concerns about regulation. They have used similar arguments to defend their products in order to prevent or delay restrictions being placed on them (Bond, et al. 2010).”

EuroCare offers this introduction: “The intention of this brochure is to inform professionals about the attempts made by the alcohol industry to influence alcohol policy globally and to subsequently arm them against the industry’s methods to prevent effective policies from being made…. For politicians and health experts it is important that they reveal to the public the subversive messaging of the alcohol industry and do not fall prey to the industry’s half-truths—or worse—outright lies.”

Message 1: Consuming alcohol is normal, common, healthy, and very responsible.

Explanation: To bring this message home, alcohol advertisements nearly always associate alcohol consumption with health, sportsmanship, physical beauty, romanticism, having friends and leisure activities.

I note here that it’s left to the social service agencies and non-profits to attempt to convey the opposite side of the coin: a dramatically heightened risk for health problems, traffic fatalities, domestic violence, loss of job, loss of marriage, suicide—you name it.

Message 2: The damage done by alcohol is caused by a small group of deviants who cannot handle alcohol.

Explanation: Indeed, the message of the industry is that ordinary citizens drink responsibly and that ‘bad’ citizens drink irresponsibly and are the cause of any and all problems associated with high alcohol consumption.

This one is insidious and unscientific. There is no evidence that alcoholics are “bad people,” or simply unwilling to stop engaging in bad behavior. For the industry, irresponsible drinkers are a major revenue source—the dream customer— even though alcohol manufacturers continue to insist that their advertising is primarily about driving home the message of responsible alcohol consumption and brand choice.

Message 3: Normal adult non-drinkers do not, in fact, exist.

Explanation: Only children under 16 years of age, pregnant women and motorists are recognized by the industry as non-drinkers.

My personal favorite, this one. The existence of non-drinkers is seen by the industry as a threat. Accordingly, they have subtly reinforced the message that moderate drinking is not only normal, but also good for you. Never mind that the real profits come from excessive drinking and pricing strategies that encourage it. Estimates vary, but recent studies  at UCLA show that “the top 5% of drinkers account for 42%of the nation’s total alcohol consumption.” If 5% of all drinkers account for nearly half of total alcohol sales, it would be folly for the alcohol industry to get serious about encouraging moderation. It’s not too far off the mark to say that the alcohol industry’s quarterly statements hinge on the success they have in encouraging alcoholics to believe that everything’s okay, everybody drinks that way. The message becomes clearer: Drinking is mandatory—unless you’re a deviant.

Message 4: Ignore the fact that alcohol is a harmful and addictive chemical substance (ethanol) for the body.

Explanation: The industry does not draw attention to the fact that alcohol (ethanol) is a detrimental, toxic, carcinogenic and addictive substance that is foreign to the body.

Naturally, pointing out the neuroscientific parallels between alcoholism and heroin addiction is not part of the message. Alcohol is a hard drug—ask any addiction expert. Alcoholism can kill you quick. But so far, the labeling mania that struck opponents of Big Tobacco has not played out in a major way in the battle against deceptive alcohol advertising.

Message 5: Alcohol problems can only be solved when all parties work together.

Explanation: Good, effective policies to combat alcohol consumption would require a higher excise-duty, no marketing or sponsoring, an increase in the drinking age to 18, a prohibition of the illegitimate sale of alcohol, and an increase, through a campaign, in the public’s awareness of the damages that alcohol can cause (Babor et al, 2010; WHO, 2009).

Obviously, these bullet points are not high on the alcohol industry’s agenda.

Message 6: "Alcohol marketing is not harmful. It is simply intended to assist the consumer in selecting a certain product or brand."

Explanation: Meanwhile, research has indisputably demonstrated that alcohol advertisements are both attractive to young people and stimulate their drinking behavior (Anderson et al., 2009: Science Group of the Alcohol and Health Forum; 2009). Yet the industry continues to flatly and publicly deny that advertising stimulates alcohol consumption (Bond et al; 2009).

Stuffed with attractive young people meeting and mating over alcohol, it seems fair to suggest that alcohol ads had better stimulate increased drinking, i.e., a boost in quarterly sales, or else the industry is wasting a lot of money fighting over pieces of a pie that isn’t getting any bigger. These days, slow growth is no growth.


Message 7: “Education about responsible use is the best method to protect society from alcohol problems.”

Explanation: Effective measures such as a higher alcohol excise-duty, establishing minimum prices, higher age limits and advertisement restrictions can reduce alcohol related harm and will therefore decrease the profits of the industry (Babor, 2003; Babor, 2010). The industry therefore does its best to persuade governments, politicians, and policy makers that the above mentioned measures would have no effect, are only symbolic in nature or are illegitimate.

A truly great dodge, because the strategy being advertised sounds so imminently sensible. Who could be against the promotion of responsible alcohol use? Irresponsible zealots and deviants, that’s who. Why should all of us happy drinkers be made to suffer for the sins of a few rotten apples?

Indeed, all of the messages, overtly or covertly, send the same signal: You should drink more. It’s good for you.

Photo Credit: http://www.frankwbaker.com

“They’ll Drink Bucket Loads”

The subtle subterfuge of alcohol advertising.

“To own all routes to sociability; football, music, and everything else that brings the lads together, is to dominate the beer market.”

--Ad agency Mobious in Carling strategy document, 2006.

“Carling Commandments: Thou shalt never abandon your mates in favour of a girl… though shall never desert thy mates in drunken distress, thou shalt always welcome a mate’s mate.”

--Slide presentation by Hill & Knowlton advertising agency, pitching Coors for sports advertising, 2006.

“Shot used to crank up the evening, accelerate the process of getting drunk with less volume of liquid. Sense of danger. For a pleasure ride or to get blasted.”

--Slide presentation by ad agency Cheethambell JWT, 2003.

When the U.K.’s House of Commons Health Select Committee ordered up a report on alcohol last year, the resulting paper once again put the alcohol industry in the spotlight, after researchers at the University of Stirling gained access to a treasure trove of documents from four alcohol companies and their ad agencies. 

The title of the report—“They’ll Drink Bucket Loads of the Stuff”—comes from a “creative brief” prepared by the Cheethambell JWT ad agency in 2005 for the makers of Lambrini, a sparkling pear drink with a kick (7.5 % alcohol by volume) that is popular with young women:

Drinking starts early! Early afternoon at the weekend or straight after work Monday to Friday meeting your girly mates and getting on it is the only way forward…. A light, easy to drink, affordable ‘wannabe’ wine that gets their nights out or in off to a good start. They’ll drink bucket loads of the stuff and still manage to last the duration.

As in the U.S., the U.K. government has a love-hate relationship with the alcohol industry. The flashpoint for disagreement, in many cases, is advertising. Druglink (PDF), a magazine for drug treatment professionals and the criminal justice community, published its analysis of the report in the January/February 2011 issue. Editor Max Daly argues that the alcohol industry in the U.K. is adopting “a similar strategy to that used amid mounting regulation of cigarette advertising 30 years ago.”  Under increasing regulatory pressure, cigarette ads “became more and more elliptical and imaginative as the codes on content were tightened.” The supposedly restrictive advertising codes imposed on cigarette manufacturers simply “honed the advertiser’s skills—either in camouflage or creativity.”

Daly also points to a report on the use of social networking sites to promote alcohol use, prepared by Scottish Health Action on Alcohol Problems, an independent medical advocacy group. Facebook and other sites, the report warned, are being colonized by alcohol promoters “due to the youth appeal of these sites, the difficulties associated with enforcing age restrictions, the relative lack of regulation and the sheer volume of promotional messages. The extensive use of new media to market alcohol represents a proliferation of alcohol branded messages directed at consumers.” 

 In the U.S., Bacardi-branded Mojito Party apps were installed by more than 100,000 Facebook users in 2008. Brewing giant Anheuser-Busch hosts a “VIP micro-site” on Facebook as well. 

A few months earlier, the British Medical Association called for a thoroughgoing ban on alcohol advertising more in line with restrictions on tobacco advertising.

 The Health Select Committee’s report was met with a “furious response” by the alcohol industry, according to Daly. Simon Litherland, managing director of alcohol maker Diageo GB, claimed that “inappropriate consumer views and early proposals” were part of early marketing consultations and were subsequently rejected.

Perhaps because there were no outright examples of law breaking, or perhaps due to a change in U.K. government four months after the report was made public, “They’ll Drink Bucket Loads of the Stuff” has evidently disappeared, leaving few tracks for others to follow. As Daly concludes in the Druglink feature, “whichever political party is at Number 10, there will not be the stomach for a fight with such a powerful adversary as the British drinks industry.”

Photo Credit: http://weblogs.jomc.unc.edu

Swipe, Smile, Breathe: Wine Vending Machines in the USA.

Move by Pennsylvania supermarkets sparks controversy.

Pennsylvania, one of the last few states in the nation where liquor sales are state-controlled, has kicked off a plan to sell wine in grocery stores via vending machines. Consumers would need a valid I.D., a matching picture taken by an onsite video camera, and a puff of breath in the direction of a no-touch air sensor to complete the purchase.

Whether you consider this a convenient or a cumbersome way to buy your bottle of Chianti for the evening’s meal, many Pennsylvanians seem supportive, according to news reports, if only because it saves them a trip to a state-run liquor outlet. Grocery stores cannot sell wine off the shelf under the rules of the Pennsylvania Liquor Control Board (PLCB).

Japan and Europe have beer vending machines, but the two prototype machines now in Pennsylvania are believed to be the first supermarket wine kiosks in the U.S.

A spokesman for the ISSU, the union representing state liquor store managers, complained that “cigarettes are banned from being sold in vending machines in Pennsylvania supermarkets and yet Americans’ number one drug of choice will now be vended only in Pennsylvania by the PLCB.”

Putting it a bit more directly, the union’s vice president, David Wanamaker, said: “Alcohol is not a Red Box DVD—it is the most abused drug in every town, city and state in the USA.”

Keith Wallace, president of the Wine School of Philadelphia, had other objections. “The process is cumbersome and assumes the worst in Pennsylvania’s wine consumers—that we are a bunch of conniving underage drunks,” he told Kathy Matheson of The Associated Press.  Liquor board members, he added, “are clearly detached from reality of they think these machines offer any value to the consumer.”

And the CEO of the Wine and Spirits Wholesalers of America, presumably with a straight face, chipped in with concerns about the machine’s ability to prevent sales to minors.

One of the major drawbacks is that the kiosk is not really a genuine vending machine, but rather a large box full of wine bottles, attached to a camera, with a live person at the other end—a state employee in Harrisburg who approves each and every remote sale only after verifying a visual match with the photo I.D.

The wine vending machines represent “a technology kludge for bad laws,” and “an attempt to solve the age-old problem of underage drinking with new technology” according to Damon Brown at BNET.

Brown offers 3 suggestions:

--Facial recognition software—“A much more reasonable solution for the vending machines than a person sitting on the other end of a camera.”

--Program tweaks—“Japan now gives out magnetic strips that, when placed on IDs, allow customers to confirm their identity… Pennsylvania has spent money on the machines, but hasn’t come up with an elegant solution to identity.”

--Just change the law—Most state allow wine sales in grocery stores, and the earth hasn’t cleaved in twain.  This Rube Goldberg-style contraption, as the store managers union has characterized it, has yet to prove that it is worth the money.

Photo Credit: http://wduqnews.blogspot.com

Risky Drinking

 

The one-question questionnaire.

Answer: Once or twice.

Question: “How many times in the past year have you had 5 or more drinks (for men), or 4 or more drinks (for women) in a single day?"

A recent study published in the Journal of Internal Medicine strongly suggests that this simple question identifies those drinkers at risk for alcohol use disorders roughly 75 % of the time.  While the one-question screening test has been endorsed by both the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for several years, little clinical evidence existed for assuming that it worked. 

It seems weirdly unrealistic as a standard measure, leaving out, as it does, so many other telling features of active alcoholism. Nonetheless, the group at the Boston University School of Medicine that conducted the research concluded that “the single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in the sample of primary care patients.”

It seems safe to assume that the majority of people who occasionally overdrink are not alcoholics. Is the occasional binge or bender by recreational drinkers really that rare? In a research summary comment on the results, Dr. Peter D. Friedmann opens up the possibility of using the one-question screen to “facilitate more discussion of heavy episodic (binge) drinking, a major source of adverse consequences among nondependent drinkers.”

Five or more drinks, on a single occasion in the past year? Is that really sufficient data? Is a response of  >1 really a genuine cause for concern?

But it gets even stranger. In 2006, the Journal of Studies on Alcohol published a primary care validation study which showed that narrowing the criteria to one incident in three months did not significantly change the results. When the choices available were “within 3 months,” “within 12 months,” “ever,” or “never,” the 3 month and 12 month positive answers were predictive of risky consumption levels about 75% of the time in a study of 625 patients.

One conclusion to be considered is that “normal,” non-alcoholic drinking males rarely—if ever—consume more than 5 drinks in one evening (4 for women). For heavier drinkers, this seems an impossibly Puritan standard, and useless as a diagnostic tool.  As usual, more studies are needed. But the authors of the 2006 paper were confident enough to conclude: “A single question about the last episode of heavy drinking is a sensitive, time-efficient screening instrument that shows promise for increasing alcohol screening in primary care practices.”

Photo Credit: http://talesblog.com/2008/07/19/highlights-of-tales-so-far/

Rules for a Night of Serious Drinking

Simple moves to dodge a hangover.

Let's face it: Despite all the folk remedies--ginseng, prickly pear extract, peanut butter, miso soup, and Vitamin B6, there really is no cure for a hangover except more alcohol.

However, there are things you can keep in mind when contemplating a night of serious drinking. What you do while you are drinking can mitigate or exacerbate the effects of the Day After. The following list was adapted from a post by the folks over at the Nursing Schools Network and Directory and used with their kind permission.

--If you're in it for the long haul, consider alternating an alcoholic beverage with a non-alcoholic drink. The reward for this is continual hydration, which helps offset the tendency of alcohol molecules to replace water molecules in the cells.

--Choose your liquor carefully. Red wine and cheap dark booze have more congeners, which are organic molecules that can contribute to a hangover. ML01, a genetically-modified yeast, is being touted as a way of cutting back on the headaches commonly associated with a night of red wine.

--Keep Count. When you lose count, it's time to stop. Know your measure.

--Skip the Sugar. Sweet drinks mess with your blood sugar level even more than regular drinks.

--Keep the smoking to a minimum. You'll need your oxygen come morning.

--Don't diss the bar and cocktail snacks. Foods high in fat well help absorb excess alcohol.

--Skip the Tylenol and Ibuprofen before going out. They probably won't help, and the combination with alcohol taxes the liver.

--Drink water. And keep drinking water. Morning-after dehydration causes many of a hangover's lingering effects.

--Stop drinking an hour before you go to bed. Better to nod off than to pass out, and you will have a better chance of sleeping through the night.

Picture Credit: www.ehow.com

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1 in 25 Global Deaths Linked to Alcohol

Vodka kills more Russians than war, Lancet reports.

A team of researchers at the University of Toronto reported in Lancet that 3.8 % of global deaths could be attributed to alcohol. In Europe, the report stated, the rate of premature death from alcohol was 1 in 10 during 2004, the year studied. And in a related study, more than half of all premature deaths among adult males in Russia were attributable to booze.

The world health care burden, as spelled out by Dr. Jurgen Rehm and others at the University of Toronto, is staggering: “The costs associated with alcohol amount to more than 1% of the gross national product in high-income and middle-income countries, with the costs of social harm constituting a major proportion in addition to health costs.”

In a BBC News report,the study authors warned that the worldwide effect of alcohol-related disease was similar to that of smoking in prior decades. The report takes note of prior research indicating a health benefit from moderate drinking, stressing that any purported benefit is “far outweighed by the detrimental effects of alcohol on disease and injury.”

The Lancet study concludes that the overall mortality figures are “not surprising since global consumption is increasing, especially in the most populous countries of India and China.”

Professor Ian Gilmore of the Royal College of Physicians, quoted by the BBC, called the report “a global wake-up call,” and urged the adoption of “evidence-based measures” for reducing alcohol-related harm, such as price increases and advertising bans. “Many countries are investigating new ways to cut deaths and disease and reduce the burden on health services by using the price of alcohol to lower consumption,” Gilmore said. Pricing strategies have been used effectively in the past to lower cigarette consumption, researchers have noted.

In one of the Russian studies, Professor Richard Peto of the University of Oxford led a statistical analyses, concluding: “If current Russian death rates continue, then about 5% of all young women and 25% of all young men will die before age 55 years from the direct or indirect effects of drinking.” The Russian figures are also affected by the high rate of associated smoking in the former Soviet Union.

Peto added: “When Russian alcohol sales decreased by about a quarter, overall mortality of people of working age immediately decreased by nearly a quarter. This shows that when people who are at high risk of death from alcohol do change their habits, they immediately avoid most of the risk.”

Photo Credit: www.adaweb.net

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Raise the Bottom--Book Review

Recognizing alcoholism in the workplace.

In addition to all the other damage they do, alcoholics can literally cost businesses a fortune, says marketing consultant Arthur M. Jackson in his new book, Raise the Bottom. As a means of helping employers identify the problem, Jackson offers a checklist of early, middle and late-stage alcoholic behaviors, from drinking everyone under the table, to blame games, to personal financial problems.

The litany is at times simplistic, and the book is written in the Kenneth Blanchard “One-Minute-Manager” style of easily digestible business books, with a fictional senior consultant doling out data to his fictional protégé. Nonetheless, the author manages to impart some useful information, and draws attention to a problem most people choose to avoid or ignore—the toll active alcoholism takes on workplace efficiency and trust.

Physical early warning signs to watch for, Jackson writes, include a family history of alcoholism, “pre-drinking” before social functions, frequent lying, and cigarette smoking (a majority of alcoholics smoke cigarettes). These are all valid potential red flags, but often difficult to discern in a workplace setting.

Alcoholism is more likely to show itself in the middle stage, when “quotas go unmet, goals unachieved, and promises not kept.” At this stage, bosses and managers are likely to help the alcoholic with his excuses, agreeing that he or she is having an “off year,” or “problems at home.” Indeed, multiple divorces and increasing financial difficulties often accompany the progression of addictive disease.

The author leaves no doubt about where he stands on the disease debate: “We don’t punish someone for having a disease. We separate the alcoholic behavior from the alcoholic... The maladaptive and negative behaviors, and the poor business results following from them, must face direct consequences or they will continue.”

Two other maladaptive behaviors characteristic of the middle stage are “sexual exploitation” and “road rage,” writes Jackson. As odd as this may sound, I think the author is right here. Both behaviors—compulsive promiscuity and episodes of instinctual rage--can be seen as impulse control problems, which alcoholics often exhibit.

As the middle stage increasingly leads to poor job performance and declining results, “the downward slide of the progression begins to be noticeable to others, although the cause—alcoholism—is still well hidden most of the time.” The presence of the “pink elephant in the office” goes unaddressed—and things get worse.

Sensibly, the author notes that a single DUI or DWI does not prove the case for alcoholism. However, landing a second DUI, or continuing to regularly drink while driving, may be another matter entirely.

Jackson is a firm believer in early intervention on the part of friends, family, and coworkers. Moreover, “The job lever—the risk of losing his job because of alcoholism—can have a crucial effect.” Jackson’s two-word prescription: “Stop enabling.” By recognizing potential alcoholism and moving toward treatment rather than turning away, workers can break through the conspiracy of silence and help “raise the bottom” for alcoholics--saving their jobs, their relationships, and often their lives.

Photo Credit: http://www.freshknowledge.co.uk/

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Alcohol and HDL levels

Should Middle-aged Men Stop Drinking ?

Heavy drinking and age don't always mix very well, despite the alleged beneficial health effects of taking just a single drink per day. Now comes news that, for men in their 50s, even high levels of the protective HDL type of cholesterol will not shield them from the ravages of high blood pressure if they are heavy drinkers.

A recent Japanese study of more than 21,000 men suggests that even HDL cholesterol, the so-called “good” cholesterol, does not protect drinkers from high blood pressure once they reach their 50s.

High blood pressure is a known side effect of excessive drinking, but in 20-something drinkers, healthy levels of HDL, or high-density lipoprotein, help protect young men from developing high blood pressure due to excessive intake of alcohol. According to the paper, published in the September issue of Alcoholism: Clinical and Experimental Research, “The blood pressure of middle-aged men is elevated by alcohol drinking independently of blood HDL level and is more sensitive to drinking than is the blood pressure of young men.”

In other words, a man’s blood pressure become more sensitive to alcohol as he ages, regardless of his HDL levels. The research, undertaken at the Hyogo College of Medicine, demonstrated that men of any age cannot escape the likelihood of higher blood pressure if they are moderate to heavy drinkers. But for aging men, the problems are much greater. Even keeping their good cholesterol number high will not protect them from soaring blood pressure, if they continue to drink heavily in their 50s.

While men with the lowest HDL levels consistently showed the lowest blood pressure overall, the finding “fits well with the observation that the risk of stroke—which is more sensitive to blood pressure than heart attack—is not really substantially lower in moderate drinkers,” according to Dr. Kenneth Mukamal of the Harvard Medical School. 

Add to that the likelihood that moderate to heavy drinkers in their 50s are also likely to be cigarette smokers, and more likely to be overweight, and high blood pressure in 50-something men becomes all too easy to understand. The lifestyle changes required to do something about it are as obvious as they are profoundly challenging.

Graphics from: http://www.upei.ca/~stuserv/alcohol/effectsonbody.htm