Wednesday, July 16, 2008


The study of alcohol abuse is vast. This Family Journal piece will present a synopsis of the research, and includes well-researched “self-tests” you can take. These self-screenings are the first line of defense against alcohol abuse and will force you to honestly think about your drinking behaviors. Clinics often conduct free and confidential alcohol screenings, usually a written self-test along with an interview with a health professional.

Researchers are trying to increase our understanding of why, how, and when people drink, and why and how some people develop alcohol use disorders. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) developed a Five Year Strategic Plan for Research FY08-13, which can be found on their website at: The following is a synopsis of their findings:

Alcohol across the age span:
1. Midlife: Researchers consider “Midlife” to be between the ages of 30–59. This age period is where the consequences of heavy drinking often become evident. Alcoholic liver disease, alcohol pancreatitis, several types of cancer, disorders of the heart and circulatory system, alcohol-related brain disorders, and other adverse effects upon the endocrine and immune system are most likely to emerge. Researchers are studying how alcohol damages body tissues, as well as methods for better tailoring treatments and interventions to this segment of the population.

Individuals in midlife are more likely to seek treatment for alcohol dependence. Three drugs—disulfiram, naltrexone, and acamprosate—have been approved for use in the United States to treat alcoholism. Although some patients have responded well to these medications, others have not. Research shows that a variety of factors—both biological and social— influence an individual’s response to therapy.

2. Senior Adults: Once in their 60’s, senior adults tend to drink less. However, senior adults drinking is on the rise and studies show that alcohol problems in older adults soon may become a national health issue. Little alcohol-related research has been conducted among this age-group. Researchers are exploring how the physiological and social changes in seniors interact with alcohol use. Increasingly, they’re studying the effectiveness of current medications in seniors with alcohol use disorders, as well as developing medications that might work better in older individuals. Particularly, much funding goes to studies of how alcohol impacts the development of diseases such as Alzheimer’s, type 2 diabetes, and other age-related health problems. Ongoing research will reveal how changing demographics may affect the use, impact, and consequences of older adult drinking. Alcohol-related problems increase for older adults as well.

As individuals age they metabolize alcohol more slowly; as a result, alcohol remains in the body longer. Older adults are more likely to have health conditions that can be exacerbated by alcohol, including stroke, hypertension, neurodegeneration, memory loss, mood disorders, and cognitive or emotional problems. Additionally, older adults are more likely than younger people to take medications, putting them at risk for interactions that can be dangerous or even life-threatening. Alcohol also may decrease effectiveness of some medications.

Research shows that treatment can be effective in older individuals because they respond better to treatment that takes place in groups of people in their same age range. Cognitive behavioral therapy has been shown to be effective in older patients. Group family therapy also has been shown to be successful, perhaps because family therapy engages support systems that might have been lacking or even exacerbating the patient’s alcohol use.

Studies reveal that education is the most beneficial treatment for alcohol use disorders in older adults. The age at which they begin drinking also is important. Older adults who began problem drinking earlier in life tend to have worse treatment outcomes than those who began drinking later in life.

What about Moderate Alcohol Consumption?
Moderate drinking is, obviously, less of a health risk than heavy alcohol consumption. In fact, some research suggests that moderate alcohol consumption may protect individuals from some of the health problems that tend to strike during midlife, including coronary artery disease, type 2 diabetes, dementia, and ischemic stroke. However, more research is needed to determine whether these potential benefits outweigh the risks of drinking {NIAAA and National Institute of Health (NIH)}.

What do studies show about medications to treat alcohol abusers?
Disulfiram, naltrexone, and acamprosate are now used and are highly effective with some patients but ineffective in others. Research reveals that drinking and alcohol-seeking behavior are influenced by multiple neurotransmitter systems, neuromodulators, hormones, and intracellular networks. New medications will be developed to target these sites.

Unfortunately, a disconnect exists between research and practice regarding the use of medications to treat alcohol abusers. For example, many physicians while few drug/alcohol counselors suggest patients take naltrexone. This medication helps reduce the frequency of drinking and the severity of relapse among alcohol-dependent patients. True, there are occasional reports of no effects, but large-scale analyses of clinical trials have continued to support an improvement in treatment outcomes with the use of this naltrexone (Kranzler, H.R., and Van Kirk, J. Efficacy of naltrexone and acamprosate for alcoholism treatment: A meta-analysis. Alcoholism: Clinical and Experimental Research 25:1335–1341, 2001).

Conclusion of 5-year NIAAA plan
Researchers will explore how alcohol affects individuals at different stages of development and how different stages of development affect drinking behaviors. NIAAA’s Lifespan Perspective offers a new approach to the age-old question: Why do some people drink too much? They’ll focus in on how alcohol intersects with one’s biology and the environment, which will result in more effective and better-targeted interventions that take into account the changing needs of individuals at every stage of life.

What about alcohol abuse between ethnic groups and minorities?
National surveys show alcohol consumption and alcohol-related problems among White Americans have declined since the mid-1980s (Caetano, R., and Clark, C.L. Trends in alcohol consumption among Whites, Blacks and Hispanics: 1984 and 1995. Journal of Studies on Alcohol 59:659–668, 1998). At the same time, however, alcohol consumption and alcohol-related problems have remained stable or even increased among Blacks and Hispanics. Studies also show that, for any given level of alcohol consumption, ethnic minority populations experience more negative health and social consequences of drinking (unemployment, poor education outcomes, and alcohol-related legal problems) than Whites (Boyd, M.R.; Phillips, K.; and Dorsey, C.J. Alcohol and other drug disorders, comorbidity, and violence: Comparison of rural African American and Caucasian women. Archives of Psychiatric Nursing 17:249–258, 2003).

How much alcohol consumption is too much?
Men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits (National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide. NIH Pub No. 05–3769. Bethesda, MD: the Institute, 2005).

Have you ever really contemplated whether you were consuming too much alcohol or not? Here's some self-assessments you can do on yourself, in private. The first of two self-questionnaires is the CAGE, which will make you more aware of the extent to which alcohol consumption is or is not affecting your life. The CAGE identifies alcohol problems over your lifetime and is commonly used to screen in primary care settings. It is short and easy to remember and has been highly researched and shown to be reliable for detecting a range of drinking problems. Begin your self-assessment by honestly answering the four CAGE questions below:

C Have you ever felt you should cut down on your drinking?
A Have people annoyed you by criticizing your drinking?
G Have you ever felt bad or guilty about your drinking?
E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Two positive CAGE responses are considered a positive test and indicate further assessment is warranted. You may want to take the second self-assessment below called the Alcohol Use Disorders Identification Test (AUDIT):

With the Alcohol Use Disorders Identification Test (AUDIT), simply circle the answer below that is correct for you:
1. How often do you have a drink containing alcohol? a. Never b. Monthly or less c. Two to four times a month d. Two to three times per week e. Four or more times per week

2. How many drinks containing alcohol do you have on a typical day when you are drinking? a.1 or 2 b. 3 or 4 c. 5 or 6 d. 7 to 9 e.10 or more

3. How often do you have six or more drinks on one occasion? a. Never
b. Less than monthly c. Monthly d. Two to three times per week
e. Four or more times per week

4. How often during the last year have you found that you were not able to stop drinking once you had started? a. Never b. Less than monthly
c. Monthly d. Two to three times per week e. Four or more times per week

5. How often during the last year have you failed to do what was normally expected from you because of drinking? a. Never b. Less than monthly
c. Monthly d. Two to three times per week e. Four or more times per week

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? a. Never
b. Less than monthly c. Monthly d. Two to three times per week
e. Four or more times per week

7. How often during the last year have you had a feeling of guilt or remorse after drinking? a. Never b. Less than monthly c. Monthly d. Two to three times per week e. Four or more times per week

8. How often during the last year have you been unable to remember what happened the night before because you had been drinking? a. Never
b. Less than monthly c. Monthly d. Two to three times per week d. Four or more times per week

9. Have you or someone else been injured as a result of your drinking? a. No b. Yes, but not in the last year c.Yes, during the last year

10. Has a relative or friend, or a doctor or other health worker, been concerned about your drinking or suggested you cut down? a. No b. Yes, but not in the last year c. Yes, during the last year

The Alcohol Use Disorders Identification Test (AUDIT) can detect alcohol problems experienced in the last year. A score of 8+ on the AUDIT generally indicates harmful or hazardous drinking.
How to score your AUDIT responses: Questions 1–8: a = 0, b =1, c = 2, d = 3, e = 4 points. Questions 9 and 10: a = 0, b = 2, or c = 4 only

If you answered “Yes” two or more questions on the CAGE and scored 8+ on the AUDIT, perhaps you should consider seeking help to better control your alcohol consumption.

Watch the four videos on alcohol abuse and take the Alcohol Poll in the right margin. Also, read "Hot Off The Press", which has daily Ohio newspaper headlines covering the topic of alcohol abuse in Ohio.