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01/07/2008 - Screenings for Alcohol
Alcohol use accounts for approximately 85,000 US deaths per year, making it the third ultimate preventable cause of death. Only tobacco use and obesity account for more deaths in this category.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has set recommended maximum daily and weekly amounts of drinking for healthy adult men and women based on epidemiological studies of drinking-related morbidity and mortality that indicate what level of consumption carries increased medical risk.
- Healthy men ages 21-65 years should have no more than 14 drinks/week and no more than 4 drinks/day.
- Healthy women and men over 65 should consume no more than 7 drinks/week and no more than 3 drinks per day.
- Individuals who drink more than these limits are at risk for harmful consequences.
All patients should be screened for heavy drinking. This can be achieved easily by asking a single screening question that determines the frequency of heavy-drinking days, for example: "How many times in the past year have you had 5 or more drinks in a day (4 or more in a day for women)?"
Exceeding the daily limits once a month or more is associated with an increased risk of having an alcohol use disorder.
Abuse and dependence differ in the specific types of problems they set as criteria: abuse is characterized directly by adverse consequences, whereas criteria for dependence include not just consequences, but also behavioral factors that suggest a compulsive pattern of use, loss of control, and physiological tolerance.
To be diagnosed with alcohol abuse, a patient must have a maladaptive pattern of alcohol use leading to clinically significant distress or impairment and demonstrate one or more of the following within the previous 12 months.
- Use of alcohol in situations where it is physically dangerous, such as while driving a car or hunting.
- Failure to fulfill major role obligations at work, school, or home. Classic examples would include missing school or work because of hangovers related to excessive drinking, or failing to fulfill household obligations because of alcohol.
- Recurrent alcohol-related legal problems, such as "drunk and disorderly" citations.
- Continuing to drink alcohol despite the fact that it persistently or recurrently causes or exacerbates social or interpersonal problems.
The diagnosis of alcohol dependence, in contrast to alcohol abuse, is focused more on symptoms of compulsive use and loss of control.
Criteria for Alcohol Dependence (3 of 7 criteria met within one year)
- Repeatedly unable to cut down or abstain
- Repeatedly goes over limits
- Spends a lot of time on it
- Decrease involvement in other activities
- Persistent psychological or physical consequences
- Tolerance
- Withdrawal
If both abuse and dependence criteria are met, the diagnosis of dependence takes precedence.
There are problems with the current approach to diagnosing alcohol use disorders. Not all heavy drinkers meet the criteria for alcohol use disorders: only 41% of individuals who exceed the recommended levels of intake daily or near daily meet the dependence criteria, and only 16% meet the criteria for alcohol abuse.