2006-01-13

Health & Intolerance: Alcohol Abuse Tests

Mr.Charles Kennedy's fall from power is a graphic example of the toll that drinking all too often exacts on the one-in-20 people in the UK who are thought to be addicted to alcohol. Mr.Kennedy has finally taken the crucial step of acknowledging that he has a problem but, if he drinks as heavily as reports suggest, then tackling it effectively is likely to involve more than a 'chat with my GP and some vitamin C'. 'Denial' and 'ambivalence' are common among heavy drinkers, who often refuse to admit that their drinking is damaging their physical or emotional welfare. If you drink steadily throughout the week and average no more than the equivalent of three bottles of wine in seven days (two for a woman) then you are unlikely to come to much harm. The problem drinkers I see fall into two very different patterns of consumption -- they either drink in occasional 'binges' until drunk, or consume large amounts on a regular basis. Government guidelines suggest that any more than 21 units a week for a man or 14 units a week for a woman is a 'serious' amount of alcohol. But I use different thresholds for identifying patients most at risk, and rely on a more realistic guide as to how many units their drinks may actually contain. Conventional wisdom has it that a bottle of wine contains six units, but that's based on wines that are just nine per cent alcohol. Drink a modern white, which contains more like 13 per cent, and you'll be consuming ten units a bottle. The same goes for beer, cider and lager, with some of the stronger brews containing four to five units a pint rather than the standard two. If a man is drinking 35 units a week -- that's half a bottle of white wine a night or two to three pints of normal-strength beer a day -- then he is likely to be doing physical harm. If he is drinking more than 50 units -- that's a bottle of wine five days a week, or 25 pints across the week -- then it's not a matter of if he is going to come to harm, so much as when. The thresholds for women are lower at 22 and 33 units respectively to reflect their smaller size. I tend not to worry so much about units when it comes to 'binge drinkers', and concentrate more on their behaviour. Although occasional heavy 'binges' can lead to long-term alcohol-related liver disease and other complications such as brain damage, heart disease and internal bleeding, 'binge' drinkers tend to be troubled more by the short-term implications of their habit -- everything from practising unsafe sex and losing their driving licence to getting into fights. Much is often made about the type of alcohol a person drinks. Hardened drinkers go for 'bangs-per-buck'. Sherry, strong lagers and ciders are often the cheapest way to get drunk and are popular among drinkers with a finite budget. Spirits are another popular choice because they are easy to conceal and only need to be drunk in small volumes. But I have met alcoholics who drink nothing but the finest claret, and 'near teetotallers' who only ever drink shorts on their infrequent visits to the pub. So, if you can't spot a problem reliably by the type of alcohol someone drinks, or the amount they consume, then what should you look for? The CAGE or fast alcohol screening test (FAST) -' see below -' are useful indicators that will pick up most problem drinkers. Answering yes to two or more questions on CAGE, or scoring more than three points on FAST, indicates a potential alcohol-related problem and should be a prompt to discuss your habits with your doctor. A chat with a GP can be surprisingly effective and is all that is required for many people - studies suggest that just ten minutes with a GP can cut alcohol consumption by 25 per cent -- but drinkers with a more serious problem can benefit from expert intervention and referral to a local NHS specialist team. Once under the care of such a team, there is a wide range of different approaches that can be used to help - everything from in-patient detoxification programmes to implants and drugs that help reduce craving and encourage abstinence.
  • Contact Drinkline on 0800 917 8282 for free and confidential advice on what to do if you have a drink problem, or for guidance on what to do if you are concerned about somebody else's drinking.
TEST YOUR CONSUMPTION
THE CAGE QUESTIONNAIRE C -- Have you ever felt you should cut down on your drinking? A -- Have people annoyed you by criticising your drinking? G -- Have you ever felt guilty about your drinking? E -- Have your ever had an eye-opener drink in the morning to steady your nerves? Answering yes to two or more questions suggests hazardous drinking.
FAST ALCOHOL SCREENING TEST (FAST) One drink= One unit (one very small glass of wine, half a pint of beer or cider, or a pub measure of spirits).
  • Men: how often do you have eight or more drinks on one occasion? Women: how often do you have six or more drinks on one occasion?
Never - 0; less than monthly - 1; monthly - 2; weekly - 3; daily or almost daily - 4
  • How often during the past 12 months have you been unable to remember what happened the night before because of drinking?
Never - 0; less than monthly - 1; monthly - 2; weekly - 3; daily or almost daily - 4
  • How often during the past year have you failed to do what was normally expected of you (work, social engagements, etc) because of drinking?
Never - 0; less than monthly - 1; monthly - 2; weekly - 3; daily or almost daily - 4
  • Over the past year, has a relative, friend or physician (or other health worker) been concerned about your drinking and suggested cutting back?
No - 0; Yes, on one occasion - 2; Yes, on more than one occasion - 4 A total score of more than three suggests hazardous drinking. 'Are you drinking too much?', Dr Mark porter, The Scotsman, 2006-01-12

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