Search for tag: "alcoholism"

Interviewer: What is the fine line between a few drinks to relax or blow off steam and a potential alcohol abuse problem?

Dr. Troy Madsen is an emergency room doctor at University of Utah Health. Dr. Madsen, I hear that doctors have a series of questions that they ask patients, and it's pretty accurate at indicating if somebody has a potential alcohol use problem.

Troy: We do have a screening tool we use. We all learn this in medical school, and it is something that we will then use in our practice, is a quick screen to say, "Does this individual potentially have an alcohol use disorder that we should look into further and ask some more questions and see, 'Well, how much are you drinking? Do you need some help?'"

This is a tool that's called the CAGE questionnaire. So the first C, the C stands for cut down. Have you ever felt you need to cut down on your drinking? The A is annoyed. Have people annoyed you by criticizing your drinking? So, for each of these, you get a point if you answer yes. G is for guilty, G of CAGE. Have you ever felt guilty about drinking? And E is for an eye-opener. Have you ever felt you need a drink first thing in the morning or an eye-opener to steady your nerves or get rid of a hangover?

Now, if you answer yes to two of those questions, so if you have a score of 2 or higher, it has a 93% sensitivity for identifying excessive drinking and a 91% sensitivity for identifying alcoholism. That means it's a pretty good tool for potentially identifying individuals who may be needing some help, again, just answering yes to two of the four CAGE questions.

Interviewer: When you say over 90% accuracy that that person may have a drinking problem, this is research supported?

Troy: It is. Multiple studies. This CAGE questionnaire has been around for many, many years, decades. They've got studies going back into the '80s on this. So it's something that's been studied over many, many years, many, many people.

If you're answering yes to two or more of these . . . let's say you've had people tell you, "You really should cut down," and let's say people are critical of you, you get annoyed by it, if you've got two of those four, that's potentially a sign that maybe you need some help. Maybe you do have an alcohol use disorder.

Interviewer: What if you just have one? Is that supported by the research? Does that necessarily mean anything?

Troy: So that's considered a negative screen. So, if you just had one . . . let's say you felt guilty about your drinking, so you got the one point there, but you didn't answer yes to any of those others. It's like, "Well, no one has ever told me I should cut down. I've never really felt annoyed. I don't really need an eye-opener in the morning to take care of a hangover," so if you just get the one, technically, that doesn't get you a point.

Obviously, there are a whole lot of other variables that play into this, like who you are hanging out with. If you're hanging out with people who are drinking a lot, they're probably not criticizing your drinking and you're probably not getting annoyed by it. So it's one of those tools where it's not a perfect tool.

The advantage of this tool is just something quick that we can do as healthcare providers. It's a quick screen. Just talking through those questions took us maybe 30 seconds. And if you're getting a score of 2 or higher, it doesn't mean you have an alcohol use disorder. It just means, "Let's do some additional screening to see if that's potentially an issue."

Interviewer: It's pretty amazing how accurate the CAGE questionnaire is, but is that where doctors stop, or are there some additional questions that a doctor might ask, or is there an additional resource that a patient could go to on their own to find out a little bit more information?

Troy: There's something called the AUDIT questionnaire, and if you search for that, you can find it online, but that goes through in more detail about getting into exactly how many drinks you have per week, how many you have at once, and getting into the whole binge drinking thing.

And some of those CAGE questions, it kind of goes through some of those again as part of it, but it's a 10-question questionnaire and that really then breaks things down by a score to say "Are you a medium risk? Are you a high risk? Are you at a point where addiction is likely?"

So it's an additional questionnaire. We don't need to go through all the questions on it, but I think that can be helpful as the next step to potentially see, "Is there an issue that I should get some help for, or where are things right now?"

Interviewer: And if somebody has taken the test and they're thinking, "Wow, maybe I should look at getting some help or I would like to get some help," what would the next step be? Because that seems like it could be intimidating.

Troy: If you're looking for inpatient treatment where you need inpatient detoxification and you need medically-assisted treatment to be able to just reduce your drinking or cut off from drinking, it's something you can talk to your doctor about. I think, regardless, I'd talk to your doctor, but they can help set those things up for you. There are many community resources available for that as well.

In some people, it's just the sort of thing where they just reach a point and they just say, "I need help, and I need it now, and I need to make this happen, and I don't have time to wait on that." We see those individuals in the ER on a regular basis. You can come in. We can talk to you about options. In some cases, we admit people to the hospital for this if they are in withdrawal and they have severe symptoms. I'd say I admit people for this . . . it's a weekly thing for me where I'm admitting patients for this.

So, with any substance use disorder, I think the important thing is just reaching out for the help. And I think that's the hardest part, taking that initial step, but if you can reach out to family and say, "Hey, I've got an issue. I need help," I think that's . . . it's a huge thing just to be able to do that. Then you take it from there and you'll get the help you need as long as you just keep pushing forward.

Interviewer: You have somebody in your life who is entering the alcohol recovery process or is in recovery and you want to be supportive but some of the things you say might actually be harmful.

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Interviewer: We're talking with Dr. Jason Hunziker, psychiatrist at the University of Utah. Dr. Hunziker, people who are recovering from alcohol addiction, it's a really hard process and they need all the support they can get.

Dr. Hunziker: The choice to go into recovery is a big deal for everyone who does it. It's a very difficult process and it does take a lot of support not only internally but from people in the environment and from systems that help people enter the recovery process. We do have to be careful however what we say to people as they are getting ready to enter that process and as they are in that process so that we can motivate them to stay sober and make this big change in their life.

Some of the things I recommend that we don't say are things like, "Hey you can have just one, and it's not going to hurt anything." That clearly is not going to be helpful to somebody who is telling you that their life has been destroyed by alcohol. That's sets you up for failure in your process and in your program and so that's something that should be avoided.

Interviewer: So what are some other things that people say sometimes that you think are supportive but really aren't?

Dr. Hunziker: Somebody is in the program and you think you're being supportive by visiting them and then you say, "You know I'm glad you're doing this right now. It's a good time for you to do this but one day you're going to be able to drink again."

Interviewer: Really? They say that?

Dr. Hunziker: Yes, and again that is not something that is helpful at all to maintain the sobriety that they're looking for. When you stop, you still have the addiction. You just choose now not to use. And I use the word choose pretty lightly because if it was that easy to quit, everybody would just quit. So they make the decision to everyday get up in the morning and realize that they're not going to use and then go through that day not using even though they still have some cravings, they still have some desires and they still fight that impulse to go get some alcohol.

Interviewer: Okay, what are some other things that people might say?

Dr. Hunziker: Other things people say when they don't realize you don't realize you're an alcoholic at all they'll say, "Wait a minute. I see you go to work every day. You have a job. You're still making money. How can you be an alcoholic?" They think that just because you can function that you're not an alcoholic. But that still does not mean that this does not interfere with other aspects of your life.

Some people will say when you've been in the process for a long time and you've been going to your recovery meetings and you haven't had a drink they'll say, "Aren't you done yet? I mean, you've been doing this for years, shouldn't you be cured already?" There's no cure. I mean the cure is to not drink and the only way to not drink is to get positive support and to be actively making sure that doesn't happen.

Interviewer: Okay, any other things that people might say they think are supportive to a recovering alcoholic but might not really be that supportive?

Dr. Hunziker: Well I think sometimes people want to down play or minimize the alcoholism in the other person's life and so they will say things like, "Well I eat food every day, that doesn't make me addict so how could you be an addict?"

Interviewer: Because those two things are so comparable.

Dr. Hunziker: Exactly, exactly. So clearly our words are very important when somebody has made the decision to go into recovery and we need to choose those words carefully. We don't shy away from having conversations but I don't think we want to interfere and actively seek out information about the alcoholism. If somebody wants to give it to us, great. Let's listen, let's be supportive but if you start asking a lot questions people feel like you're being intrusive and then when you're intrusive it sets them up for failure.

Interviewer: So what are the words and the conversations that you can say to recovering or you should be saying to a recovering alcoholic?

Dr. Hunziker: It's not so much what you say all the time but some of the things that you do. Be available so if they call you in the middle of the night you don't say, "Oh, you're just drunk again" or " Oh, here it goes again." You're supportive, you're available, and you're encouraging them to use you as a support system so they don't go drink. Other things, you stay positive. Keep giving them encouragement all the time because it is a difficult process.

I mean you could imagine if you had to give up something you really enjoyed doing even if you didn't really think it was causing you that much problems. So you want to make sure that you're positive and they get encouraged by you so they will continue to fight the addiction.

Interviewer: So say you know someone who is thinking, who is considering the recovery process, what can you say to them to kind of motivate them to enter it?

Dr. Hunziker: You know I think normally what you want to do is have them think about how this helps them or doesn't help them. If you can say to them, "Okay, let's make a list of how alcohol helps you in your life, and then let's make a list of how alcohol hurts your."

Interviewer: Doesn't help you in your life.

Dr. Hunziker: Exactly, exactly.

Interviewer: Pros and cons.

Dr. Hunziker: And then people can look at that and then you can provide motivation based on the positive feature say, "Look what you can... You want these, you want that, you want this. The only way to get that is to be sober and if you can be sober, good things are going to come."

Interviewer: So any final thoughts that you have about recovering alcoholics, what you should and shouldn't be saying?

Dr. Hunziker: The only thought I have is that if somebody comes to you and says, "I'm contemplating stopping my drug use or my alcohol use." Please refer them to somebody who has a knowledge of recovery, has a knowledge of treatment, their primary care doctor, Alcoholics Anonymous, Al-Anon, somewhere that they can get that process moved from contemplation to full active recovery.

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updated: March 12, 2019
originally published: November 5, 2014

The teenage brain on booze. What do we know about it? How is it different from adult brains on alcohol and what's the problem?

Most states have laws restricting the sale of alcohol to people under the age of 21. These laws have been in existence for much longer than our knowledge about the worrisome affect of alcohol on the developing adolescent brain and we know that many adolescents get around the laws and drink alcohol at parties or privately and usually to excess. Adolescents who break the law by drinking alcohol rarely just have one social beer, so what's the problem? What do we know now about the brain development that makes us even more worried about adolescents and alcohol?

Adolescence is a time of transition physically, socially, and emotionally. There are two critical times in brain development after birth. One is about age 2 to 3 and the other is at adolescence. During adolescence the brain undergoes major remodeling involving the formation of new connections between nerve cells.

These changes affect the processes involved in planning and decision making and impulse control, voluntary movement, memory and speech. Alcohol appears to have different affects on the brain of adolescents than on adults. Adolescence has a greater affect on memory center in the brain in adolescence than adults. In animal studies this affect seems permanent. Adolescents also have an underdeveloped part of the brain that helps with decision making and impulse control and risk assessment, something every parent teacher and cop knows. In animal studies the ability of this part of the brain to develop is impaired by alcohol. A fancy term for this is neurodevelopmental dysmaturation and that fancy term means that the adolescent brain exposed to binge drinking a common practice among under age drinkers, that brain may not mature normally. This impairment may actually accelerate the use of alcohol in adolescence and predict its use and abuse in later life.

Forty-seven percent of those who began drinking alcohol before the age of 14 become alcohol dependent at some time in their lives compared to 9% of those who wait until at least age 21. The correlation holds even when genetic risks for alcoholism are taken into account. Binge drinking we find as four drinks in one period of time for women and five for men, is common in adolescence and at the same time the same amount of alcohol adolescents are less likely than adults to suffer the side effects of binge drinking; sleepiness, nausea and vomiting and staggering. And the adolescence memory is worse on the same amount of alcohol than adults and it may be impaired for weeks after.

Think about the weekend binge drinking common on college campuses and high school parties and the affect on memory in the following weeks. And for women...girls really, the affect of alcohol and sexual decision making can have devastating long term affects. Having sex without protection against sexually transmitted diseases, having sex without protection against pregnancy and having sex without their permission and all of the above. And for boys and girls with car keys, drinking which is usually to excess isn't usually perceived by the drinker who gets in the car unaware of how impaired they are.

So the laws against underage drinking are even smarter than we know and our adolescents are no smarter than we think they are. They're under social pressures to drink. They're treating anxiety and depression with alcohol and if they're in an environment where there is illegal underage drinking they're not under the social stigma against getting drunk that is in place with most adult drinking.

So what to do? Support the police in enforcing the laws about underage drinking. Two, remember the adolescent brain is still developing until age 25; four years after adolescents can drink legally. Three, know who your kids are with, where they are and where's the responsible adult, that would be someone over 25 and preferably over 30. Four, be very careful in investigating the culture of the dorms and fraternities and sororities that your adolescents choose to join. Five, if you're an adolescent and listening to this, aren't you wise or did your mother make you do it. You are not invulnerable. You don't look cool when you drink. You just don't look very smart.

updated: February 18, 2020
originally published: October 30, 2014