The new patient sitting across from me was a neatly dressed 50-year-old Wall Street stock analyst providing crisp answers to the questions that are part of my routine history-taking. Following an emphatic denial to my question about smoking cigarettes, when I asked about alcohol use, he replied, “Doesn’t everyone?” I probed further. “How often do you have more than five drinks in an evening?” Turning defensive, he said, “Only on rare occasions like the office holiday party, and maybe a wedding or something.”
With that one question I was able to tag him, with a high degree of certainty, as a problem drinker. You might well ask if I wasn’t too quick to judge--doesn’t everyone drink a little too much, at least every once in a while? The truth is that about three out of every four U.S. adults never exceed the threshold for “problem drinking”--five or more drinks for men or four or more drinks for women in any one day, according to a large survey by the National Institute on Alcohol Abuse and Alcoholism. My concern (and the accuracy of that lone question) was reinforced the next day when my patient’s wife called to tell me about some recent alcohol-related antisocial behavior.
Adult drinking patterns vary all over the lot. That national survey found that almost half of us say that we drink fewer than a dozen drinks a year. (For purposes of our discussion, a drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof spirits.) The Institute of Medicine estimates that 20 percent of the population are problem drinkers who habitually exceed the acceptable daily limit of two drinks for men and one for women or who binge, meaning that they consume five or more drinks at any one sitting. And about 5 percent are physically addicted to alcohol.
Many studies have established beyond a doubt that screening and counseling for alcohol misuse is one of the most cost effective measures in health care. About 85,000 deaths per year, and many more injuries, are associated with excessive drinking. Compared with hard-core alcoholics, problem drinkers tend to be younger, have been misusing alcohol for a shorter period of time, are still able to hold on to their jobs, and have better social support. The unwelcome consequences of drinking--especially in binges--include not only motor-vehicle accidents but also spouse and child abuse, fetal alcohol syndrome, and unsafe sex.
Help and self-help
A 10-question test, developed by the World Health Organization, can accurately identify problem drinking. If you are at all
concerned about your own alcohol use, take the quiz, called the Alcohol Use Disorders Identification Test, or AUDIT (Type “AUDIT form” in the search box). If you score over 8, it is time to own up, wise up, and look up a physician
or social worker for some alcohol counseling.
If your score is close to the critical number, you might have a problem. Face up to the fact and try the following self-help tips:
- Pace yourself. Don’t have more than one alcoholic drink per hour, and alternate alcoholic drinks with club soda, soft drinks, or just plain water.
- If you enjoy hard liquor, use a jigger to measure; don’t estimate. Underestimates are common.
- Never exceed 14 drinks per week (seven for women), or four in a day (three for women). And don’t make up tomorrow what you didn’t drink today.
- Never drink on an empty stomach. Food helps delay the absorption of alcohol into your bloodstream.
- Never, never drink and drive. If you’re with a group, always have a designated (abstinent) driver. If you’re alone, call a taxi or a friend.
- Avoid drinks served “neat” or “on the rocks.” Use a mixer; a diluted drink takes longer to finish, allowing your body time to metabolize the alcohol.
- Never use an alcoholic drink to quench your thirst, as some beer commercials suggest. Start with a glass of water and then savor the brew. If those steps don’t help, talk with your doctor about getting professional help.
Our stock analyst took the alcohol-use test. It was the first time he had failed at anything since college physics. I referred him to a substance-abuse counselor. Six months later I ran into him at a cocktail party. He raised his glass of club soda at me from across the crowded room, and smiled.
This article first appeared in the October 2008 issue of Consumer Reports on Health.
