A new evidence-based protocol offers insight into helping those at risk because of their drinking. Most people in America drink little or nothing at all, but a significant number of those who do drink develop problems. We know from cost analyses and review of morbidity and mortality statistics that alcoholism is a number one health concern in our county and in North Carolina. The challenge is how to help people before problems develop and the self-deception of addiction kicks in to convince the person they don’t have a problem.
If a doctor notices an ugly mole, neither he nor the patient would ever decide to wait for it to become melanoma. The physician removes the mole. With most symptomatic expressions of possible illness typically a doctor doesn’t wait to find out if the patient has the disease. We address the illness as soon as soon as we identify the risk.
This standard medical practice is now coming to behavioral health issues, and to the management of potential alcohol problems.
There are straight forward techniques emerging to help people determine if they are at risk. The new standards used for determining at risk patients avoid the judgment or assessment of whether or not alcohol use is currently affecting that person’s life. Rather, the new prevention protocol is based on a statistical methodology that has been found to be helpful when uncovering medical risks. This scientifically derived method possesses striking similarities to the way we physicians manage heart risk by checking cholesterol, cancer risk by checking the Pap smear, and emphysema risk by asking about smoking.
Drinking behavior in America
- 1/3 nondrinkers
- 1/3 occasional drinkers
- 1/3 regular drinkers (high alcoholism risk)
- 50% consumption by 6% adults
Sometimes drinkers are shocked to learn the actual use of alcohol consumption in America. A third of the people here don’t drink. Another third drink occasionally– weddings or other celebrations, but generally no more than once a month. A third of the population, the ones who would call themselves social drinkers, drink on a regular basis. This third does almost all the drinking in our society. The methodology of screening focuses on this third, who are drinking essentially all the alcohol, by asking a simple question:
How many times in the past year have you had 5 (men)/4 (women) or more drinks in a day?
If the answer is not “None” or “zero,” that person has self identified as a “risky drinker.” This prevention protocol focuses only on risk, and approaches the problem of addiction to alcohol the same way the health system address risks for other illnesses like diabetes, lung disease, melanoma, colon cancer, breast cancer, heart disease, and many other costly and disabling health problems. If we can identify risk there’s a good chance we can focus resources on interventions that are most effective to eliminate the costs and suffering a disease brings when the process becomes full blown.
Being able to screen for and identify risks allows us to intervene with education and risk modification. Even though a person may not have a fully developed or an apparent addiction brief interventions help the person reduce their risk by knowing a little bit more about when and how to draw the line.
Single Question Screening
- Ask: “In the past year, how many times have you had 5 drinks or more in a 24 hour period of time?” (4 drinks for women)
- If greater than 0: The risky drinker needs intervention/treatment
Educational Intervention
There is no standard for what educational intervention needs to be and a lot of different things can be done. However, once I’ve identified a person who is at risk, I will bring into the equation information, literature, personal contacts, anything that would enlighten that person more about the risk that they are engaging in with their particular drinking pattern.
If a person recognizes they are at risk and chooses to cut back then that’s good. If they choose not to drink at all then that’s great. This all helps mitigate risk. A remarkable number of people are aware of their drinking issues, but haven’t been empowered to do anything. Acknowledgement of that risk exists actually opens the door for individuals to request help. Some people will be in obvious need of a professional assessment, and this brief screening and risk assessment methodology should never be used to avoid treatment of a recognizable problem.
If a person decides to heed the wake up call of being at risk and cut back with the knowledge that drinking is not a necessary life practice, the worry may be off the table for ever. If they decide how many drinks they should drink, and then exceed their self imposed limit, they are no longer just in the at risk group. They have a problem. The line has been crossed. That is if a person decides not to drink but has trouble stopping or realizes that they can’t, then it’s no longer a risk issue. They are now trapped in a disease. Showing up in the ICU, or jail or no longer being allowed to live at home because of their drinking or failing to accomplish things they are expected to do in life are all signs that they have already passed the risk phase and some sort of higher level intervention by a professional is in order.
I encourage people at risk to get to know the nature of the risk they face. I’m very quick to partner a “risky drinker” up with a person who has been down the road and who has solved their own problem. A person who fits the risk category benefits from finding a person with recovery experience and getting to know them well. There are open recovery meetings where people can go, whenever they want to, learn more about the problem of alcoholism.
It’s important for people to understand that risk intervention can come in many different flavors. It’s not always what I call “Big I” intervention – the kind you see on TV where everyone gets in a room and puts someone in a hot seat. The risk phase “Little I” intervention is more appropriate and can be just as effective because it is accomplished over time.
The book called Alcoholics Anonymous is available everywhere, and by reading that book, one can get in the heads of some of the original people who found a path to recovery from alcoholism. This path has a firm medical and scientific foundation, as well as, a spiritual and humanistic approach with proven efficacy. So I encourage people who determine they are at risk to intervene with educational understanding with people who understand alcoholism. This “Little I” intervention is not anything bigger or more dramatic than that.
Little Intervention with the LAP
One built in solution for a lawyer at risk is to plug into the Lawyer Assistance Program. The LAP network has volunteers that are bound by confidentiality, who are well trained, and who often have been down the road of alcohol illness.
The LAP volunteers are willing to talk with lawyers who want to learn more. Very little self disclosure or personal risk is necessary to talk to these volunteers. There is complete confidentiality. An inquiry can always be done under the guise of “I’m worried about a friend/family member or colleague and I just want to learn more about this problem because I think I might be able to alleviate the suffering that is happening and will get worse if someone doesn’t do something.”
by Al J. Mooney M.D.*
*Al Mooney, M.D., is a Lawyer Assistance Program Board member and former Medical Director at Willingway Hospital. He is co-author of “The Recovery Book.”
Tags: alcoholism risk, LAP Posted by