About 14 million Americans have some type of alcohol problem. Timely screening might help identify many of those problem drinkers sooner.
What is alcohol screening? Can even moderate drinking have unhealthy consequences? How can you help someone you think may have an alcohol problem?
Answering those questions and others are David Rosenbloom, Ph.D., and Anara Guard, M.S. Rosenbloom and Guard are director and information director, respectively, of the RWJF-funded Join Together, a program that supports community-based efforts to reduce, prevent and treat substance abuse across the nation. It sponsors an online alcohol screening tool at www.alcoholscreening.org, which has already been accessed by more than 100,000 people.
Q: What is "alcohol screening"?
DR: Alcohol screening involves answering a small set of questions that have been pretested to show with great accuracy the likelihood that you do or do not have an alcohol problem, as well as the severity of that problem.
The screening tool we use—at www.alcoholscreening.org—is used all over the world with the approval of the World Health Organization.
AG: This screening tool doesn't diagnose someone as being an alcoholic, but it's valid for answering the question: Is my drinking risky? And because this is health-based information, if your drinking is risky you are urged to consult with a health care provider to get more information.
Q: How can people constructively talk to family members or friends about their drinking?
DR: One of the beauties of the Web-based approach is that it maintains anonymity; you can find out in the privacy of your home whether you have a problem that affects your health.
AG: We also thought it was important to frame our information in nonjudgmental terms. We try to present information in a way that won't be a turnoff and will allow people to make decisions on their own. Some people have completed the screening tool with someone else in mind and then have persuaded that person to take it. We hope it's a conversation starter.
Q: If the screening tool suggests you might have an alcohol problem, how might that information be presented?
DR: We return the message that your drinking behaviors may be affecting your health.
AG: Also, that you drink far more than other people of your age and gender. Often people think what they are consuming is a normal amount, and we think it's important to let them know that a very large proportion of adults don't drink at all, or drink in extremely moderate amounts. That by itself can be an important message for people to hear—that they aren't as mainstream as they think.
We've heard stories from people in recovery who were asked by their doctors how much they drank. When they said they drank a normal amount, the doctor didn't pursue it. But their "normal amount" is not really normal.
Q: Is the screening message complicated by the fact that some research has shown that moderate alcohol consumption might be beneficial?
AG: There is some research that shows that alcohol in moderate amounts may be good for some people. That doesn't mean alcohol in moderate amounts is good for you.
We recognize that there is some evidence that it may be helpful and that's another reason you should talk to your health care provider. We don't have a no-alcohol message, but there are some people who should not drink at all, such as pregnant women and anyone with a history of alcoholism.
Q: Is there still a stigma attached to discussing alcohol problems with your doctor?
DR: Survey evidence suggests that patients are not surprised to have their doctor ask about their drinking, and they think it's relevant. But doctors don't ask about it nearly as frequently as they should.
AG: Although the screening tool has a numerical score, we don't give that score because we don't want patients showing up at their doctor's offices with a number. We're hoping people are going to go and say, "I used this screening tool online and it said 75 percent of men my age drink less than I do." That would tell the health care provider something meaningful.
Q: Might people be unwilling to get treatment because of health insurance issues? Either the treatment isn't covered, or there is a fear of having that health history follow you around?
DR: It is rational for people to be worried about getting treatment because of discrimination. Almost all insurance policies—80 to 90 percent—have higher co-pays and limitations on coverage for alcohol treatment, compared with coverage for other diseases.
AG: We know that some people who can afford treatment choose to pay out of pocket so they don't get that red flag on their records. But not all risky drinkers need treatment. We are hoping that by catching the problem early, people can modify their own behavior with guidance from their health care provider or people close to them. There also are Internet-based support groups and in-person support groups.
Q: We hear a lot about underage drinking, but what about problem drinking in older people? Is it overlooked?
DR: The cumulative health consequences of problem drinking appear in the late 30s and 40s. Lost productivity, cumulative health effects and family problems continue into middle age, and drinking problems in the elderly go unrecognized, particularly in the isolated elderly who have lost a spouse or are retired. Those are real problems and not at all discussed in the same depth as underage drinking.
AG: The average age of people completing the screening online tends to be the early 30s, but we've found that the percentage of people who exceed the amount they should drink per week is much higher in the elderly population. The alcohol consumption guidelines are much lower for people over 65, and there is always the issue of how alcohol consumption might effect medications they are taking.
Q: What are some health effects of alcohol consumption?
AG: The chronic effects include liver illnesses, high blood pressure and diabetes. The acute effects include injuries from auto accidents, falls and things people don't think about as much. For example, house fires have been linked to alcohol intake. For any form of injury you can think of, alcohol turns out to be a large factor, including sexual assaults.
DR: There are chronic effects from long-term heavy drinking, acute effects and subtle short-term effects. The next-day hangover and reduced performance at work are real. Even in people who are not chronic heavy drinkers, if they drink heavily before something they need to do, their performance can easily be affected. It's no accident that pilots are prohibited from drinking for a certain number of hours before they fly.