The Perspective

When “One More” Becomes “One Too Many”

How much is too much?

According the Centers for Disease Control and Prevention (CDC), about 38 million adults in the United States drink too much. And while the majority of these people are not alcoholics, too much drinking has tremendous economic impact (workplace productivity, health care costs, motor vehicle crashes, criminal justice system) reaching in the neighborhood of $224 billion and negatively effects lives in immeasurable ways, causing about 88,000 deaths each year.

What’s considered too much?

Binge drinking, high weekly alcohol use, any use by pregnant women and alcohol consumption by anyone under the age of 21. For men, binge drinking is five or more drinks consumed on one occasion – usually within two to three hours. For women, it’s four or more. High weekly usage breaks down to 15 or more drinks on average for a man and eight or more for a woman.

In Nevada, about 15.1 percent of adults reported binge drinking and about 6.5 percent reported heavy drinking according to the 2012 Behavioral Risk Factor Surveillance System. While these might not seem significant, consider that many automobile accidents, including those involving pedestrians, involve alcohol.

Excessive alcohol consumption is the third leading cause of preventable death in the United States according to the CDC. Alcohol abuse can lead to significant health consequences like unintentional injuries, violence, risky sexual behavior, alcohol poisoning, miscarriages and stillbirths. Over the long term, excessive alcohol abuse can lead to chronic illnesses such as cardiovascular disease, liver disease, neurological problems, and gastrointestinal illnesses. Social problems such as long-term unemployment, lost productivity and family dysfunction can all result from alcohol abuse.

Despite these consequences, just under 17 percent of adults discuss their drinking habits with a health care professional and similarly, a mere 17 percent of pregnant women have discussed their drinking with their health care provider. According to the CDC, alcohol screenings and brief counseling by a health care provider can reduce the amount of alcohol consumed on any occasion by about 25 percent.

The new thinking among public health officials at the state and local levels is to make alcohol screening and brief counseling routine in medical practices. By utilizing a set of questions, physicians can determine how often and how much alcohol a patient consumes on a regular basis as well as counsel them on their use, especially pregnant women. Patients who need specialized treatment for their alcohol use can be referred to appropriate treatment. The Affordable Care Act requires that new health insurance plans provide coverage for alcohol screenings/brief counseling without co-payments.

Alcohol screening should be part of everyday medical practice, just as screening for cholesterol or other health issues. It should be done by primary care providers, OB/GYN practitioners, emergency departments and trauma centers.

Screening steps

If you’re a physician, there are four steps that can be done to screen patients about their alcohol use:

  • Ask – outright – about the patient’s alcohol use.
  • Discuss – directly – what the patient believes is good and not so good about his drinking habits.
  • Offer options – ask if the patient wants to cut down, quit, seek help or remain the same and provide options. Make a plan to accomplish what the patient wants.
  • End the counseling on a positive note, regardless of results of the counseling.

Discussing alcohol use can be an uncomfortable subject. As the patient, you can start the conversation by asking questions about alcohol consumption and discussing your own use. As the physician, encourage patients to be honest and open about their alcohol abuse.


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