"Risky Drinking" Syndrome

"There is somewhat an implicit understanding that we don't talk about that."

"Doctors shy away from asking, and patients also believe that they disclose a weakness or a moral problem if they disclose that they have problems with alcohol."

"So, you would expect a doctor to ask, 'do you smoke? How about running up a stairway? Are you completely out of breath? Is your heart pumping?"

"Like checking cholesterol, doctors should get used to checking alcohol."

"Almost everybody has somebody among their friends or family who has problems with alcohol -- 'Uncle so-and-so can't control his drinking. He's a weak character." 

"Women have been increasing their consumption."

"If you hear in parliamentary debates, 'Oh, we have to protect our young'...No. It's the age group of the parliamentarians -- it's us, it's the adults who drink that much."

Dr. Jurgen Rehm, senior scientist, Centre for Addiction and Mental Health, Toronto

 (AP Photo/Julio Cortez)

There are new guidelines aimed at doctors and their patients, revolving around alcohol consumption, a topic up to the present viewed as verboten, but now being prioritized in view of a startling statistic: roughly one in five people in Canada age 15 and older meet the criteria for alcohol use disorder during their lifetime. And the purpose of the new guideline is to ensure that proven and needed treatment is offered to people to reduce alcohol-related medical conditions. 

Moderate to heavy drinkers, according to one study, who abstain from drink for a month gained improvement in their insulin resistance, weight and blood pressure, along with a decrease in circulating concentrations of cancer related growth factors. And then there is 'on the other hand', where Dry January is capable of revealing symptoms of a serious problem should heavy drinkers begin experiencing severe withdrawal symptoms, according to Harvard Health Publishing.

The new Canadian guideline offers advice identifying and managing high-risk drinking and alcohol use disorder (AUD), starting with annual screening of adults and youth. Dr. Rehm asserts that queries relating to alcohol consumption should become routine in medical examinations. AUD, one of the most prevalent mental disorders, fails to attract the medical attention it deserves, states Dr. Rehm.

All the more so, since Canadians consume greater amounts of alcohol than the global average, including over the median for high-income countries; embedded in Canadian culture where governments promote drinking not only for the revenue they derive from alcohol sales, but also by catering to popular public demand. And, says Dr. Rehm, alcohol is relatively "dirt cheap". AUD, he states is one of the most persistently stigmatized mental health conditions.

Canada's drinking guidelines released last year caution the safest amount of alcohol to imbibe in relation to optimum health, is none. Any alcohol consumption that exceeds one or two 'standard' drinks weekly increases risk of cancer. 12 ounces of beer, five ounces of wine, 1.5 ounces of whisky vodka or other spirits represent a 'standard' drink in volume. Alcohol should be used 'sparingly', is a statement that most people polled on the issue agreed.

Dr. Rehm's committee recommends a start with a "single alcohol screening question" to identify risky drinkers. A brief question that asks "How many times in the past year have you had five or more drinks in a day (for males) or four or more drinks in a day (for females)?" A response of one or more signals doctors to engage in a more detailed interview. If someone has at least two of the 11 criteria: more than once wanting to cut down or stop drinking; spending time drinking; being sick or getting over after-effects of drinking, wanting a drink so urgently "you couldn't think of anything else", they meet a diagnosis of AUD.

Included are other criteria; drinking more or for longer than planned; feeling tense or anxious because it takes more alcohol than it once did to experience the same effects; and drinking even though it's causing problems with relationships. Meeting two to three criteria signals mild AUD; moderate AUD if four or five criteria are met, and severe AUD with six or more. 

 

The guidance offers advice on managing withdrawal and plotting treatment plans that can include medications. Its goal is the reduction of untreated heavy drinking. About 17,000 Canadians die yearly from alcohol-attributable diseases, yet fewer than two percent of eligible people receive therapy.

Amanda Hintzen is shown in a handout photo. Hintzen's alcohol addiction became so severe that she sought help from a family doctor, only to be given medications for related symptoms without treatment to address the severity of the alcoholism. THE CANADIAN PRESS/HO