January 10, 2014
News Review From Harvard Medical School -- CDC Urges Doctors to Talk about Drinking
Doctors aren't talking with their patients enough about alcohol, a government study finds. And that's true even if the patient is a binge drinker, the study says. The U.S. Centers for Disease Control and Prevention (CDC) did the study. It was based on surveys from 44 states and the District of Columbia. Only 1 in 6 adults and 1 in 4 binge drinkers said that a doctor or other health professional had ever discussed alcohol with them. Only 1 in 6 pregnant women recalled such a talk, even though drinking can harm the developing fetus. Even drinkers who binge 10 or more times a month got little counseling. Only 1 in 3 reported ever having a serious talk with a doctor about alcohol use. For every alcoholic, 6 other people are problem drinkers, CDC officials said. They urged doctors to make alcohol counseling a routine part of patient care. Counseling that lasts about 15 minutes has been shown to help people reduce problem drinking, they said. The CDC released the report at a news conference. HealthDay News wrote about it January 7.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
I recently saw a new patient in my office. He was an older man, and he had numerous recent falls. His family privately told me that he had gone into a tailspin of decline in his thinking and memory. They were certain he was suffering from dementia. But when I tested his memory, he scored perfectly. He was a delightful and very intelligent man.
I asked him about his alcohol intake. He drank between one and two bottles of wine every night. His wife nodded knowingly as he described his drinking to me. He understood he was drinking too much. But his wife and his other family members were surprised by the connection between alcohol and his poor functioning.
I talked with him frankly about his alcohol use. Since our discussion, he has been able to cut down to two drinks per day. And, he says, "I am no longer feeling depression."
The Centers for Disease Control and Prevention (CDC) believes in these conversations between doctors and their patients who are drinking too much. So do I. But, according to a survey done by the CDC, they don't happen very often. Only one in six adults reports ever talking with a doctor or other health professional about alcohol use. Among self-reported binge drinkers, only one in four said a doctor had counseled them about alcohol.
Either we are not talking with patients about their drinking, or our patients forget what they may not want to hear.
Alcohol can cause an incredible range of medical misfortunes. These include liver failure, stomach and intestinal bleeding, and heart failure. Alcohol can also:
- Impair mental function
- Result in lost income
- Damage relationships
- Lead to injury
- Contribute to family conflict
It is easy for regular drinkers to become heavy drinkers. Alcoholism sneaks up on people. And it can be hard to recognize alcohol dependency in yourself until the pattern is extreme.
Your drinking is risky if you are a man who regularly has more than 14 drinks in a week, or a woman who has more than 7 drinks in a week. (Women absorb alcohol roughly twice as efficiently as men.) Binge drinking is also risky. This would be more than 4 drinks in a day for a man or more than 3 drinks in a day for a woman.
What Changes Can I Make Now?
If you are alcoholic, you need to stop drinking. You are certainly not alone. By a recent estimate, 1 out of every 10 people in the United States drinks harmful amounts of alcohol.
Has your doctor asked you about drinking? Perhaps you should bring it up. Your doctor can help you to think through a variety of strategies to help you to quit or cut down.
Each of these strategies can help:
- A long-term support program, such as Alcoholics Anonymous (AA) -- About half of the people who visit their first AA meeting find it helpful or appealing enough to remain active with the group for at least several months.
- A hospital alcohol "detox" program
- Naltrexone pills or injections -- This medicine is available as a daily pill (ReVia, Depade) or as a monthly injection (Vivitrol) in a doctor's office. Naltrexone blunts the amount of pleasure that alcohol triggers in the brain. The drug reduces cravings and gives people more control over urges to drink alcohol. In at least two studies, people taking naltrexone pills were twice as likely to remain off alcohol for six months or longer as people who were given a placebo pill.
- Acamprosate (Campral) -- This medicine reduces heavy drinking and risk of relapse. It can also minimize symptoms of alcohol withdrawal right after you stop drinking.
- Gabapentin -- This drug (brand name Neurontin) has only recently been used to help alcoholics. A small study, published this November, treated heavy drinkers who were ready to limit their drinking. They received either gabapentin or a placebo. After 12 weeks, people who took a fairly high dose were twice as likely to avoid heavy drinking and 4 times as likely to avoid alcohol completely as people who got the placebo. They also seemed to sleep better, to have improved mood, and to have fewer alcohol cravings. This is a low-risk way to possibly improve your chances of success.
- Treatment for depression, if this part of what has led to your alcohol abuse
What Can I Expect Looking to the Future?
One out of every 20 deaths in the United States is related to alcohol use. If you are dependent upon alcohol and you don't stop drinking, your life expectancy may be shortened by 15 years or more.
If you do stop heavy drinking, you can regain your health and your future. It is a challenge to remain a non-drinker after you quit. Relapse is not a sign of personal failure. Rather, it is evidence that alcoholism a lifelong illness. You can improve your chances of remaining sober if you join and stay involved with a long-term support program such as AA.