Screen for Alcohol Abuse During Holiday Season
Andy Williams famously sang that the holidays are "the most wonderful time of the year." Unfortunately, the season is not the "hap-happiest" for everyone, as Williams' song suggests. Although I, like many people, eagerly anticipate the holidays, it's important to recognize that many others associate the season with increased stress, anxiety and depression.
In a 2012 poll of U.S. consumers who use alternative financial services such as payday loans and prepaid debit cards, nearly half said they wished they could skip Christmas because of the financial pressures related to gift-giving. And there are plenty of other factors that prevent people from being merry; including busy schedules, travel and tense family gatherings. Some, no doubt, are missing loved ones lost. (And, with apologies to Williams and his crooner colleagues, more than one in five Americans say they dread the ubiquitous Christmas music.)
As family physicians, we need to acknowledge both sides of the holiday season when we see our patients and be aware that many people turn to alcohol in an attempt to alleviate the anxiety and sadness that can spoil what is intended to be a joyous time. The statistics regarding alcohol use and abuse during the holidays are -- pardon the expression -- sobering, showing that 16 percent of Americans say they drink more during the holidays, and half say alcohol plays a role in their family gatherings.
Not surprisingly, alcohol sales surge this time of year. In December 2015, U.S. beer, wine and liquor sales totaled more than $5.8 billion. That was $1.3 billion more than the next highest monthly total.
The results of holiday drinking aren't pretty. According to the National Safety Council, nearly 800 Americans died in automobile accidents on Thanksgiving Day, Christmas Day and New Year's Day combined in 2013. Nearly one-third of the fatalities stemmed from drunk driving.
Primary care physicians already screen for a multitude of conditions, including depression, addiction and tobacco use. But at this time of year, it would be prudent to also have a heightened awareness of the need to screen for alcohol misuse. Binge drinking and heavy drinking are common during the holidays, but as 2017 begins and people ponder New Year's resolutions, some patients might be more inclined to consider needed changes.
I like to start the conversation in an open-ended way, asking patients, "How much alcohol do you use every day?" Fortunately, most of my patients look shocked and say, "I don't drink every day." However, for those who are regular, daily drinkers, the responses are often more honest than if I asked, "How many drinks do you have per week?"
Patients' answers can trigger the need for more specific screening tools for hazardous alcohol use that many of us are familiar with, such as the CAGE questionnaire. That tool involves four simple questions and can be administered in less than a minute.
The National Institute on Alcohol Abuse and Alcoholism recommends asking just one simple -- but powerful -- question. For men, ask how many times in the past year they have had five or more drinks in one day. For women, the question is how many times in the past year they have had four or more drinks in one day.
The AAFP and the U.S. Preventive Services Task Force recommend the Alcohol Use Disorders Identification Test (AUDIT) or the abbreviated AUDIT-Consumption (AUDIT-C).
Just as asking our patients about tobacco use can increase success with tobacco cessation, asking our patients about daily alcohol use can open the door for discussing alcohol use and improve the health of our patients. Although opioid use, misuse and abuse have made headlines all year, let's also think about making this an important time to remember alcohol screening. A few minutes of our time could make a big difference in the lives of our patients, our friends and our families.
Lynne Lillie, M.D., is a member of the AAFP Board of Directors.
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