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Alcohol and Alcoholism At The Hospital

25 June 2016 Written by 

Screening For Alcohol Abuse Is Confusing

From Psychology Today By Stanton Peele: You get some sense, and some nonsense, at the hospital about alcohol. 

I spent a night in the hospital recently (I'm better now, thank you).

First, let me mention that you can’t wet your whistle in a New York hospital—they just ain’t going to give you a drink (unlike Irish hospitals, where they serve the national drink, Guinness, the effects of which are regarded as healthful).

Then they tell you not drink in the 24 hours after leaving the hospital. I wondered if that was a medical recommendation, but quickly realized that the concern was the effect of alcohol on wobbly patients withdrawing from anesthesia.

The rest of what I learned consisted of one step forward and one step back.

The Good

Several times, I was screened as follows:

Can I ask you a few screening questions?

Sure.

Do you drink alcohol?

Yes.

Do you drink daily?

Yes.

How much?

One-to-two drinks.

Have you had five or more drinks at one time in the last year?

No.

Thank you.

Me (the first time this occurred): "That’s it? Those are all your screening questions? What about my weight and exercise and health care?"

What they were doing here was conducting a brief intervention (BI) for alcohol. Such interventions have been found to be the single most effective therapy in the field. The next step in the BI occurs if the person reports excessive consumption—the definition of which is some matter of debate, but let’s say five-to-six drinks daily.

In that case, the health provider then says, in a neutral way: “That amount of alcohol is probably/may be contributing to your current health problem. We recommend cutting back. Is it possible for you to do so?” (This discussion should include the person’s partner, caregiver, or other available concerned party.) “We’d like to check with you on your progress at our next meeting” (which could be months ahead).
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The key elements in the BI are that it is non-judgmental, includes affected people who influence the drinker, and is part of a longer care relationship involving follow-up contacts.

Contrary to the disease notion that problem drinkers are out of control, BIs work with the assumption that people will, long-term, act in their own best interests. Outcome research has shown that, indeed, they generally do, both with alcohol and with drugs such as cocaine.

And while general screenings are far more likely to turn up mildly excessive or problem drinkers, rather than clinical alcoholics, further research indicates that the same process is effective for them, too. According to the Drug and Alcohol Findings Effectiveness Bank description of yet another study confirming the benefits of brief interventions aimed at reducing drinking for even diagnosed alcoholics, now called dependent drinkers:

“Commonly presumed unsuitable for dependent drinkers, the evidence is stacking up that brief advice after screening can lead even these drinkers to cut back. This study of heavy drinking Taiwanese hospital patients provides one of the most convincing demonstrations yet that brief intervention can work in this setting, and the drinking reductions were particularly steep among dependent patients.”

So good for American hospitals there!

The Bad

Following such a BI, I always ask the health provider about how much alcohol I can drink. And the medical response is universal.

Well, an occasional drink is fine.
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Me: "What’s an occasional drink?"

A glass of beer or wine every now and then. I can’t tell you how many people we see in here for heart and other problems after they’ve been overindulging at the holidays.

Don’t you, like me, imagine that these hospitalized drinkers had something like 10-20 drinks? Do you see the problem of the excluded middle—where the only possibilities presented are either having a dozen drinks at once, or one drink “every now and then”?

Of course, this plays into America's binge-or-bust style of drinking, the one represented by AA. Daily moderate drinking, on the other hand, is life- and cognition-prolonging.

In other words, even in a medical setting where providers have just conducted a highly-effective choreographed BI, Americans can’t deal rationally with alcohol.

Stanton Peele is a columnist for The Influence. His latest book, in 2015, with Ilse Thompson, is Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life. Stanton has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His website is Peele.net. Dr. Peele has won career achievement awards from the Rutgers Center of Alcohol Studies and the Drug Policy Alliance. You can follow him on Twitter: @speele5.

Read more: What I Learned About Alcohol and Alcoholism at the Hospital

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