Former Deputy Director of the US Office of National Drug Control Policy Dr. Andrea Barthwell was one of the featured speakers at a conference I was a part of last spring. Her focus was prevention and she identified six gaps in our current efforts – Awareness, Motivation, Treatment Access, Treatment Success, Treatment Completion, and Long-Term Outcome. Dr. Barthwell believes that a successful demand reduction strategy relies heavily upon effectively closing those gaps. The Awareness Gap is the most significant because studies indicate that 76% of those individuals who meet established criteria for alcohol or drug problems dont believe they have a problem.
(Inaba, DS (2008). Current Status of Prevention Efforts, www.CNSProductions.com May 9)
Over the past year, I have noticed an attempt to close the Awareness Gap by implementing Screening, Brief Intervention, Referral, and Treatment initiatives known as SBIRT. Hospitals and other health care providers have imbedded research-validated substance use disorder (SUD) assessment tools in their intake forms to identify patients with potential SUD issues. Some government agencies and private businesses have made these assessment tools part of their employment application forms.
Studies by the National Institute of Alcohol Abuse, and Alcoholism (NIAAA) found a wider spectrum of alcohol-use disorders than previously thought. These are associated with certain patterns of consumption that clearly correlate to the development of future problems. NIAAA established a web site: http://rethinkingdrinking.niaaa.nih.gov to allow people to screen themselves anonymously. Visitors can compare their daily and weekly alcohol use to that of the general public and problem drinkers. This screening helps people recognize problem drinking patterns early and suggests changes they can make before they fall into more harmful patterns. The site also provides information on what responsible or low-risk use of alcohol really consists of.
I am increasingly irritated by the drink responsibly tag line found on every beer and alcohol ad. In my opinion, this is a hollow attempt at political correctness, because the ads never explain, define, or clarify what responsible drinking actually means. An explanation would, of course, not be in the best interest of the advertiser. Rethinking Drinking is a great way to close the awareness gap and perhaps even do a lot to prevent problem drinking.
The NIAAA Rethinking Drinking website asks how much is too much?, defines the standard drink equivalent for beer, wine, and liquor; and provides strategies for cutting down alcohol consumption while suggesting alternatives to drinking. There is also a section on refusal skills for social situations, and an urge tracker to record when, why and how the urge to drink was avoided. The site also helps to identify and deal with external situations and internal emotions that tempt one to drink.
The sections are comprehensive and practical. Low-risk for serious alcohol problems is defined as consumption of no more that four standard-size drinks a day for a man and no more than three for a woman. The weekly limit for low-risk is 14 drinks for a man and 7 for a woman. Several studies demonstrate that drinking more than the daily or the weekly limit has been associated with higher risk of alcohol abuse or dependence. Studies have demonstrated that about 35% of Americans dont drink alcohol at all. Of the 9% of Americans who exceed both daily and weekly levels of consumption, half (50%) have alcohol use problems. 19% of Americans exceed either the daily or weekly levels and about 1 in 12 of this group has already progressed to alcohol abuse or alcoholism. Then, of the 37% of Americans who always stay within the daily and weekly low-risk levels of alcohol consumption only 2% of them ever progress to serious alcohol problems. The site also clarifies that low-risk levels of alcohol use can be risky for pregnancy, those on certain medications, and those with liver, heart, kidney, chronic pain or bipolar disorders.
Though SBIRT and Rethinking Drinking are clearly having impact on closing the Awareness Gap in prevention of substance use disorders, the Motivation and Treatment Gaps need to be addressed as well. Of those individuals who recognize that they have a problem with drugs or alcohol, only 5% will try to find treatment, this is the Motivation Gap. The individuals who want or need treatment but are unable to access help fall into the Treatment Gap undercutting the prevention efforts. Still, the current efforts provide great optimism for future success. SBIRT studies show that once screened and identified, just five minutes of discussion with a physician, or perhaps exploring the Rethinking Drinking website can reduce heavy alcohol consumption by 25%!
Darryl S. Inaba, PharmD., CADC III
April 2009