COMMENTARY

How Much Is Too Much?

David L. Rosenbloom,PhD

Disclosures

November 16, 2007

 


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Fewer than one third of physicians ask their patients who drink alcohol, "How often in the past year have you had more than 4 drinks on a single occasion (more than 3 drinks for women)?"[1] They should ask.

Most patients do not know what the safe level of drinking really is for them. We're all urged to drink responsibly, but what does that mean? Two standard drinks a day or a total of 14 a week for adult males with no alcohol history or contraindications. One a day or 7 a week for similar adult females except if they are pregnant when they should not drink at all.[2] When a person consistently drinks above these levels or binge drinks,unhealthful consequences are likely to occur.[3] Most of us don't know that.

Excessive alcohol use can exacerbate, hide, or trigger other medical conditions, interfere with some medications, and contribute to serious injuries. If you don't ask, you won'tknow.

About 5% to 7% of the time, a screening may reveal a patient with alcohol abuse or dependence. Referral to a specialist for further evaluation and treatment will be in order because treatment for alcohol disorders is efficacious. Two thirds of patients who receive appropriate behavioral and/or pharmacologic treatment have reduced consequences from alcohol at 1 year.[4]

There is good news coming for doctors who do screen and counsel their patients about alcohol. Insurers are starting to recognize its value and reimburse doctors for the time it takes. So I urge all physicians to learn and use the techniques of alcohol screening and brief intervention. And for their own health, follow the guidelines themselves.

That's my opinion. I'm David Rosenbloom, Professor of Public Health at Boston University.

 


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