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Alcohol and Drug Addiction

Alcohol and drug problems are not restricted to alcoholism, nor are they restricted to alcohol use at intoxicating levels. Adolescents provide some of the most dramatic examples of the dangers of alcohol and other drug use.

The danger of alcohol use by the individual who is depressed is not alcoholism — it is suicidal thoughts being “loosened” by the impaired state and diminished capacity. Therefore, those who are in treatment for depression should be counseled to abstain from the drink.

For teenagers, the primary danger of alcohol/drug use isn’t dependence, although it certainly does occur. The leading causes of death in this age group are accidents, suicide, and homicide, all of which are clearly linked to alcohol and other drug use. The next and tragic result is that the age group from 16 to 24 years is the only group in our country with a declining life expectancy. Alcohol use may also have more subtle dangers for adolescents, such as impending emotional and social maturation. In addition, there are the problems related to sexuality, unwanted pregnancy, and HIV infection. Any drinker is at some risk for alcohol/drug problems. Alcohol is a potent pharmacological agent.

Negative consequences can follow on the heels of a single drinking episode. These would represent problems of acute use. Negative consequences can also result from the pattern of use. This represents a chronic problem. Evaluation and assessment need to explore both possibilities.

What is a “safe” dose of alcohol or a low-risk pattern of alcohol use? This varies from individual to individual. What is judicious use similarly varies for a single individual throughout his or her life span. For the pregnant woman, no alcohol is the safest alternative. Alcohol use is a health issue. The alcohol treatment professional is unlikely to see an individual until some problem becomes evident. Therefore, much of the burden of prevention and identification of individuals at risk falls to those outside the alcohol field. Another pitfall can occur when conceptualizing all alcohol/drug problems in terms of the progression of the ‘disease’ of alcoholism.

Screening and evaluating a potential problem drinker/drug abuser: The ability to intervene in an alcohol/drug problem depends upon two obvious factors. First, it requires the problem to be identified. Second, it requires an adequate evaluation to determine the nature of the problem. Alcohol problems have many guises beyond also being quite common. Consequently, screening for alcohol problems needs to be routine in any counseling or health-care setting. What are the usual screening instruments? Several very easily administered screening tests have been shown to be effective in identifying those with a high likelihood of having alcoholism/and other drug dependencies. Parents may want to take advantage of these tests for their kids. As their name indicates, they are screening instruments–not diagnostic instruments. They are intended to rapidly distinguish between those who are exceedingly likely to have a problem and those who are unlikely to have a problem. They do not provide sufficient information to allow formulation of a treatment plan. But if routinely administered, they can assist in identifying those whose alcohol use warrants closer scrutiny.

In ensuring that those who don’t “look” like people with alcohol problems don’t go undetected, these tests may have less utility in a setting that deals exclusively with alcohol and or other drug problems. But they are basic tools that are used in most health care organizations. One of the screening tests used since the early 70’s is the CAGE device, recognized as one of the most efficient and effective. Not an intimidating test. Scoring two or three affirmative answers should create a high index of suspicion of the presence of alcoholism. Four positive responses are seen as equivalent to a diagnosis of alcoholism dependency. A score of one or two does not indicate alcohol abuse. The MAST screening test became widely used in the mid 70’s — a 25-item yes or no questionnaire. It was designed for use either within a structured interview or for self-administration. There are variations of the MAST screening, including ‘the short’ MAST, and ‘the brief’ MAST, each having fewer questions. These tests have been established in multiple populations.

A third test, but not the least, is the Trauma Index. Recognizing how commonly trauma is associated with excessive alcohol/drug use, several Canadian researchers developed a five-question scale to identify early-stage problem drinkers, among both adult men and women, and late teens in an outpatient setting.

The questions are as follows: Since your 18th birthday, have you — 1. Had any fractures or dislocations to bones or joints? 2. Been injured in a traffic accident? 3. Had a head injury? 4. Been inured in an assault or fight? 5. Been injured after drinking?

Two or more positive responses are indicative of excessive drinking or alcohol/drug abuse. Though not as sensitive as the CAGE, or the MAST, it will identify slightly over two thirds of problem drinkers. Now, a word to those who are suspicious of screening instruments and their ability to detect a problem, especially given that prominent symptoms of alcohol/drug dependency include minimizing, denial, repression and distortion of memory and perception: The CAGE, and the MAST have both been used extensively.

The Trauma is a newer instrument. The purpose of such screening instruments is, after all, to approximate the judgment that would be made by a clinician were they to undertake a systematic evaluation. Follow up questions to these and other tests are: Do you usually drink/use to get high? Do you sometimes drink alone? Have you found yourself looking forward to drinking? Have you noticed an increased tolerance to drugs and alcohol? Do you have blackouts? Have you found yourself using alcohol/drugs in an unplanned way? Do you drink for medicinal reasons? Do you work at protecting your supply of alcohol or other drugs?

Some of this information may sound uninteresting, however, for those who know someone in the throws of, or beginning stages of dependency, the information may be invaluable.

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