PORTLAND, Maine — April is Alcohol Awareness Month, an opportunity to check in with yourself and your loved ones to make sure you are drinking responsibly.
According to the Maine Center for Disease Control and Prevention, alcohol is the most widely misused substance in Maine by youths and adults.
Nationally, more than 178,000 alcohol-related deaths occur each year, making alcohol a leading preventable cause of death in the United States, according to the National Institutes of Health (NIH). More than 200 disease and injury-related conditions are associated with alcohol misuse, researchers say.
NEWS CENTER Maine spoke with the medical director at Spring Harbor, psychiatrist Dr. Lee Wolfrum, and InterMed primary care physician Dr. Emily Libby, about alcohol misuse, how to identify it, the cause of it, and treatment options.
There are different ways to categorize a person’s relationship with alcohol, whether it’s normal consumption, alcohol misuse, alcohol dependence, or alcoholism.
"Alcohol 'misuse' is somewhat of a broader term that describes generally heavier alcohol consumption that can put someone at increased risk for adverse health outcomes or social consequences," Libby said. "Alcohol misuse can sometimes lead to a true alcohol use disorder (AUD), or alcohol dependence, 'alcoholism,' which is defined by an impaired ability to stop or control alcohol use."
Characteristics of alcoholism include cravings, withdrawal symptoms, and impaired function—things that impact a person’s job or personal relationships, Libby said.
Wolfrum said another term often associated with alcohol misuse disorder is "binge drinking," meaning consuming more than five drinks a day in one setting.
Who is alcohol misuse impacting?
As a PCP, Libby said she sees people ages 18-30 struggling the most with alcohol use disorder, "mostly males, especially those with coexisting mental health issues such as major depressive disorder."
Wolfrum said as a psychiatrist for adults, he sees "two peaks happen" with alcohol misuse for age groups 18-35 and the senior community (65+). While he attributes the younger generations' alcohol consumption to having "more freedoms" and the older population's to "losing a sense of purpose," Wolfrum said recreational drugs have now joined the equation.
"I think it’s affecting all age demographics. The thing that I’ve seen and that my colleagues really talk about is when we start to see alcohol consumption joining in with the change in recreational cannabis and some of the other things. That's probably what we are seeing the most of right now and where our focus kind of goes to. ... Because it’s new, it’s different, it’s looking different," Wolfrum explained.
What makes someone more prone to alcohol misuse?
Alcoholism is like any other addiction or condition. Certain factors make some people more susceptible than others. Both Libby and Wolfrum said genetics and mental health disorders play a huge role in a person's likelihood of developing a drinking problem.
"What we do know is that people who have a direct genetic connection to someone who has a history of an addiction have a higher likelihood of developing unhealthy alcohol or other substance patterns," Wolfrum explained. "What we do know is there’s a lot of mental health diagnosis that do come along with unhealthy alcohol use."
For example, Wolfrum said those with schizophrenia are far more likely to develop an issue with alcohol compared to the general population.
Libby agreed that mental health disorders are commonly associated with alcohol misuse, including those suffering from depression, anxiety, post-traumatic stress disorder (PTSD), and ADHD.
She echoed what Wolfrum said about genetics being a huge factor as well.
"Some stats from the NIH estimate maybe even up to 60% accountability. So I always make sure to ask patients about a family history of alcohol disorders," Libby explained.
Another contributing factor is exposure at a young age. Libby said other data suggests individuals who start drinking at a younger age like 15 instead of the legal drinking age of 21 are three times more likely to develop alcohol misuse disorder.
Identifying the problem
Drinking alcohol is a socially accepted activity, so how can you tell when you or someone you know has a problem?
"The definition of addiction is the dependence and tolerance of a substance that causes functional impairment," Libby said.
Signs of alcohol use disorder
- Unable to stop drinking once started
- Needing a drink first thing in the morning
- Feeling a strong need to drink/needing to consume more to feel the effects of alcohol
- Hangovers interfere with job, school, family, relationships
Libby said in a primary care setting, health providers sometimes use a screening tool called AUDIT (Alcohol Use Disorders Identification Test), a questionnaire designed to assess for the presence of AUD.
Wolfrum said there is cause for concern "when we see alcohol go from something we participate in because we enjoy or look forward to it, but instead, it becomes something that helps us get through every single day. ... We have to have a drink or multiple drinks every night to decompress."
He said people with AUD tend to isolate themselves, pull back from people, and make the choice to stay home and drink alone.
Health risks from excessive alcohol misuse
- Heart disease, high blood pressure, coronary artery disease
- Heart attacks, stroke
- Liver disease, "fatty liver," cirrhosis, liver failure
- Dementia
- Cancers: breast, colorectal, liver
"And of course, we can't forget about the risk of unintentional injuries—motor vehicle accidents, drownings, falls. In addition, acts of violence like homicide or suicide," Libby added.
To drink responsibly, Libby said the standard recommendation for maximum alcohol consumption is one drink daily for women and two drinks daily for men. However, Libby said, "less is more when it comes to alcohol and your health."
Getting treatment for AUD
"As corny as it sounds, the first step really is admitting that there’s a problem—so until a patient is ready to actively get treatment, I continue to provide support and have judgment-free discussions around their alcohol use, their general mental health, and how it’s impacting their daily lives," Libby said.
"Once someone is ready to seek treatment, their primary care physician can help guide them in the right direction for which treatments would be the best fit for them based on their preferences and the severity of the disease. These can range from medications, referrals to a community therapist (for CBT or 'cognitive behavioral therapy' or to individuals with particular experience with addiction), community support groups such as AA or inpatient /residential treatment centers for rehab," Libby added.
Wolfrum said depending on whether a person wants to get help or a family member wants to find help for their loved one, there are resources out there. He also said Alanon (AA) is a great resource for people who have family members suffering from AUD. In addition, he said calling 211, the state resource line, can be helpful. Above all, Wolfrum said the best place to start is by making an appointment with your primary care provider.
Societal norms
There is no denying that drinking is a social pastime and alcohol is readily available for any type of gathering, including ball games, weddings, birthday parties, concerts, and dinner dates—the list goes on. Of course, we know that prohibition doesn't work, so how do we regulate something that is so readily available?
"I don’t really know if reducing access would be as helpful as education," Wolfrum said. "We certainly know that other cultures and other places have the same amount of availability of alcohol and different rates of alcohol use disorder. So I wouldn’t necessarily say I would fully decrease access, but I’d say having more education would be helpful."
Libby said that our society does indeed normalize alcohol consumption in ways that "can be risky."
"It’s such a social norm to drink heavily at events such as weddings or sports games, to spend a whole weekend day brewery hopping, to poke fun at feeling hungover, to 'reward' ourselves at the end of a hard work day with a drink," Libby said. "People who don’t order an alcoholic drink at a social gathering are often questioned why they’re not drinking. I really try hard to have open discussions with my patients about how to frame their relationship to alcohol, ways to normalize limiting or abstaining from consumption, and how to have conversations about this with their peers. Thankfully, I’ve seen a big uptick in the availability and normalization of non-alcoholic beers and beverages that are available at more and more restaurants, sporting events, and breweries, which can be a great way to still partake in social gatherings without the health risks."
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Maine Crisis Hotline: 1-888-568-1112
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