Most people who drink alcohol are not alcoholics and never will be. But the National Institute on Alcohol Abuse and Alcoholism knows all too well that millions of Americans drink in amounts or patterns that put them at risk of developing a dependence on alcohol and having to face the attendant medical, legal and social problems.
Based on a 2001 to 2002 nationwide survey of 43,000 adults conducted by the National Institutes of Health, the alcohol institute estimates that 30 percent of people 18 and older drink at levels that raise their risk of alcoholism. And since helping those people identify themselves before they get into trouble with alcohol is easier than treating alcoholism, the institute has begun a groundbreaking preventive program called Rethinking Drinking.
The program includes a 16-page booklet for the public (Rethinking Drinking: Alcohol and Your Health), a product set for clinicians with a 34-page booklet (Helping Patients Who Drink Too Much: A Clinician’s Guide) and an interactive Web site for people who drink, RethinkingDrinking.niaaa.nih.gov, complete with quizzes, calculators and other tools.
The materials can be downloaded from the Web site. Together, they represent a sea change in the approach to alcohol abuse: identify and treat risky drinking patterns before anything bad happens.
MAKING ADJUSTMENTS
“This is a wellness project, patterned on the risk-reduction concept used to prevent other chronic diseases like heart disease and diabetes,” Mark Willenbring, the main architect (with Maureen Gardner) of the program, said in an interview. “As with lowering cholesterol or high blood pressure to prevent heart disease, the idea is early identification of risky drinking patterns and early intervention instead of waiting until the person is chronically ill.”
Willenbring, who directs the institute’s Division of Treatment and Recovery Research, added: “Once they know who they are, most people at risk of becoming alcohol abusers can cut down on their alcohol consumption and reduce their risk. We know that many heavy drinkers are able to change on their own.”
For those who already drink at abusive levels, the new program can help them acknowledge their problem and seek treatment earlier, before they suffer irreversible medical and social problems like liver or brain disease, legal difficulties, job loss or divorce.
The beauty of Rethinking Drinking is that it can be used in the privacy of the home or in a doctor’s office, sparing people the embarrassment and stigma that often accompany public acknowledgment of a
problem with alcohol and entering a treatment program.
“A single session with a physician — just five minutes of advice — can have lasting effects on reducing a person’s drinking,” Willenbring said. Yet many primary care doctors don’t know how to identify a potential drinking problem in their patients or what to do if they suspect a problem may develop.
“More than 90 percent of alcohol treatment programs offer group counseling or Alcoholics Anonymous,” Willenbring noted. “This is not a medical model. Doctors are not involved.”
The Rethinking Drinking materials can also be used in other settings, like college campuses, workplaces and churches, and in the criminal justice system. A student who repeatedly wakes up hung over without knowing what he did the night before might consult the program and modify his behavior. Someone who is cited for driving while intoxicated might be referred to the program and prompted to take better control of his or her drinking before a disaster occurs.
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