Alcoholism is under-diagnosed. Why? It’s a hard subject to raise.

Whether their beverage of choice is a full-bodied red or an ice-cold Blue, Canadians love to drink. In fact, according to the most recent figures from the Canadian Centre on Substance Abuse (CCSA) in Ottawa, alcohol is the psychoactive substance of choice for nearly 80 per cent of the population over the age of 15. Most people tend to drink moderately—consuming one or two drinks a day, doctors say, is healthy. But others frequently drink a very unhealthy four or five drinks at a sitting. The CCSA puts that number at about seven per cent of the population, or 2.3 million people. “And if that doesn’t appear high,” says Doug Beirness, a senior CCSA analyst and a scientist, “the problems caused by those people are huge.” Not only do alcoholics lose jobs and destroy relationships, they cost our medical system untold millions in the treatment of alcohol-related diseases. Alcohol, say experts, goes to every cell in the body and can result in neurological and gastrointestinal disorders, high blood pressure and a whole raft of psychiatric illnesses including depression.

In Canada, certainly, selling alcohol is a booming business. During the fiscal year ending in March 2006, beer and liquor stores and their agencies reported sales of more than $17 billion worth of alcoholic products, up more than $1 billion in just two years. Says Dr. Peter Selby, the clinical director of addiction programs at the Centre for Addiction and Mental Health in Toronto, “Does that mean more people are drinking or people are drinking more? It could be both.”

Exactly who is drinking and how much, however, is a tricky thing to document, especially since any sort of survey depends on honest answers from the drinkers themselves. According to the latest Canadian Addiction Survey, released in 2004, those most likely to have a drinking problem fall into a number of different categories. Overall, people who are male, young, divorced, separated or widowed, have a good education and a high income, are likely to drink, but those who abuse alcohol tend to be less educated, young singles. Still, those findings aren’t hard and fast—they are “self-reported,” Beirness says.

This spring, Health Canada began a new Canadian Alcohol and Drug Use Monitoring Survey (CADUMS). It relies on questions and answers over the telephone to determine the prevalence, incidence and frequency of alcohol, cannabis and other drug and substance use in the Canadian population aged 15 years and older in order to measure the extent of associated harms. Will the 10,800 respondents answer honestly? “Sales data tells us more alcohol is being sold than people tell us they are drinking,” says Beirness. “And people are not buying it and pouring it down the drain.”

One thing experts are sure of, though, is that alcoholism is being under-diagnosed by Canadian doctors, probably because it’s a hard subject to raise. “The stigma has gone down for depression,” Selby says. “But doctors don’t feel comfortable about asking their patients how much they drink for fear of offending them.” This is unfortunate, Selby adds, because “there is good evidence that a brief intervention by a physician can help people who are drinking too much cut down.” In this Selby has support from the CEO of the most famous addiction treatment centre in the world, the Betty Ford Center in Rancho Mirage, Calif., Dr. Garrett O’Connor.

O’Connor points to a 2002 Columbia University study that said turning to a family doctor may be “a missed opportunity.” Says O’Connor, “It’s a terrible tragedy. It’s been shown in England that even a 10- to 15-minute chat with a patient can be almost as good as treatment in terms of helping people to stop drinking and stay sober for up to 18 months.” O’Connor himself is a recovering alcoholic, and, he says, the only person who ever suggested he might have a problem was a dentist. Plus, O’Connor says, many alcoholic patients are ambivalent—it’s like they want to get help and not get help at the same time.

But when it comes to stopping alcoholism in its tracks, experts say, someone in the medical profession should catch it in the very young before it becomes entrenched. Increasingly, studies are showing that some children as young as 11 or 13 are already alcoholics, and that the younger a child is when he begins to drink, the higher his risk of becoming addicted. It may be that adolescent drinking actually alters the growing brain. Says Selby: “That’s why a lot of people say if you can delay consumption until early adulthood, you can reduce the risk. Maybe the developing brain just learns more quickly.” Or maybe the brain’s pathways are altered.

A recent study done at Wake Forest University in Winston-Salem, N.C., on brain tissue samples taken from the superior frontal cortex (part of the brain that involves feelings of desire and reward) in chronic alcoholics post-mortem reveals that changes occur at the molecular level. In other words, the brain was irreparably altered. Even that is not wholly new. As far back as 2000, researchers at the University of Texas studying the same part of the brain discovered that chronic alcohol abuse changed its programming and corrupted decision-making and judgment. Still, Selby thinks addiction is both nature and nurture. “The more genetically disposed you are, the higher the chance that you will start drinking sooner,” he says. “And if the pattern in the home is drink to get drunk, rather than as part of a meal or a social lubricant, that will prime a developing brain.”

Whatever the cause, experts like Beirness say drinking tends to go in waves and right now Canadians are at a peak. But anyone looking to lay the blame on the boomers will have to look somewhere else, he says. “As people get older, they do tend to drink more frequently—but they consume less quantity. It’s a very complicated issue.” Adds O’Connor, “The most interesting statistic to me is that of the 23 million people in the U.S. right now who have a problem and don’t get treatment, 97 per cent of them don’t think they need it.”
source: Maclean's