Sober N Clean

The conventional wisdom used to be that alcoholics had to hit bottom before they got better. But it can be a long, slow way down. A new government Web site called "Rethinking Drinking" aims to help people recognize problem patterns earlier and catch themselves before they fall.

"Most people don't know what 'drink responsibly' means -- they think it means not getting tanked," says Mark Willenbring, director of treatment and recovery research at the National Institute of Alcohol Abuse and Alcoholism. "But there are levels of drinking that raise your risk for alcohol problems just like high cholesterol raises your risk for heart disease."
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Behind the NIAAA's effort is a new understanding that there is a spectrum of alcohol-use disorders, which some experts hope will replace the current criteria for "abuse" and "dependence." The old definitions were based on observing addicts in treatment. Several large studies of drinking in the general population show that some patterns clearly pave the way for future problems.

The NIAAA say you are at "low-risk" for serious problems if you consume no more than four standard-size alcoholic drinks a day for a man or no more than three for a woman. That may sound like a lot, but you can't drink like that every day. The weekly "low-risk" limit is no more than 14 drinks for a man or seven for a woman. Drinking more daily, or weekly or both carries higher risk of abuse or dependence.

At www.rethinkingdrinking.niaaa.nih.gov, you can plug in your average consumption and see how you compare with the general population and problem drinkers. Since this is anonymous, you can try different amounts and see what they mean.

Some 37% of Americans always stay within the daily and weekly limits, according to the site. Only two in 100 of them progress to serious alcohol problems.

But 19% of Americans exceed either the daily or weekly levels; one in 12 of those people has already progressed to alcohol abuse or alcoholism. About 9% of Americans exceeds both the weekly and daily limits; half of them have alcohol problems.

Very few Americans exceed the weekly limits without exceeding the daily limitations, according to Dr. Willenbring. That contrasts with drinking patterns in Europe, where people are more likely to have wine with lunch and dinner on a daily basis.

About 35% of Americans don't drink at all. "That can be a real eye-opener for people who drink heavily and surround themselves with other people who drink a lot," says Ann Bradley, an NIAAA spokeswoman.

Even "low-risk" drinking can be risky for people with bipolar disorder, liver disease, abnormal heart rhythm and chronic pain, the Web site notes. It also links to a list of dozens of medications that can react adversely with alcohol, including drugs for high blood pressure, high cholesterol, pain and depression.

The limits are lower for women than men not just because of their size. According to the NIAAA, women's bodies tend to have less water so the alcohol tends to become more concentrated and more damaging to organs like the liver.

The Web site also notes that being able to "hold" a lot of liquor is actually a warning sign of dependence. And driving and judgment can be impaired even if you don't feel a buzz.
Safer Spirits

Most people are at low risk for alcohol problems if they stay within these limits:

* Men: No more than four standard-size drinks on any single day and no more than 14 weekly.
* Women: No more than three standard-size drinks on any single day and no more than seven weekly.

*Source: NIAAA

Knowing the size and strength of a "standard" drink is critical, so the site has a size chart and a content calculator. Some cocktails contain as much alcohol as three standard drinks. A wine bottle usually holds five 5-oz. glasses.

"Rethinking Drinking" leaves it up to you whether and when to change your habits, though it notes that alcohol is a factor in many fatal accidents and increases the risk of heart and liver disease, depression, sleep disorders, diabetes and many cancers. One section discusses the merits of cutting down versus quitting completely. Another lists pros and cons to consider—including "I'd need another way to wind down."

In focus groups when the site was tested, "some people got very quiet and engaged when they got to this part. It turned into an intervention," says Maureen Gardner, who co-authored the program.

The site also lists strategies for changing drinking habits, from "space and pace" (no more than one per hour) to "avoiding triggers" (recognizing external situations and internal emotions that tempt you to drink). An "urge tracker" lets you record times when you wanted a drink and why, what you did and what you might have done differently. A section on "refusal skills" helps you plan ahead to say no in social situations.

Dr. Willenbring hopes the site, and a downloadable print version, provides a tool for doctors, clergy and others who counsel people concerned about their drinking habits.

Awareness already seems to be rising, says Eileen Travis, director of a New York City Bar Association program that assists lawyers with substance abuse. "We get calls all the time from people who say they think they have a problem and want to stop before it gets bad—many more than in the past, when the only people we dealt with were in trouble in some way," she says.

Studies show that just five minutes of discussion with a primary-care doctor can reduce heavy drinking by 25%. Exploring online all by yourself might be just as useful.
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source: Wall Street Journal