DRINKING BECOME A PROBLEM?

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DRINKING

A Resource for Recognising and Dealing with Alcohol Abuse

WHEN DOES

BECOME A PROBLEM ?

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• The Facts

• The Effects o Social o Mental o Physical

• The Signs o Alcohol Abuse

o Alcohol Addiction (Alcoholism) o Who’s at Risk?

o Assessment Tests

• The Choices o Fancy a Drink?

o Staying in Control o Common Myths

• The Help

o Do’s and Don’ts o What can Families do?

o The National Addictions Management Service o Useful Websites

• The Testimonials o Inspiring Others o Looking to the Future

Excessive alcohol consumption can lead to various medical conditions, such as liver disease, kidney damage, stomach ulcers, impaired cognitive development and alcohol addiction. It can also diminish the capacity to think clearly or act responsibly—resulting in injuries and deaths due to drink driving or drunken brawls.

Studies show that underage drinkers are 5 times more likely to become addicted to alcohol or abuse alcohol later in life. Youths should therefore stay alcohol-free and be made aware of the consequences of drinking at an early age.

This guide offers general advice on how to recognise and deal with problem drinking—including alcohol consumption guidelines, assessment tests and individual testimonials. You’ll also find details for getting professional help and more information.

1 Binge drinking is defined as having 4 or more alcoholic drinks in one session for women, and 5 or more for men.

Facts

The

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THE EFFECTS

Most people are able to ‘eat, drink and be merry’ without it affecting their daily lives.

However, binge drinking or excessive alcohol consumption can have serious, long-term consequences in a number of ways.

Aggressive, irrational behaviour.

Arguments. Violence.

Depression. Nervousness.

Alcohol dependence.

Memory loss.

Premature aging.

Drinker’s nose.

Weakness of heart muscle.

Heart failure. Anemia. Impaired blood clotting. Breast cancer.

Vitamin deficiency. Bleeding. Severe inflammation of the stomach.

Vomiting. Diarrhea. Malnutrition.

In men:

Impaired sexual performance.

In women:

Risk of giving birth to deformed, retarded babies or low birth weight babies.

Inflammation of the pancreas.

Frequent colds. Reduced resistance to infection.

Increased risk of pneumonia.

Trembling hands. Tingling fingers.

Numbness. Painful nerves.

Ulcer.

Numb, tingling toes. Painful nerves.

Impaired sensation leading to falls.

Liver damage.

Cancer of throat and mouth.

Effects

The

Social

It could lead to criminal behaviour or violence at home or in public.

Some may even lose their jobs or places at school due to poor performance or absenteeism. Drink drivers can put themselves and others at risk, while drunken females are at risk of being molested or raped.

Young people who drink are more likely to get into fights and commit crimes.

Mental

Some people drink to cope with problems, relieve stress or reduce anxiety. However, drinking can lead to a range of mental health issues, such as depression, increased anxiety, memory loss and risk-taking behaviour—especially among the young.

Left unchecked, uncontrolled drinking can also result in alcoholism.

Excessive consumption of alcohol in the long term can cause permanent brain damage.

Physical

Drinking too much alcohol can cause someone to lose consciousness, have a fit or lapse into a coma. By depressing the central nervous system and the body’s reflexes, it may also inhibit breathing, lower heart rates and cause people to choke on their own vomit

—resulting in deaths.

Heavy drinking can drastically cut short life and decrease one’s quality of life through liver disease, epilepsy, hypertension, stroke and certain types of cancer.

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When alcohol has a negative impact on someone’s life, then he/she has a drinking problem—but he/she may not even realise it. It’s like the drunk guy you see at a party who insists that he is sober enough to drive home.

The first step in helping a family member, friend, colleague or student who may have a drinking problem is recognising the signs and symptoms of alcohol abuse and alcoholism.

Someone with a family history of alcoholism or who associates closely with heavy drinkers is more likely to develop a drinking problem.

Alcohol Abuse

This is when someone misuses or overuses alcohol, which then has a negative impact on his/her relationships, family, work, health, life or finances. It may be associated with one or more of the following situations over a 12-month period:

• Encountering recurring alcohol-related legal problems.

Examples include: being arrested for driving under the influence of alcohol, damaging property or physically hurting

someone while drunk.

• Drinking that results in physical injury. Examples include:

any injuries that occurred when driving a vehicle or operating machinery under the influence of alcohol.

• Continuing to drink in spite of ongoing relationship difficulties.

• Failing to address important responsibilities at work, home or school.

Left untreated, alcohol abuse can lead to alcohol addiction—

though not all abusers become alcoholics. As it’s difficult to tell who will eventually develop an addiction to alcohol, alcohol abusers should stop drinking altogether or at least reduce the amount that they drink.

Someone with mental health problems, such as anxiety or depression, may end up drinking more to feel better.

THE SIGNS

Signs

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Assessment Tests

Here are two easy-to-use questionnaires that can be used by individuals or professionals to help recognize problem drinking.

C.A.G.E.

The CAGE questionnaire consists of four simple questions:

1. Have you ever felt you should Cut down on your drinking?

2. Have people Annoyed you by criticising your drinking?

3. Have you ever felt bad or Guilty about your drinking?

4. Have you ever had an Eye opener (that is, a drink first thing in the morning) to help steady your nerves or get rid of a hangover?

Answering “yes” to two or more of the above questions, indicates a drinking problem and professional help should be sought.

The Alcohol Use Disorders Identification Test

The Alcohol Use Disorders Identification Test (AUDIT) can also be used to screen for problem drinking. It provides a framework for intervention to help risky drinkers and alcoholics reduce or cease alcohol consumption—and thereby avoid the harmful consequences of drinking.

Drinking excessively not only affects one’s health in the long run, it can also interfere with certain medications and medical treatments.

It’s therefore crucial that each question is answered truthfully. The AUDIT can be done in private and no one needs to know the result.

Simply, place an X in the box that best describes your answer to each question. Then, add up the scores. If the results show that a drinking problem exists, please do not fret.

Simply turn to the ‘The Help’ section and speak to a professional today.

Alcohol Addiction (Alcoholism)

This is when someone drinks uncontrollably despite the negative consequences, such as recurrent physical or psychological problems caused or exacerbated by alcohol. Alcoholics may:

• Have a strong and continued compulsion to drink.

• Drink more and more in order to ‘feel a buzz’ or ‘get high’.

• Experience withdrawal symptoms, such as anxiety, sweating, nausea or ‘the shakes’.

• Consume larger amounts of alcohol or spend more time drinking than initially intended.

• Often want to cut down or control their alcohol use—without much success.

• Spend increasingly more time obtaining or drinking alcohol, or recovering from its effects.

• Miss important social, occupational or recreational activities due to alcohol abuse.

Who’s at Risk?

According to research, there are three groups most at risk of developing a drinking problem.

1. Young adults with disposable incomes, spare time and no parental responsibilities. In general, the younger the age at

which someone starts drinking, the greater the chance of him/her becoming addicted to alcohol.

2. Those with a family history of alcohol-related problems, or with underlying personality and mood disorders, are more likely to be dependent on alcohol early on in life.

3. Those aged around 40 may undergo various forms of psychological or social difficulties associated with reaching the middle stage of their lives.

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1. How often do you have a drink containing alcohol?

(0) Never (3) 2 to 3 times a week

(1) Monthly or less (4) 4 or more times a week (2) 2 to 4 times a month

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

(0) 1 or 2 (3) 7, 8, or 9

(1) 3 or 4 (4) 10 or more

(2) 5 or 6

3. How often do you have X (X = 5 for men, 4 for women) or more drinks on one occasion?

(0) Never (3) Weekly

(1) Less than monthly (4) Daily or almost daily (2) Monthly

4. How often during the last year have you found that you were not able to stop drinking once you had started?

5. How often during the last year have you failed to do what was normally expected from you because of drinking?

6. How often during the last year have you needed an alcoholic drink first thing in the morning to get yourself going after a night of heavy drinking?

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

9. Have you or someone else been injured as a result of your drinking?

(0) No (2) Yes, during the last year

(4) Yes, but not in the last year

10. Has a relative, friend, doctor, or another health professional expressed concern about your drinking or suggested you cut down?

(0) No (2) Yes, during the last year

(4) Yes, but not in the last year

Source: The Alcohol Use Disorders Identification Test, Second Edition (World Health Organization, 2001).

Total Score

Scoring and Interpretation

Add up the points associated with the answers.

A total score of 8 or more indicates a hazardous or harmful alcohol consumption level and possibly alcohol addiction.

On questions 2 and 3, a score of 1 or more shows consumption at a hazardous level.

For questions 4, 5 and 6, a score above 0 (especially 3-4) shows there may be alcohol addiction or, at least, the early stages of it.

And for questions 7, 8, 9 and 10, a score above 0 indicates that alcohol-related harm is already being experienced.

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THE CHOICES

Choices

The

Set Limits

Work That Drink

Drink Slowly

For many individuals with no health issues, drinking alcohol in moderation and responsibly can be fun and enjoyable. However, there are groups of people who should not drink at all. These include:

• Children

• Adolescents

• Recovering alcoholics

• Pregnant women or women trying to conceive

• People on medication

• People with certain medical conditions, such as alcohol allergies, liver problems, high blood pressure or asthma

• Vehicle drivers and operators of heavy machines

• Anyone engaged in activities that require concentration, skill or coordination

If someone is unsure whether it’s okay to drink, he/she should consult a doctor first.

In small-to-moderate amounts, alcohol (particularly red wine) can only benefit post-menopausal women, middle-aged men and older men—provided it’s not against doctor’s orders.

Fancy a Drink?

When people are invited to go for a drink, some may feel a little pressure to simply accept. However, it’s perfectly okay to:

• Say “no thanks, not today” and leave it at that.

• Tell a little white lie, such as “I can’t drink tonight. I’ve got an early meeting tomorrow.”

• Order a non-alcoholic drink or mocktail instead.

• Suggest doing something else, such as going bowling or to the movies.

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Staying in Control

For those who enjoy a drink, here are some useful tips to help keep things under control—and prevent it from becoming a problem.

• Keep count. If you tend to lose track of how many drinks you have had, ask a friend to help. You should also note the alcohol content (expressed as a %) of the drinks.

• Set a limit. And stick to it. For example, you can make a pact with a friend not to exceed more than two drinks a night.

• Be assertive. Don’t allow anyone to make you drink more than your limit.

• Work that drink. Move around, dance or mingle with people instead of sitting down and just drinking.

• Drink ‘spacers’. Alternate your alcoholic drinks with non- alcoholic drinks, such as water or mocktails.

• Drink slowly. When thirsty, drink some water or something non-alcoholic.

• Avoid drinking games. If you do decide to take the risk, however, be sharp, stay within your limit and know when to

bow out.

• Eating isn’t cheating. Before and during drinking, have something to eat and avoid food that makes you thirsty.

If you drink occasionally, you should avoid binge drinking—

defined as 4 or more alcoholic drinks on one occasion for women, and 5 or more for men.

In general, women should not drink more than 1 standard drink per day, and men no more than 2 standard drinks per day.

A standard alcoholic drink contains 10 grams of alcohol.

This roughly equates to:

• A can (330 ml) of regular beer with 5% alcohol content

• A small glass (175 ml) of wine with 15% alcohol content

• A shot (35 ml) of spirits with 40% alcohol content Common Myths

To make an informed choice about whether or not to drink, it pays to be aware of some of the urban myths about drinking—as well as the facts.

MYTH: Everyone has a similar reaction to alcohol.

FACT: People react differently to alcohol due to many physical factors, such as weight, metabolism, gender or body chemistry.

MYTH: Men and women, of similar height and weight, can drink the same amount of alcohol.

FACT: Women have less water in their bodies than men, so the alcohol concentration in their bodies will be higher after drinking—resulting in a tendency to get drunk faster.

Females also metabolise or break down alcohol slower.

And hormonal changes during menstrual cycles can affect alcohol absorption.

MYTH: A cold shower or hot coffee helps to sober you up.

FACT: Only time will remove alcohol from the bloodstream.

It takes the body about an hour to eliminate one standard alcoholic drink.

MYTH: Switching between beer, wine and spirits gets you drunk quicker than sticking to one type of alcohol.

FACT: The level of blood alcohol content determines intoxication. A standard drink of beer, wine, or spirits contains equivalent amounts of alcohol. So it makes no difference to the type of alcoholic you consume when they

all contain the same amount of alcohol.

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MYTH: Eating a big meal or oily food before drinking will keep you sober.

FACT: Although a full stomach will help delay the absorption of alcohol into the bloodstream, alcohol will still get into your blood. And depending on the amount consumed,

you can still get drunk.

MYTH: Anyone who passes out from drinking should just ‘sleep it off’.

FACT: If a friend you’re with has had too much to drink and passes out, they should not be left alone. Instead, you should keep an eye on them and check their breathing and heart rate. They should also lie down with their head to one side to prevent them from choking if they throw up.

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Help

The

HOW TO HELP

DO:

• Listen sympathetically, and be tactful and non-judgmental.

• Help him/her weigh up the pros and cons of alcohol abuse.

• Share your own observations and concerns sensitively.

• Be supportive by helping him/her set or stick to controlled drinking and abstinence goals.

• Offer timely affirmation and encouragement for his/her efforts made in achieving any treatment goals.

• Suggest healthy or alternative activities to drinking, such as playing sports.

• Encourage him/her to seek professional help or join a support group, such as Alcoholics Anonymous.

Helping someone with alcohol dependence can be emotionally draining—especially if it’s someone close to you. So it’s important that you also get support for yourself.

DON’T:

• Attempt to punish, threaten, bribe or preach.

• Be overly emotional or try to be a martyr. This may only increase his/her feelings of guilt and the compulsion to drink

or use other drugs.

• Cover up or make excuses for him/her, or shield him/her from the potential consequences.

• Take over his/her responsibilities. He/She needs to feel responsible to maintain self-esteem and dignity.

• Hide or dump bottles, throw out medicines or shelter him/her from situations where alcohol is present.

• Argue with him/her when he/she is drunk.

• Drink with him/her.

• Feel guilty or responsible for his/her behaviour.

If someone close to you shows signs or symptoms of problem drinking, you can help him/her in a number of ways. Here’s a list of basic do’s and don’ts.

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Recovering from alcohol abuse or addiction is not an easy journey.

Sometimes it feels like it’s an impossible one—for those trying to recover and those providing support. Any relapses can simply help both sides to learn more and be better equipped for the future.

Where possible, be a pillar of strength and offer encouragement.

What can Families do?

Alcoholism doesn’t just affect drinkers. It affects everyone who is close to them. Families, in particular, are often angry and confused by an alcoholic’s behaviour—yet, still don’t want to lose him/her.

They want to keep everyone together and often go to extreme lengths to protect him/her. Over time, however, if nothing changes, a family can feel bitter and betrayed.

There are, however, several things that can be done to help.

Firstly, family members should find out as much as they can about alcoholism. It’s easier to understand an alcoholic’s thinking and behaviour when you know more about the disease.

Families should also be aware of their own needs, which they often neglect when coping with an alcoholic. Children, for instance, are often neglected in these situations—resulting in them growing up feeling isolated or unloved. Staying in touch with extended family and friends is also important.

Finally, seeking help from professionals who understand alcoholism can be very beneficial. The opportunity to talk to someone else who’s medically trained, for instance, can reduce the burden. It can also help get an alcoholic to seek treatment sooner as most alcoholics often minimise or deny their drinking and associated problems.

The National Addictions Management Service The National Addiction Management Service (NAMS) offers treatment for anyone suffering from alcohol abuse or alcohol addiction.

At the first appointment, a doctor will examine the patient and a counsellor will provide a comprehensive assessment. A suitable treatment plan will then be drawn up.

In addition, a full psychiatric screening will take place to identify any problems that could hinder the recovery progress, such as depression.

Family members and close friends will be encouraged to participate in the treatment process. In particular, they will be

taught how to provide much-needed encouragement and support.

Treatment Overview

• Initial assessment by counsellor

• Medical consultation and treatment

• Individual counselling with an addiction-trained professional

• Group treatment

• Family support group If you know someone who may have a drinking problem, encourage him/

her to call 6-RECOVER (6-732 6837) and speak to a NAMS counsellor.

All calls are kept strictly confidential.

Useful Websites For additional information about alcohol abuse and addiction, please visit:

www.nams.sg www.hpb.gov.sg www.breathe.sg/liveitup

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MORE INFORMATION

Inspiring Others

“When I was growing up, my mother and I were abused by my alcoholic father. I also witnessed my father killing my mother in cold blood! He was sentenced to life imprisonment and later died from diabetes while in prison.

To get away from my family, I was involved in gangs when I was young. I was angry with my dad and at the same time, I was grieving for my mother. I went into depression. All these took a toll on me and I started drinking in 2007.

Then, three years ago, I decided to turn my life around. I sought treatment at NAMS for my alcohol addiction because I hated the person that I was becoming. My health was affected and psychologically, I felt bitter and angry.

A few times during my treatment, I was warded at the Institute of Mental Health. But I persevered and went through counselling to help me deal with my anger and grief. I’m glad I did because I was able to make amends with my father before he passed away.

And now I feel more at peace with myself.

I can do it, so can you!

Today, I’m proud to say that I have not touched a drink in two years. I’m now working in a halfway house for teenagers, helping those with addiction problems. I also give talks to youths.

I have also completed a diploma and am looking forward to pursuing a degree in social work. To anyone out there who’s struggling with alcohol addiction, I simply want to tell you this – if I can do it, so can you!”

Albert

Testimonials

The

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Looking to the Future

“I had my first drink when I was six years old – at my brother’s wedding. Then, when I was doing my National Service, I began drinking regularly. When I started working, I drank even more because of the stress from work.

I didn’t think I had a drinking problem until I was referred to the Institute of Mental Health in 1993 for alcohol addiction.

I managed to stay ‘clean’ between 2004 and 2009. During that time, I attended Alcoholics Anonymous regularly. I began to build up my business and was doing well financially. My relationship with my family also improved.

In 2009, I began to suffer from severe neck pain. I sought treatment from various doctors but the pain persisted. I gave up my business because I was unable to work. I was in such agony that I decided to mix alcohol with my medication, hoping to ease the pain.

I’m glad I went back to NAMS.

In 2011, I suffered a relapse and started drinking heavily again.

My marriage ended in divorce. I had to sell my home. The divorce and medical bills left me with hardly any money. I felt that life was meaningless. I even contemplated suicide.

Then, on one of my more sober moments, I decided to go back to NAMS for treatment. I’m glad that I did, as I know that I couldn’t do this on my own. I find the group counselling sessions useful. My friends from our support group are also there to check on me and encourage me when I’m feeling down.

Today, I’m in a halfway house to continue with my recovery. I’m feeling more confident and am hopeful about my future. I still have my business connections and am waiting for the right moment to rebuild my life.”

Mr J

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This resource booklet is co-authored by the Health Promotion Board and the National Addictions Management Service.