Following the Covid-19 pandemic concerns have been raised regarding alcohol use generally for example, Dr Farren recently pointed to a 40% increase in alcohol consumption, with a lot of this moving to drinking at home. Some people may have had no issues with alcohol before the pandemic, but, over the course of 18 months, find themselves at the stage where there is serious alcohol abuse.
This increase in problems associated with alcohol has led families across Ireland to worry about loved ones, and to wonder what they can do to approach the issue with their family members. Here are some practical tips on how to address the issue with the person and begin moving forward.
If you are worried about how to approach a person’s drinking or alcohol use with them, there can be some fear about how best to do this. The first step is to talk about it yourself: speak about your concerns with friends, family or even someone who has been through the experience themselves. By getting some peer support for yourself, you can build up the courage and knowledge to approach the person themselves.
When it comes to opening the conversation with the person, there is no one thing you can say or “one phrase fits all” that will resolve the situation. Instead, consider the following points
- It is best not to approach someone when they are intoxicated or when they have been drinking. Wait for a day or two until there is an opportunity to speak to them.
- Suggestion is better than confrontation. Rather than accusing or giving out to the person, it is more helpful to open a conversation with something like “Have you noticed you were quite out of it the other evening and it’s been that way for a while.
- It is good to be able to share a number of points of evidence to the person, rather than just one. For example, this could mean letting the person know a few different things, such as finding several empty bottles around the home, or seeing their children or family members upset because the person had been drinking. Having a few scenarios and points of proof to share with them is helpful.
- Having one or two close family members or friends with you when you are talking to the person can avoid the situation becoming too personal. It also gives the opportunity for the person to hear these people’s perspectives and know that people care and are affected by what is going on. This does not mean having what can be known as an intervention with a large number of people present; this can be too much.
- It is important to have something positive to suggest, rather than focusing only on the problem. This can be as simple as suggesting the person could read some information, watch a video or talk to their doctor. It can be better to wait a little before suggesting the person attends a group like Alcoholics Anonymous or receives rehabilitation treatment: a few positive suggestions that lead up to a step like this can be more powerful in the beginning.
If you are worried about your children or young people drinking, It’s important to convey the message to them. Research shows that softened, persistent messaging works, particularly if it’s consistent over time: putting gentle restrictions in place – such as not allowing them to drink in the house – can also help with this.
What is excessive alcohol consumption?
There are many forms of excessive alcohol consumption that can cause substantial risk or harm to anyone of us. Some people drink large amounts of alcohol each day. Others have repeated episodes of drinking until they are drunk, so-called binge drinkers. Others keep drinking despite the fact that their alcohol use is causing them physical harm or harm to their mental health. Lastly, some people drink in a way which is dependent or addicted to alcohol and so they find it very difficult to stop.
Excessive alcohol drinking causes illness and distress to the drinker, but also to his or her family and friends. It is a major cause of the breakdown of relationships, of trauma, of hospitalization, of prolonged disability and of early death. Alcohol-related problems represent an immense economic loss to many communities around the world.
Today, I would like to invite you to look at the World Health Organisation (WHO) “Alcohol Use Disorders Identification Test” (AUDIT), published by Thomas F Barbor et al. The aim of the test is to try and find out whether our drinking:
- is modest and within safe limits
- is hazardous and risks causing harm to our physical or mental health
- is already likely to be harmful and is already damaging us or
- is actually dependent and likely to be difficult to stop.
What are the risks of excessive drinking?
According to the WHO, “alcohol is implicated in a wide variety of diseases, disorders and injuries, as well as many social and legal problems”. Alcohol use is associated with road traffic accidents and pedestrian injuries with falls and injuries at work. It is a major cause of cancers of the mouth, esophagus and larynx as well as cancer of the breast. It is associated with damage to organs, such as liver psoriasis and pancreatitis, especially after long-term excessive consumption. Alcohol causes harm to the developing baby in the womb and may lead to growth retardation or learning disability or so-called fetal alcohol syndrome.
Alcohol also exacerbates many common medical conditions, such as hypertension, gastritis, diabetes and some forms of stroke. These may be aggravated by even occasional or short-term alcohol consumption, as are many mental health disorders, such as depression.
The risk related to alcohol is linked to the amount of the consumption and to the pattern of drinking. Obviously, these risks are most prominent in people who are dependent on alcohol. This is simply because there are people who drink more than other people. However, the bulk of harm associated with alcohol occurs amongst people who are not dependent, if only because there are so many of them.
The identification of drinkers with various types and degrees of at-risk alcohol consumption has a far greater potential to reduce all types of alcohol-related harm and ill-health. No one develops alcohol dependence without first having engaged for some time in hazardous alcohol use. Screening for alcohol misuse and dependence is worthwhile, but it is most useful in those people who are not dependent yet who may be well advised to reduce or stop their alcohol use because of the hazardous or harmful consequences that it is already having.
Many of us are ignorant or unaware of the safe limits of alcohol use and there are many social and cultural pressures on us to drink heavily. Heavy alcohol consumption is part of our custom and this can be a very big pressure on us. Many of us indeed may simply be in denial about our alcohol use, so that using a screen such as the audit tool is helpful because it allows us to take the preventative measures which are proven to reduce alcohol-related risks.
How can I tell if I am drinking too much?
Download and complete the Alcohol Use Disorders Identification Test below.
The test was developed for health professionals, general practitioners and community nurses, but it can also be taken as a self-report measure. All we are doing now is to try and facilitate a guide and allow you consider your own alcohol use. By giving you the tool that your doctor is likely to use, you can understand where the assessment is coming from and perhaps benefit from it all the more.
This test should help reveal whether we are:
- modest drinkers who need to be advised about safe drinking
- hazardous drinkers who need to recognize the danger alcohol consumption puts us in
- harmful drinkers who are already damaging our physical or mental health, or
- dependent drinkers who need to seek professional help and should do so as soon as possible.
Each of these groups can benefit from education.
If your alcohol use is in the hazardous region, then you need to consider this evidence and consider reducing your alcohol use or even abstaining. You need to get the best possible support for this; ideally, speak to your doctor and seek advice and encouragement. If your alcohol use is already causing you harm, you need to consider stopping drinking and you may need some brief form of counselling or continued monitoring to help you do this. If you are already in the dependent region and are addicted to alcohol, you should seek specialist support for further evaluation and treatment.
The Alcohol Use Disorder Test can be accessed and downloaded from here: https://www.who.int/publications/i/item/WHO-MSD-MSB-01.6a