BEHAVIORAL HEALTH/ADULT CHRONIC DRINKING INITIATIVE

Rationale for Forum's Initiative

Chronic or "at-risk" drinking poses a serious health threat in Brevard County. Over 9% of adults reporting consumption of more than 60 drinks during the past month in a 2004 community health assessment. 

What is "At-Risk" Drinking?

For healthy adults in general, drinking more than these single-day or weekly limits is considered "at-risk" or "heavy" drinking:

• Men: More than 4 standard drinks on any day or 14 per week

• Women: More than 3 standard drinks on any day or 7 per week

• Binge Drinking: More than 4 standard drinks for women and 5 for men in one sitting

What Counts as a Drink?

Many people are surprised to learn what counts as a drink. In the United States, a "standard" drink is any drink that contains about 0.6 fluid ounces or 14 grams of "pure" alcohol. Although the drinks pictured below are different sizes, each contains approximately the same amount of alcohol and counts as a single drink.

How Many Drinks are in Common Containers?

Below is the approximate number of standard drinks in different sized containers of:

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Could You Be An "At-Risk" Drinker?

Take this quiz to find out if you qualify as an "at-risk" drinker.

Try this Drinker's Check-up for a comprehensive analysis of your drinking patterns, potential health risks, and strategies to modify your current relationship with alcohol.

Comparing Your Drinking Pattern to Other U.S. Adults: You Might Be Surprised

Health Risks

Over time, excessive alcohol use can lead to the development of chronic diseases, neurological impairments and social problems. These include but are not limited to problems of the:

Neurological System. Includes dementia, stroke, and neuropathy. Alcohol kills nerve cells, and many heavy drinkers show evidence of brain damage. If this process continues for a period of years, the brain literally shrinks in size, due to the destruction of so many brain cells. In fact,the mental abilities of a 30-year-old heavy drinker can resemble those of an 80-year-old nondrinker

Digestive and Gastrointestinal System. Includes pancreatitis and gastritis. Alcohol can irritate and damage the sensitive tissue of the digestive system. Perhaps the most direct experience of this is to take a drink of straight liquor. It burns -- all the way down. It irritates the lining of the lips, mouth, throat and stomach. Alcohol also releases digestive acid in the stomach, which adds to the irritating effect of the alcohol itself. Heavy drinkers experience higher rates of gastritis, ulcers, and bleeding of the digestive system. Cancers of the digestive system are much more common in heavy drinkers -- occurring at more than 40 times the normal rate.

Cardiovascular System. Includes myocardial infarction, cardiomyopathy, atrial fibrillation, high blood pressure, and hypertension. Alcohol weakens heart muscle, decreasing cardiovascular fitness, and heavy drinkers have much higher risk of heart disease. Heavy drinking also increases blood pressure, and can contribute to hypertension.

Liver Functioning. Includes alcoholic hepatitis, cirrhosis, and worsening conditions of Hepatitis C. The liver is the body's main defense against poisons and impurities in the blood. It is also important in manufacturing energy for the whole body, including the brain, muscles, and heart. Because alcohol is a toxic chemical, it is the liver's job to remove it from the bloodstream. When alcohol is present, the liver gives priority to getting rid of it, and in the process doesn't perform some of its normal work, like getting rid of fats and body waste products. Over time, liver cells begin to die off, and are replaced by scar tissue. The beginnings of this irreversible process can be seen long before it reaches the disease stage known as cirrhosis. The liver becomes less and less able to produce energy and filter impurities (including alcohol) from the bloodstream.

Immune System. Includes increased risk of infection and cancer of the mouth, throat, esophagus, liver, colon, and breast. Alcohol decreases the body's ability to fight off diseases and infections. The immune system -- the body's defense -- works less efficiently whenever a person drinks, and over a period of heavy drinking the body's defenses can be greatly weakened. As a result, the person becomes more vulnerable to infections, cancers, and other illnesses. The risk of cancers in general among heavy drinkers is twice that of other people. Sores and injuries tend to heal more slowly, and it becomes harder to shake off the sickness.

Psychiatric Health. Includes depression, anxiety, and suicide. Drinking also affects mood. After one or two drinks, some people feel happier, more relaxed, less tense and anxious. Interestingly, these same changes happen when people believe they are drinking alcohol, even if they are not. Alcohol itself is a depressant drug, otherwise known as a downer. Its effects, in heavier doses at least, turn good feelings bad, and make bad feelings worse. After several drinks, mood tends to take a turn for the worse. It is around this same point, however, that alcohol also affects memory, so people tend to not remember the depressing effects of drinking - only the seemingly positive effects of the first drink or two. Among heavy drinkers, depression and anxiety are common.

Reproductive System. Includes impotence and birth defects. Alcohol has clear negative effects on the reproductive system. In men, drinking decreases the body level of testosterone, the primary male hormone. If a man drinks heavily for a period of time, this loss of testosterone can result in a "feminization" of his body -- the loss of body hair, enlargement of fatty tissue in the breasts, and a shrinking of the testicles. Heavy drinking can also contribute to sexual problems such as impotence. In women, heavy drinking has been linked to increased rates of sexual, menstrual, and other gynecological problems. Heavy drinking during pregnancy has been clearly linked to increased rates of miscarriage and still-birth, and to birth defects, behavior problems, and mental retardation in children exposed to alcohol in the womb. Alcohol consumed by a pregnant woman directly affects the fetus, and there is no known safe level of drinking during pregnancy.

Social Relationships. Includes unemployment, lost productivity, and relationship troubles. One reason why heavy drinkers' relationships may get into trouble is that the person begins to drink alcohol as a solution to problems, or as a way of trying to cope. Drinking takes the place of talking and working out difficulties in other ways. Alcohol dulls memory, and makes problems seem to go away -- at least for the time being. Yet while people are drinking to ease cares and worries, the troubles aren't really going away. In fact, they often get worse, because the drinker makes little or no attempt to find better ways to handle things. As a result, life begins to fall apart for the person -- sometimes a little at a time, sometimes in bigger shocks until all aspects of the person's life become unmanageable.

Physical Well Being. Drinking too much increases your chances of being injured or even killed. Alcohol is a factor, for example, in about 60% of fatal burn injuries, drownings, and homicides; 50% of severe trauma injuries and sexual assaults; and 40% of fatal motor vehicle crashes, suicides, and fatal falls.

Harmful Interactions: Mixing Alcohol with Prescription Medications

Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for more severe medical problems like internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless. It can even make the medication harmful or toxic to your body.

Click here to investigate the harmful effects that alcohol has on your medications.

Is It Time For A Change?

If you’re considering changing your drinking, you’ll need to decide whether to cut down or to quit. It’s a good idea to discuss different options with a doctor, a friend, or someone else you trust. Quitting is strongly advised if you:

• Try cutting down but cannot stay within the limits you set
• Have had an alcohol use disorder or now have symptoms
• Have a physical or mental condition that is caused or worsened by drinking
• Are taking a medication that interacts with alcohol
• Are or may become pregnant

If you do not have any of these conditions, talk with your doctor to determine whether you should cut down or quit based on factors such as: family history of alcohol problems, your age, whether you’ve had drinking-related injuries, and/or symptoms such as sleep disorders and sexual dysfunction

Strategies for Cutting Down

Small changes can make a big difference in reducing your chances of having alcohol-related problems. Here are some strategies to try. Pick two or three to try out for a few weeks, then add some more as necessary:

1. Write it down. Why do you want to cut back? To lose weight, get healthier, set an example for your kids, save money, etc. Put your list where you will see it each day.
2. Set a goal. Limit yourself to two drinks a day for men or one a day for women. Anything more is unhealthy.
3. Keep a record. Track how many drinks you have each day to help you track your progress. Find a way that works for you, such as a 3x5” card in your wallet, check marks on a kitchen calendar, or notes in a mobile phone notepad or personal digital assistant. Making note of each drink before you drink it may help you slow down when needed.

   

4. Set goals. Decide how many days a week you want to drink and how many drinks you’ll have on those days. It’s a good idea to have some days when you don’t drink. Drinkers with the lowest rates of alcohol use disorders stay within the low-risk limits.
5. Find alternatives. If drinking has occupied a lot of your time, then fill free time by developing new, healthy activities, hobbies, and relationships or renewing ones you’ve missed. Exercise can help take the edge off. Physical activity will cut anxiety and curb cravings.
6. Avoid triggers. What triggers your urge to drink? If certain people or places make you drink even when you don’t want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan something else to do instead of drinking. Maybe meet friends at a cafe or coffee shop, not a bar. Watch sporting events at home instead of at a bar
7. Pace and space. When you do drink, pace yourself. Sip slowly, and don’t start out thirsty. Down a large glass of water first, and drink your beer or cocktail for the taste, not to quench your thirst. Incorporate "drink spacers"--make every other drink a nonalcoholic one such as water, soda, or juice.

   

8. Plan to handle urges. When an urge hits, consider these options: Remind yourself of your reasons for changing (it can help to carry them in writing) or talk things through with someone you trust who shares your goals to cut back on your drinking (or to stop drinking). Instead of fighting the feeling, accept it and ride it out without giving in, knowing that it will soon crest like a wave and pass.

Forum Actions to Date

Behavioral health is a priority for the organization, and the Forum continues to support behavioral health initiatives consistent with its beliefs that:

1) Physical and mental health is inextricably linked, and

2) Positive mental health is essential to overall health.

Over the past year, the Behavioral Health Committee has worked diligently to make strides in the following areas: 

At-Risk Drinking:

A brochure was created aiming to educate consumers about the health benefits of decreasing alcohol use. The brochure was disseminated to numerous health organizations throughout Brevard County. Following its distribution, the committee evaluated its effectiveness in conveying the brochure's main points and overall message. The committee plans to translate a Spanish version of the brochure and distribute it throughout the community as well.  

Integrated Behavioral Health:

Integrated health care has been demonstrated to meet behavioral health needs in the community and within the primary care setting specifically. For this reason, a partnership between Brevard Health Alliance (BHA) and Florida Tech's doctoral program in clinical psychology was formed, resulting in the implementation of behavioral health services within the BHA Barton clinic. In the first year of the partnership, Florida Tech's doctoral practicum students provided behavioral health services to 246 unduplicated patients for a total of 485 encounters.