ASSESSMENT OF ALCOHOL USE

Alcoholism is a huge social problem, yet there are many individuals who drink occasionally with little or no consequence, except perhaps the hangover after a party. While a family might be wildly upset over the fact of their teenage son coming home after a party smelling of liquor, this one offense would probably not constitute problematic drinking or the need for treatment. Yet, if these episodes continued and the teenager was a minor, intervention and treatment would be indicated in order to avoid severe consequences.

There are those who are described as “functional” alcoholics who go to work by day and drink by night. Many have become successful. Yet their lives often cut short by medical complications connected with long term alcohol use. Sadly, many do not receive the help or intervention that they need because of appearances that they are getting away with their drinking.

Then there are religions and sects that forbid the use of alcohol at all and one drink could constitute sever social consequences.

Counselors, teachers, family members and those in the addiction field can be faced with the responsibility of determining if drinking is problematic enough in an individual so as to require treatment. Often these practitioners do not receive information from the abuser but from family and through the family information an assessment may be necessary in order to determine if there is a need for intervention.

GUIDELINES FOR ASSESSMENT

There are simple guidelines suggested in the book Substance Abuse by Gary Fisher and Thomas Harrison to determine when a “user” has crossed the line and has become an individual who needs outside assistance to stop the drinking. They categorizations they describe are use, misuse, abuse and addiction.

While these guidelines are not meant to be used as a method of diagnosis, they can be helpful in assisting teachers, counselors and other practitioners in determining if the presenting case or the family should be referred to an alcohol addiction specialist. They are also helpful for those working in the field of substance abuse in directing a family, or convincing a drinker that their drinking has gone too far and they need treatment.

USE AND MISUSE

Fisher and Thomas define “use” as the ingestion of alcohol without negative consequences. Here we find the occasional party drinker or the family who enjoys wine occasionally at dinner.

The experience of negative consequences because of drinking would place the situation in the category of “misuse”.

In the case of an underage child who came home after drinking at a party, perhaps this one occasion did not result in severe negative consequences except with his parents. This is a “misuse”. For one thing, drinking as a minor is against the law. Secondly, if the drinking became frequent, the chances that the child would become an alcoholic as an adult statistically become greater.

In this case there is a fine line between use, and misuse but the matter of consequences is a determining factor. A counselor or teacher would be wise to advise parents to take an opportunity like this to educate their child on what consequences could occur so they never become an abuser.

In the case of the presumably “functional” alcoholic, it could appear for years that he is simply using alcohol, as there are no consequences. The probability of consequences increases with the degree of drinking that an individual is doing. So while, it may not appear that there are any consequences to an outside observer, the chances are that at the very least, there are health consequences. The damage might not be apparent to the drinker or family for a long period of time so the family or friends might not think it is necessary to intervene. However, the classifications and subsequent handling of a continual drinker as a “user” is not wise. Continual use is misuse at best, as there will be consequences.

ABUSE AND ADDICTION

Alcohol “abuse” is defined as the continued drinking of alcohol in spite of negative consequences. If our high school student were to be arrested and still continued to drink frequently, he would be considered an abuser and in need of treatment. If our “functional” alcoholic were to be diagnosed with liver dysfunction, yet continued to drink, he would be an abuser and in need of treatment, no matter how well he appeared to be doing to the rest of the world.

Many abusers can be defined by the number of DUIs they have. Despite the consequences of arrest and potential loss of their license, they continue to drink. An intake counselor at Narconon once remarked that it was surprising to learn how many DUIS clients had received before treatment, all the time denying to themselves and others that there was a problem. In fact, if not treated, this person falls into the next category of alcohol use.

The next category is addiction and dependence. This is described as the continual use of alcohol regardless of consequences. Perhaps the person receiving the DUI continues to drink despite having lost their license and is so in denial that they even continue to drive. The consequences of this are severe, but the addiction is so debilitating, that the individual is driven by the addiction completely, not any consequences.

Usually individuals arrive to treatment because their family or friends have become aware of the fact that the consequences and dangers of drinking have become severe, yet the person will not stop on their own. The family sees a disaster in the making while the abuser denies that there is a problem. Often families “create” a severe consequence to get the family member into treatment. A husband may tell the wife the marriage is over unless she stops drinking. Some consequences are severe enough as to jolt the abuser or addicted drinker into accepting the fact that they need treatment. This method is called intervention. There are professional interventionists and family interventions. Interventions are usually necessary for the abuser and the alcohol dependent individual. These individuals rarely come to treatment of their own accord. By definition, they are those who continue to drink despite the consequences.

SUMMARY

Again, while these categories are not a means of diagnosis, they are useful, especially in the case where the family is giving the history of the drinker. Practitioners can use these as a rule of thumb and direct families to seek interventions and treatment when indicated. In the case of parents, they can be guided to ensure that their child doesn’t fall into any category worse than a user.