ALCOHOL ABUSE PROBLEMS AND QUESTIONS Symptom Definition Known or suspected alcohol abuse Questions or concerns related to alcohol intoxication, dependence, or abuse General Information Approximately 6% of the population in the United States and Canada meets diagnostic criteria for alcohol abuse or dependence. Women and the elderly will have a higher blood alcohol level in comparison to men for the same amount of alcohol consumption. What is the difference between moderate drinking and at-risk drinking? Definition of a Single Drink - 1.5 oz hard liquor (one shot or jigger), 5 oz wine (small glass), 12 oz beer (one can) Moderate Drinking (social drinking) Men who have 2 or less drinks/day. Women/Elderly who have 1 or less drinks per day. At-Risk Drinking - Individuals have no apparent medical, social, or legal problems related to alcohol but drink excessively. Men who have more than 14 drinks/wk or more than 4 drinks on a single occasion. Women/Elderly who have more than 7 drinks per week or more than 3 drinks on occasion. Drinking any alcohol during pregnancy. And what do the terms Alcohol Abuse and Alcohol Dependence mean? Alcohol Abuse (problem drinking, harmful drinking)  - Individuals with alcohol abuse have patterns of alcohol drinking that lead to health, occupational, legal, or social problems. This can range from minor problems like waking up with a hangover to more serious consequences such as motor vehicle accidents and missing work. Alcohol Dependence (alcoholism) - Alcoholism is a disease. Alcoholics are physically addicted to alcohol and demonstrate withdrawal symptoms when they stop drinking. Alcoholics also develop tolerance, which means that they have to drink more alcohol to achieve the same level of intoxication. Alcoholics feel compelled to drink and continue to drink in the face of adverse consequences. Cage Questionnaire - These four questions are a simple way to screen for alcohol abuse and dependence. One or two positive answers suggest at-risk alcohol drinking and individual should see their doctor for further evaluation. Three or four positive answers indicates a high likelihood of alcohol abuse and/or dependency. Have you ever felt you should CUT down on your drinking? Have people ever ANNOYED you by criticizing your drinking? Have you ever felt bad or GUILTY about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (EYE-OPENER)? See More Appropriate Topic (instead of this one) If Feeling sad or down, use DEPRESSION DRUG ABUSE PROBLEMS AND QUESTIONS WHEN TO CALL YOUR DOCTOR FOR ALCOHOL PROBLEMS Call 911 Now (you may need an ambulance) If Unconscious (e.g., not moving, not talking, not responding to stimulation) Difficult to awaken or acting very confused Seeing or hearing or feeling things that are not there (i.e., hallucinations) Seizure Slow, shallow and weak breathing Attempted suicide or threatening suicide Violent behavior or threatening to kill someone Call Your Doctor Now (night or day) If You feel weak or very sick Vomiting red blood or black ("coffee grounds") Severe abdominal pain Constant abdominal pain lasting more than 2 hours Multiple episodes of vomiting, and lasting more than 2 hours Feeling very shaky (i.e., visible tremors of hands) White of the eyes have turned yellow (i.e., jaundice) Call Your Doctor Within 24 Hours (between 9am and 4pm) If You think you need to be seen You think you need to be admitted for alcohol abuse You want to talk with a counselor (mental health worker, psychiatrist, etc.) Drinking alcohol daily and prior history of alcohol withdrawal seizures Drinking alcohol daily and prior history of DT's (delirium tremens) Drinking alcohol and pregnant Call Your Doctor During Weekday Office Hours If You have other questions or concerns Alcohol drinking is interfering with work or school Male and 14 or more drinks/week, or more than 4 drinks on single occasion Female or Elderly and 7 or more drinks/week, or more than 3 drinks on single occasion Self Care at Home If General questions about drinking alcohol Questions about blood alcohol level Questions about sobering up from alcohol intoxication Back to Top HOME CARE ADVICE FOR ALCOHOL QUESTIONS Do NOT drink and drive. Pick a designated driver if you and your friends are drinking alcohol. Do NOT drink alcohol during pregnancy. Drinking alcohol in pregnancy can harm the baby and may cause birth defects (fetal alcohol syndrome). Drinking small amounts (1 drink) occasionally may be OK as research has not yet shown this to cause harm to the baby. But the SAFEST thing for the baby is to NOT DRINK any alcohol during pregnancy. Caring for the Intoxicated (drunk) Adult: No medicines speed up the sobering up process (i.e., drinking coffee does not help) Taking a cold shower may temporarily make someone more alert, but it will not speed up the sobering process. Keep alcohol away from the patient. (e.g., take patient away from bar/party, remove any nearby alcohol). Watch and protect the patient from harm (e.g., avoid dangerous activities, driving) Lay the patient on his/her side (in case of vomiting). Call 911 if: difficult to awaken, difficulty with breathing, or violent behavior. What is the effect of drinking alcohol on the blood alcohol level? For an average sized person, each of the following will raise the blood alcohol level approximately 25 mg/dL: 1 oz (one shot) of alcohol, 4 oz (half cup) of wine, or 12 oz (one can) of beer. And an average adult will break-down (metabolize) alcohol at a rate of 15-25 mg/dL per hour. Example: Drinking 3-4 beers will raise your alcohol level from 0 to 100 mg/dL and it will take 4-7 hours before your alcohol level is back to zero. What is the effect of the blood alcohol level on behavior? 50 mg/dL - flushed skin, more talkative, loss of emotional restraint, feeling of warmth, mild impairment of judgment 100 mg/dL - reduced reaction time and coordination (e.g., writing, driving), slowed thinking, inappropriate laughter, mildly slurred speech 200 mg/dL - unsteady or staggering gait, sleepy but arousable by voice, difficulty sitting up straight in a chair, very slurred speech 300 mg/dL - stuporous and arousable only by physical means (e.g., slapping face, forceful pinching), loud snoring 400 mg/dL - coma, incontinence of urine 500 mg/dL - death Alcoholics develop tolerance and may show less physical effects at any alcohol level. At what blood alcohol level are you considered legally drunk? The normal blood alcohol level is 0 (zero). There are various different terminologies for reporting a blood alcohol level. Each of the following has the same meaning - 80 milligrams/dL, 80 grams per cent, 80 mg/100ml, or 0.08. In the U.S. the legal definition of alcohol intoxication varies from state to state: 80 mg/ dL - 100 mg/dL. In Canada it is a criminal offense to operate a car while having a blood alcohol level greater than 80 mg/dL (0.08). Some Canadian provinces have sanctions (suspensions) for levels greater than 50 mg/dL (0.05). Drinking 3-4 drinks is sufficient to make an average-sized person legally drunk. Alcoholics Anonymous (AA): The Alcoholics Anonymous organization is a "fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking." National phone number: 212-870-3400. Web site: http://www.alcoholics-anonymous.org/ CSAT National Helpline Center for Substance Abuse Treatment (CSAT) The CSAT Helpline is a great resource for locating community drug and alcohol treatment programs. National toll-free phone number: 800-662-HELP. Call Your Doctor If: You have questions about alcohol You become worse or develop any of the “Call Your Doctor” symptoms. Back to Top Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Adult HouseCalls Online. Copyright © 2001-2005 David Thompson, M.D. FACEP Reviewed 6/8/2005 Revised 6/8/2005 View Anatomic Index of Topics