Links To And Excerpts From “5 Pearls Of Unhealthy Alcohol Use” From Core IM With An Additional Resource

In this post I link to and excerpt from 5 Pearls Of Unhealthy Alcohol Use, July 11, 2018,
by  Dr. Katharine Lawrence, Dr. Martin Fried and Dr. Shreya P. Trivedi from CoreIM.

Here are excerpts from the show notes:

Above is from CoreIM

Pearl 1

  • Unhealthy alcohol use is a catch-all term meant to describe a spectrum of drinking ranging from risky use all the way to alcohol use disorder.
  • The DSM-IV terms alcohol abuse and dependence have been replaced by the DSM-5 term alcohol use disorder, which is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by psychosocial, behavioral, or physiologic features
  • According to National Institute on alcohol Abuse and Alcoholism (NIAAA), risk for alcohol use disorder is thought of as daily and weekly alcohol limits:
    • For  men less than 65 years:  more than 4 drinks/day or 14 drinks/week for
    • For women and men over 65 years: more than 3 drinks/day or 7 drinks/week

. . . the terms alcohol abuse and dependence has been replaced by the by idea of alcohol use disorder, which is a problematic pattern of alcohol use leading to clinically significant impairment or distress. Even more broadly, we have the concept of unhealthy alcohol use, which encompasses a broad spectrum of drinking patterns even beyond alcohol use disorder, and includes things like binge drinking.

Pearl 2

  • The United States Preventive Services Task Force (USPSTF) has recommended that all adults in primary care be screened for unhealthy alcohol use
  • The AUDIT-C tool is the recommended screening tool for unhealthy alcohol use, and consists of the following questions:
    • How often did you have a drink containing alcohol in the last year?
    • How many drinks containing alcohol did you have on a typical night when you were drinking?
    • How often did you have six or more drinks on one occasion in the past year?
  • single-item screening question has also been validated. It is the most sensitive question for unhealthy alcohol use.
    • For men, how many times in the last year, have you had more than four drinks in a day?
    • For women, how many times in the last year, have you had more than three drinks in a day?

Pearl 3

  • The negative health impacts of alcohol include most types of cancer [including breast cancer] with the exception of thyroid cancer.
  • Patients are often diagnosed with comorbid medical conditions that may be reversible if the underlying alcohol use disorder is diagnosed and treated appropriately
  • Labs values* can be a useful tool for assessing alcohol use and educating patients on end-organ damage; however, they are not recommended for routine diagnosis of the disease

*See Laboratory Studies from The following table is from this resource:

Returning now to excerpts from 5 Pearls Of Unhealthy Alcohol Use:

Pearl 4

  • Population health research has identified a ‘J-curve’ of potentially beneficial alcohol use, leading to a trend in ‘healthy alcohol use.’ Low levels of alcohol are associated with decreased risks for cardiovascular disease and type 2 diabetes.
  • Few medical professionals would recommend ‘healthy drinking’ however; the goal remains moderation or minimal intake.

The fifth pearl is related to a previous 5 Pearls about Hepatitis B.

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