Is Alcohol A Problem? Online Tool Helps Assess Risk And Find Help

Jan 8, 2018
Originally published on January 8, 2018 10:50 am

The thinking about problem drinking and alcoholism has changed. It's no longer considered a black-and-white, you have it or you don't condition.

"We now know that there's a full spectrum in alcohol use disorder," says George Koob, the director of the National Institute on Alcohol Abuse and Alcohohlism, part of the National Institutes of Health. You can have a mild, moderate or severe problem.

And there's not a one-size-fits-all approach to getting help. There is a wide range of options — from residential "detox" programs to cognitive behavioral therapy, to medications such as naltrexone that can help people drink less, or acamprosate, which can help people stay dry. But many people who might need help don't know these options exist. It's a big obstacle to treatment.

"A lot of people struggling with alcohol problems do not know where to turn," Koob says. "Ninety percent of adults in the U.S. with an alcohol use disorder don't get any treatment whatsoever."

That's a lot of people, given that an estimated 17 million adults have alcohol use disorder.

To help solve this problem, the NIH has launched an online Alcohol Treatment Navigator. It's a website that helps people explore all the evidence-based options.

The site is user-friendly. A list of questions helps determine the best treatment choices. A brief survey helps to determine the range or severity of a problem. The site also connects people to directories of providers. You can type in your ZIP code to find options in your community.

For instance, there's a link to a directory of licensed professional counselors, licensed clinical social workers, clinical psychologists, psychiatrists and other therapists maintained by Psychology Today. There's also a directory of treatment programs, including residential rehab and outpatient options, which is maintained by the Substance Abuse and Mental Health Services Administration, a federal agency. The NIH does not endorse any providers, it's simply connecting people to the options. The navigator site also has information about costs and insurance.

Research suggests that most people with an alcohol problem can benefit from treatment. According to the NIAAA, about one-third of people who get treatment for an alcohol use disorder are better one year after treatment. "Many others substantially reduce their drinking and report fewer alcohol-related problems," according to this NIAAA explainer.

The new navigator site comes at a time when drinking is on the rise among women, minorities and older adults in the U.S. Dietary guidelines recommend that women should not drink more than one drink per day, and men should not exceed two drinks per day. But a recent study estimates that nearly 32 million adults in the U.S. drink at least occasionally at dangerously high levels.

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The number of Americans who are drinking - drinking to a point that's harmful or dangerous - is on the rise. That's according to federal survey data in recent years. The increase is notable among older adults and especially notable among women. There are many treatment options to help people quit or cut back. And the National Institutes of Health has just offered an answer to a really basic problem that stops many people from seeking help. NPR's Allison Aubrey joins us now to talk about this. Hi, Allison.


INSKEEP: Why is it hard to get help?

AUBREY: You know, I think a lot of people don't know where to go for help. And part of the problem is that our thinking about problem drinking in general is really outdated. It's not this yes-no, black-white, you have it or you don't. What the research now shows is that alcohol misuse falls along a spectrum. So some people have a mild problem. Some people have a moderate problem. Some people have a severe problem.

INSKEEP: Oh, which means that different people might need different kinds of treatment.

AUBREY: That's exactly right. It's not a one-size-fits-all approach. I mean, a person with a severe problem might need a 28-day detox, but a person with a mild or moderate problem might start out with, say, going to a doctor, getting medication to help cut back on drinking and some counseling and therapy. There's this whole range of options, but as I say, people tend not to know anything about them. That was the case for a woman that I met. Her name is Sarah Landry (ph). And the way that she describes her drinking may sound familiar to a lot of drinkers.

SARAH LANDRY: I mean, it started as one glass of wine a night and then, you know, slowly that one glass became two or three, and I was needing that relief and almost an entitlement that I had earned it and I needed to have the wine at the end of the day to relax.

AUBREY: Now, at first this did not seem like a problem to her. She was holding down a job. She had two young children she was raising. But over time, she realized that she was really losing control.

LANDRY: I recognized that I had a problem when I started hiding alcohol from my husband and, you know, trying to deny the amount of drinking I was doing, but I knew I needed some help. I just didn't know where to go.

AUBREY: So like a lot of people, you know, she'd heard about Alcoholics Anonymous, but she had really preconceived notions about who goes to AA. She just didn't see herself there.

LANDRY: I just remember looking in the mirror one night and feeling like I didn't recognize the person looking back at myself. It was very scary. So I really didn't know if there were any options available to me.

AUBREY: And the sort of sad thing here is, Steve, that this is a very typical situation, and it's a huge problem, according to George Koob. He's the head of the National Institute on Alcohol Abuse and Alcoholism. That's part of the NIH. Here he is.

GEORGE KOOB: Ninety percent of individuals in the United States with an alcohol use disorder don't get any treatment whatsoever. That's a problem.

AUBREY: Especially when, by some indicators, more than 30 million adults in the U.S. drink at levels that can be dangerous.

INSKEEP: OK. So you've come here to tell us about a way that people can get out of this dead end.

AUBREY: That's exactly right. So Koob and his collaborators at the NIH have just launched this online tool. They call it a treatment navigator, and it's basically a website. I've got it up here on my laptop.


AUBREY: But it's a lot more than that. It brings all the resources that you need to know - what questions to ask, how to find treatment, what's the range of treatment, how to find actual providers in your community. It brings them all right here into one spot. There's tons of evidence-based options here. Now, the first thing you do that you get onto this site I think's kind of interesting. It's kind of a reality check on your drinking. There's a survey here. It asks you 10 questions. So it says in the last year, have you ended up drinking more or longer than you intended? Another question is, have you wanted to cut down or stop but you couldn't? So there's about 10 questions. The more a person answers yes to, the more urgent the need for help or change.

INSKEEP: We're figuring out this spectrum you were talking about before.

AUBREY: That's exactly right. So say you take this survey and it affirms, yes, you do have a problem, which, if you're on the site, you probably know you do. But you say, hey, I've got a job. I've got a family. I can't just go off to some kind of residential detox program. I can't afford that. So here you go on this search engine - I got it up here - you search for outpatient options or counseling options. It brings up a whole list of providers in your neighborhood. Now, there are providers that can prescribe medications to people to help you drink less. There's behavioral options that involve working with a therapist or a counselor. There's group therapy, family therapy, individual therapy. One popular treatment is cognitive behavioral therapy, and that's what Sarah Landry ended up getting.

INSKEEP: Cognitive behavior therapy - what does that mean?

AUBREY: Well, the goal of cognitive behavioral therapy is to identify and then change the kind of feelings and situations that lead or prompt you to drink. So for Sarah, she had to change her whole thought process. She realized she had a lot of distorted thinking about how she was going to kind of muscle her way or fight her way through her day or her problem.

LANDRY: I really tried to control everything in my life. And that way of operating is very, very exhausting.

AUBREY: It ended up kind of feeding the stress that led to her drinking, but now she's got a lot of new coping mechanisms.

LANDRY: Learning other skills and tools for relieving stress outside of drinking was very important in my recovery.

AUBREY: So for some people, that's going to be exercise or playing music or finding new hobbies that just don't revolve around drinking. Sarah says that her life is a lot better now. She's been in recovery for more than a decade.

INSKEEP: Well, let me circle back to what we said at the beginning, that more people are drinking and there's more problem drinking. Any idea why now?

AUBREY: There's a lot of theories about this. There's a lot of marketing of alcohol equating alcohol with the good life. There's been a liberalization of a lot of the Prohibition-era laws. For instance, I think two summers ago the state of New York passed what they called the brunch bill. It made it legal for restaurants to start selling alcohol on Sunday mornings so people could have boozy brunches. There's a very high social acceptance of alcohol right now. It's woven in to so much of our leisure time. I mean, people go on vacation, and they go on tours of vineyards and craft breweries and craft distilleries. And I think at a time when the social acceptance of alcohol is quite high, people forget that it can be problematic. I mean, the CDC points to the fact that 88,000 people die every year due to excessive alcohol use. And with so many people struggling, I think knowing about these options and knowing that there are ways to get help could really be transformative.

INSKEEP: That's NPR's Allison Aubrey. Allison, thanks very much.

AUBREY: Thanks very much, Steve.