When is the cost of drinking alcohol too high?

By John A. Cunningham
February 15, 2010

JohnCunningham- John A. Cunningham is Canada research chair in brief interventions for addictive behaviours, a senior scientist at the Centre for Addiction and Mental Health and a professor at the University of Toronto. The opinions expressed are his own. -

Whether you live in Britain, Canada, the U.S. or one of many other countries around the world, alcohol consumption is one of the leading causes of preventable death.

When people think about alcohol problems, the image of someone with severe drinking problems usually comes to mind.

However, one of the interesting facts about alcohol is that people with less severe drinking problems cause most alcohol-related problems in society.

This is because there are a lot of people with moderate drinking problems while those with severe alcohol dependence are relatively rare. Problem drinking comes in many shapes and sizes – from someone who misses work because of hangovers, gets into a fight while drunk, drinks before driving, or simply drinks too much year after year and causes long term health concerns.

One of the issues that troubles me about providing help for people who have problems with alcohol is that most do not get treatment, including Alcoholics Anonymous.

That is why I devised online screener www.CheckYourDrinking.net. The Check Your Drinking screener is a free, anonymous tool which anyone can use. Simply go online, answer some questions about drinking and a bit about who you are and get a personalized feedback report.

The report tells you how your drinking compares to others of the same age, sex, and country of origin (in the UK, Canada and the U.S. – more countries to be added).

The report also gives you an assessment of the severity of your drinking concerns and provides other information, such as the amount of money you are spending on drinking in a year and how many calories you consume from drinking.

While I recognize that alcohol problems exist on a continuum and that the large majority of people defined as problem drinkers have less severe problems, even people who meet clinical criteria for alcohol abuse or dependence are unlikely to seek help. The issues become then, why don’t people seek treatment, why bother trying to help people who don’t seek treatment, and what kind of help can be provided?

In my experience, there are a number of barriers to people seeking help for alcohol problems. These barriers include concerns about the stigma of being recognized as someone with an alcohol problem as well as personal issues such as embarrassment and pride.

Other important barriers are the problem drinker not recognizing that their problem is serious enough for treatment as well as a desire to deal with ones problems on ones own.

It is also important to consider that there are geographic and availability barriers to accessing treatment as well – many people live in places where services are not readily available or these services occur at times that people need to work or have other commitments.

Why bother trying to help people who don’t seek treatment? While many problem drinkers may be reluctant to come to face-to-face treatment, this does not mean that they have no interest in getting help. Many people with alcohol concerns voice an interest in a variety of different tools to help them evaluate their drinking, from telephone help lines, to self help books to internet based interventions.

Further, there is a potential societal benefit to thinking about finding ways to help problem drinkers who do not come to treatment.

Problem drinking costs society a huge amount of money. These costs come from things such as lost productivity, alcohol and violence, and many other ‘hidden’ expenses in addition to a substantial burden on the health care system.

There is also what is called a prevention paradox – that those people with less severe alcohol problems cause the main bulk of costs to society, simply because there are so many more problem drinkers than there are people with severe alcohol problems. Further, problem drinkers are much less likely to seek treatment than people who suffer from serious alcohol dependence.

My belief is that there needs to be more effort to take treatment to problem drinkers rather than just waiting for problem drinkers to seek help.

I don’t advocate getting rid of the current treatment services that are available – they are already overstretched and help the large number of people who do seek aid.

Rather, I believe that thought should be given to diversifying the options for accessing help beyond face-to-face services.

I have spent a lot of time figuring out ways the Internet can be used as a means of delivering help. The majority of the adult population in countries such as Britain, Canada and the U.S. use the Internet on a regular basis and it is available 24 hours a day, 7 days a week, from your own home.

The Check Your Drinking screener, was just submitted to a randomized controlled trial in which problem drinkers who used the website reduced their drinking by about a third at six months follow-up compared to a control group who did not get access to the website.

These results are encouraging because they point to the possibility that brief interventions for problem drinking can be distributed widely and at low cost, helping people who don’t come to treatment to deal with their alcohol concerns.

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