The simplest way to begin to self-assess your drinking is to implement the Cage questionnaire. However, assessing your drinking openly and honestly, is not an easy task. Make sure that once you complete the CAFE questionaairree you also review some of the other considerations listed below. The CAGE questionnaire was developed by Dr. John Ewing, founding director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill. CAGE is an internationally used assessment instrument for identifying problems with alcohol. ‘CAGE’ is an acronym formed from the italicised letters in the questionnaire (cut-annoyed-guilty-eye).
CAGE: Any positive response to these questions may indicate a possible concern:
- Have you ever tried to CUTdown on your drinking/drug use?
- Have you ever been ANNOYED with other people’s comments about your drinking?
- Have you ever felt GUILTY about your drinking/drug use?
- Have you used alcohol as an Eye opener (shortly after waking)?
If you are trying to self-assess your drinking, it is also important to ask yourself the following questions:
- Has someone close to you expressed concern about your use?
- Do you use more heavily when stressed, under pressure, after disappointments/arguments/fights?
- Is using interfering with any daily activities/daily responsibilities?
- Have you ever needed medical attention as a result of use?
- Have you ever tried to quit, or cut down and been unsuccessful?
The answers to these questions may have given you a clearer understanding of where you are at with your drinking; however, if you are suspecting that you may be developing a problem with alcohol or drugs, it may be a good time to access more information through a local Addiction and/or Mental Health Clinic. The services being offered are voluntary. They are quite often used for information or prevention only, and not necessarily treatment or counseling. You are the one deciding whether you have one or five sessions with a counselor. In my experience, people who choose to attend a session or two with an addiction specialist, get the feedback and the information they need, and ultimately make their own decisions about the need to change.
The counselor should be able to provide additional information to help a person assess their drinking. Many people make a mistake of seeing this as black & white issue, meaning “I have no problem with alcohol” vs “I am an alcoholic”. Where in fact, there is a lot of gray areas between these two statements. For example, a person may be in the stage of misusing alcohol, or abusing alcohol or in the begining stages of developing dependency on alcohol. The drawing below may help you understand how does a dependency develop:
NO USE —> EXPERIMENTATION —> MISUSE —> ABUSE —> DEPENDENCY
You might have heard the saying: “Information is Power”, so it is extremely important to have the facts before you make up your mind and choose how to proceed from here. You need to understand where you’re at on this continuum of dependency to be able to asess your drinking; You also need information about other issues as they relate to substance abuse, including, the existence of:
- Effects on major life areas (school, work, relationship, job, legal, health, friends, free time)
- Loss of control
Here is a short description of the above mentioned terms:
A Blackout is a loss of memory for events that happened while drinking or using drugs. It is quite often and indicator of a problem-drinking. Loss of control is an important factor in determining whether a problem exists – for example, if a person is unable to stop drinking or using (once they start drinking they cannot stop). Tolerance means that a person needs to use more of the substance to achieve the same desired effect (I used to need 3 drinks to get a buzz, now I need 6); Dependence means that a person needs the substance to be able to function. They are unable to get through a day without it. Some people will continue to use/drink just to manage their withdrawal symptoms. Alcohol withdrawal symptoms begin 4-8h after last drink. They may be accompanied by anxiety, insomnia, hyperactivity (tremor, sweating, increased HR, BP), “internal shaking”, disorientation/confusion. For people with a dependence to alcohol, a Delirium Tremens (AKA: Withdrawal Delirium) may begin 2-3 days after their last drink. This includes the following: paranoia, hallucinations, vomiting, diarrhea, and seizures.
It is also important to remember that a regular consumption of more than 2 drinks per day may gradually bring about:
- Liver damage
- Brain damage (Alcohol Amnestic Disorder)
- Heart disease
- Decrease in bone density
Some people believe that they don’t have a problem because they are not daily drinkers; however, the frequency of drinking is not a sole indicator of whether a problem exists. Binge drinking can become problematic if it leads to negative consequences on a person’s major life areas: school, work, relationships, finances, legal problems. Binge drinking is defined as the consumption of five drinks in one sitting by men and four drinks in one sitting by women, at least once in a two week period. In some situations, binge drinking leads to other problems in a person’s life including: relationship problems (fights/arguments/assaults); legal problems; financial trouble, poor judgment (poor decision making); and/or health problems.
Should I cut back, or should I stop alcohol completely?
Stopping alcohol completely is usually best if you are, or have been, alcohol-dependent. Also, if you have a condition due to alcohol, such as liver damage. Otherwise, reducing to a safe level of drinking is an option. (A note of caution: do not stop alcohol suddenly if you are alcohol-dependent. Some withdrawal effects can be severe. It is best to cut down gradually and then stop, or see your doctor about a detox – see later in this leaflet.)
If you are trying to cut down, some tips which may help include the following:
- Consider drinking low-alcohol beers, or at least do not drink strong beers or lagers.
- Try pacing the rate of drinking. Perhaps alternate soft drinks with alcoholic drinks.
- Consider cutting back on types of social activity which involve drinking. Perhaps try different social activities where drinking is not a part. Perhaps reduce the number of days in the week where you go out to drink.
- Resist pressure from people who encourage you to drink more than you want to.
What can help me to reduce or stop drinking alcohol?
No one can make you stop or cut down drinking. You have to be committed and determined to do this yourself. However, it can be difficult, and one or more of the following may help.
- Accepting the problem
Some people deny to themselves that they have a problem. The sort of thoughts that some people deceive themselves with include: “It’s not as bad as Joe’s drinking”, “I can stop anytime”, “It’s different”. . Accepting that you may have a problem, and seeking help where necessary, are often the biggest steps to cutting back on alcohol, or cutting it out completely.
Some people are helped by books, websites, brochures, DVDs, and their own determination. It is possible for some people who have a problem with alcohol return to sensible drinking, or to stop drinking, without professional help.
- Talking treatments
Some people are helped by counseling and advice from a practice nurse or doctor. Sometimes a referral to a counselor, or addiction specialist may be advised. They can help you to talk through the issues in more detail and help you to plan how to manage your drinking. In some cases, more intensive talking treatments such as cognitive behavioral therapy (CBT), motivational interviewing, or motivational enhanced therapy may be appropriate. For example, CBT helps you to change certain ways that you think, feel and behave, and may help some people with alcohol problems.
- Treating other illnesses
Alcohol may seem to be a quick answer to the relief of stress, anxiety, depression, or other mental health problems. However, the effect is short-lived and drinking a lot of alcohol often makes these conditions worse. If you feel that these conditions are the underlying problem then see your doctor. Medication and talking treatments such as CBT often work well for these conditions, and are a much better long-term option than heavy drinking.
Detoxification (detox) This is an option if you are alcohol-dependent.
What is detoxification?
Detoxification, or detox, involves checking yourself into a facility with a trained staff that can monitor and help you manage the withdrawal symptoms. This is usually a better option for those with little home or social support, those with a history of severe withdrawal symptoms, those with physical illness caused by alcohol, and those where previous attempts to stop alcohol have failed.
Many GPs can also assist in detox or prescribe medication to help with detox from alcohol. A common plan is to prescribe a high dose of medication for the first day that you stop drinking alcohol. You then gradually reduce the dose over the next 5-7 days. This usually prevents, or greatly reduces, the withdrawal symptoms. You must agree not to drink any alcohol when you are taking the detox medication. Your GP will usually see you regularly during the time of detox. Also, during this time, support from family or friends can be of great help.
The medication does not make you stop drinking. You need determination to stop. The medication simply helps you to feel better whilst your body readjusts to not having alcohol. Even after the period of detox you may still have some craving for alcohol. So you will still need willpower and coping strategies for when you feel tempted to drink.
Other medication sometimes used for alcohol problems
- Vitamins, particularly vitamin B1 (thiamine), are often prescribed if you are alcohol-dependent – especially during detox. This is because many people who are dependent on alcohol do not eat properly and can lack certain vitamins. A lack of vitamin B1 is the most common. A lack of this vitamin can cause serious brain conditions called Wernicke’s encephalopathy and Korsakoff’s psychosis.
- naltrexone ia a medicine which can help to ease alcohol craving. It may be prescribed to some people after a successful detox to help them stay off alcohol.
- Disulfiram is another medicine which is sometimes used following a successful detox. When you take disulfiram you get very unpleasant symptoms if you drink any alcohol (such as flushing, vomiting, palpitations and headache). So, in effect, the medicine acts as a deterrent for when you are tempted to drink. It can help some people to stay off alcohol.
- Lorazepam can be used in the treatment of delirium tremens.
After detoxification and staying off alcohol
Many people who successfully detox go back to drinking heavily again at some point. There are various reasons why this may occur. It is thought that you are less likely to go back to drinking heavily if you have counseling, or other support to help you to stay off alcohol. Your doctor, or local addiction/mental health clinic may provide ongoing support when you are trying to stay off alcohol. Self-help groups such as Alcoholics Anonymous have also helped many people to stay off alcohol.
If you do go back to heavy drinking, you can always try again to stop or cut down. Some people take several attempts before they stop drinking, or keep within the safe limits, for good.