April: Alcohol Awareness
Thanks to the National Council on Alcoholism and Drug Dependence,
April is Alcohol Awareness Month with a special focus on the
prevention of underage drinking. This month of programs and
activities provide an opportunity for all health care professionals,
parents, and educators to make efforts at early detection,
prevention, and referral of alcohol problems.
Why spend time thinking about alcohol? Alcohol creates problems
for both individuals and for society as a whole. Unfortunately,
every year, fewer than 7 percent of the approximately 10 million
Americans with alcohol problems get the help they need.
Alcohol problems tend to start during
adolescence and young adulthood. This can be a critical window
to catch alcohol problems because adolescents usually have
not yet developed the medical and legal problems that result
from alcohol. That is, long before the adult patterns of
dependence, tolerance, and severe withdrawal, the adolescent
may show a pattern of excessive drinking (more than 5 drinks
at a time). Likewise, while adults may die from the severe
medical consequences of alcohol (like cirrhosis, dementia,
or esophageal varices), adolescent users may show a large
liver, gastritis, or hematologic abnormalities. And, before
the significant legal issues such as arrests due to driving
while intoxicated, vehicular homicide, or disorderly conduct
due to alcohol, teens may have an increase in accidents (ascribed
to "clumsiness"), or complaints by friends
about the individual's drinking and driving. Long before individuals
are fired from jobs or are unemployable, they are late in getting
projects done, they miss school assignments, or have poor school
performance. All of these are serious issues when an adolescent
comes into contact with alcohol.
For adolescents with attention deficit disorder (ADD) the
combination of alcohol with baseline impulsivity can be additive.
Among those with depression, alcohol can worsen the low mood
or increase the risk of harm to others, self-harm, and/or suicide.
Such students who also use alcohol need particularly good supervision
Alcohol awareness month helps all of us confront our own denial
about consequences of alcohol problems in those we know and
in ourselves. Alcohol problems, which tend to be genetic as
well as affected by culture and environment, tend to occur
in families. Unfortunately, families with problems tend to
have a great deal of denial. Helping individuals recognize
their problems with alcohol and helping them to seek out help
can be challenging and rewarding. Health care professionals,
educators, and parents need to be familiar with the early signs
and symptoms of an alcohol problem and to hone their skills
at initiating help for those at risk. Since adolescents rarely
demonstrate the physical signs of tolerance or withdrawal,
monitoring their behavior around alcohol is especially important
when suspecting use. Rather than waiting for tragedy resulting
from alcohol, schools, clinics, and hospitals should mount
major educational programs through out the month of April.
One feature of Alcohol Awareness
Month is the no-drink weekend, on April 2-4th (www.ncadd.org).
Although alcohol is readily available to teenagers in New
York City, it is important for adults to be firm: teenage
drinking is illegal and parents need to be aware of their
responsibilities in not serving alcohol to minors. Parties
for high school students should not allow drinking. Colleges
need to have more active programs offering counseling and
help to students with alcohol problems. Many private schools
have "zero tolerance" policies regarding
drugs and alcohol. Unfortunately, teenagers are likely to experiment
and such programs may deter open reporting of problems and
open discussion—it is better to have a situation in which
teens are able to report on problems. Referrals should be made
to addiction psychiatrists, pediatricians, addiction counselors,
social workers, psychologists, and nurses for a more complete
evaluation after a problem is detected.
Adolescent drinking is as, if not more, dangerous than adult
alcoholism. Hopefully April will bring rays of light to this
major public health problem.
For further information, please call Silver Hill Hospital
1-800-899-4455 (www.silverhillhospital.org) or see the National
Council on Alcoholism and Drug Dependence website (www.ncadd.org).
Richard J. Frances, M.D. is Director of Public and Professional
Information, Silver Hill Hospital. Avram H. Mack, M.D. is at
New York University School of Medicine.