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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Alcohol
be used instead of short, wide glasses. To avoid underestimating the amount of
alcohol consumed, it may be useful in surveys using self reports of standard drinks
to ask about the shape of the glass. These results also highlight the importance for
accurate measurement of local knowledge of drink types and container size for
accurate alcohol intake assessment.
109
Citation: http://cdn.forknplate.com/wp-content/uploads/2015/08/pouring-shots.jpg
Use of Standard Drinks in Surveys
When surveys of alcohol consumption are conducted, respondents are generally
provided with the definition of a standard drink used in that country and then asked
about their alcohol consumption with that definition in mind. These drinks are often
defined for the respondents in terms of the typical container sizes of beer, wine
or spirits to assist respondents to comprehend what constitutes a standard drink.
Terms such as ounces, millilitres, or grams of ethanol are generally not used as they
are not easily understood by consumers. However, the results of the studies above
clearly demonstrate that there are considerable differences between respondents’
perceptions of what a standard drink constitutes and the actual definition of a
standard drink, especially in relation to spirits and wine. While one standard is
taken by researchers to apply to all beverage types, in reality, beverages differ by
their typical serving size and ABV. Regardless of what they are told constitutes a
standard drink, some respondents may report the number of drinks they consume
in terms of the drink they actually consume. This confusion over standard drinks
can have serious consequences and can affect the precision and reliability of the
results of the survey.
110
Citation: https://drinkwise.org.au/wp-content/uploads/Homepage_Hero_DrinksCalc.jpg
Illustrated Handbook of Drugs & Alcohol Related Health Issues
We know that surveys of self-reported alcohol consumption result in estimates of per
capita consumption well below the level calculated from alcohol sales data. It has
long been recognised that population surveys of self-reported alcohol consumption
result in estimates of per capita consumption well below the level estimated from
alcohol sales data. The usual range of coverage from surveys is in the region of
40-60%. In Australia, it is estimated from the National Drug Strategy Household
Survey that self-reported alcohol consumption accounts for 53-78% of per capita
alcohol sales. In a recent Irish population survey, selfreported alcohol consumption
based on ‘typical drink questions’ accounted for just 39% of per capita sales, even
though the concept of a standard drink was explained in detail to each respondent
and visual aids were provided depicting a standard drink according to beverage
type. The literature indicates that there are three reasons why self-reported alcohol
consumption does not accurately reflect per capita alcohol sales: the confusion
regarding what constitutes a standard drink, variations in drinking vessels and the
variations in alcohol by volume content of different beverages. When conducting
surveys it is critical that researchers and respondents define a standard drink in
a comparable way. If there are discrepancies between both values, this can have
particular implications if the survey is using self-reported alcohol consumption levels
to determine thresholds for binge or risky single occasion drinking and harmful
drinking patterns. If definitions of harmful drinking are based on self-reported
survey data, inaccurate survey responses could call the thresholds into question.
For example, if respondents underreport their true levels of consumption, which
is feasible given the published literature on consumers’ understanding of standard
drinks, then the thresholds used in surveys to denote binge drinking and harmful
drinking may be too low.
Alcohol
Citation: http://www.frostburg.edu/fsu/assets/Image/coalition/Standard%20Drink%20
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Importance of Standard Drinks for low-risk Drinking Guidelines
The best illustration of the complexity of defining risk drinking can be obtained by
comparing international low risk drinking guidelines. Many of the differences across
countries in the specific numbers of drinks comprising daily or weekly limits reflect
variation in the standard drink size used to express the daily and/or weekly limits.
Thus, according to Dawson, it must be understood that many drinkers will interpret
drinking guidelines in terms of numbers of drinks that correspond to levels of intake
that are smaller or larger than those intended by the standard drink definitions
included in the guidelines. In light of this, it might be argued that standard drink
sizes for any given country should reflect the most common container or serve sizes
in that country, even if this leads to lack of comparability across countries. That is,
the standard drink definitions that maximize prevention efforts may not be those
best suited for comparative research purposes. Research addressing how guidelines
are understood by drinkers who typically pour non-standard drinks might help to
improve the delivery of drinking guidelines to these individuals.
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Citation: http://img.huffingtonpost.com/asset/2000_1000/570e0f7d150000ad000b4b37.
Regarding the perplexing and challenging issue of drinkers’ inability to accurately
gauge their consumption in standard drinks, the most obvious solution lies in the
approach that has been adopted by a number of Western countries, in which alcoholic
beverage containers explicitly state how many standard drinks (units) they contain.
Even in the absence of such labelling, it has been argued that if risks attributed
to drinking five or more drinks are based on scientific evidence relying on actual
as opposed to standard drink sizes, coupled with other sources of consumption
underreporting, then drinking less than five drinks, irrespective of how closely
they correspond to standard drink size, will reduce harm in the aggregate. That is,
if one assumes that relative risks associated with various consumption levels are
overstated because of underreporting of consumption, then adherence to low-risk
drinking limits should prove effective even for individuals whose actual drink sizes
are larger than standard. Hence, publicizing low-risk drinking limits should play an
important role in any activities aimed at preventing alcohol-related harm.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
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Identifying Harms
As with other drugs, alcohol-related harms are not specific to the effects of the
drug. Alcohol-related harms result from the interaction between:
Alcohol
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The Drug
■ patterns of use (how much, when used, how often)
■ and other drugs used
The Individual
■ age, weight, gender and general health
■ tolerance and previous experience of alcohol use, intoxication, after effects
and withdrawal
■ expectations of use and effects
■ current mood and psychological health
The Environment
Factors that influence the drug’s effects and patterns of use such as:
■ social settings and company
■ context of use
■ patterns of drug use according to ritual or culture
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Table 4: Classification of alcohol-related harms
Thorley’s model (see Table 4) is a useful guide to identifying specific harms related
to ‘Intoxication’, ‘Regular Excessive Use’ and ‘Dependence’.
This model enables practitioners to:
■ assess the type of problem
■ assess severity of problems
■ facilitate individually tailored responses
General points:
■ Intoxication-related problems have substantially greater impact on the
community than dependence, however, dependence results in more severe
problems for individuals
■ Regular use is not generally considered a problem unless it exceeds the
‘at-risk’ thresholds described by the NHMRC.
■ Primary care practitioners are likely to have most success in their interventions
with people experiencing problems related to intoxication and regular use
■ Patients experiencing problems related to dependence are best referred to
specialist agencies
Alcohol
115
Drug and Alcohol Treatment Assessments
Drug and alcohol treatment assessments determine whether a person has a drug
or alcohol problem and if so, what level of treatment would be most appropriate.
According to Hazelden, a provider of drug and alcohol treatment, counselors
sometimes conduct assessments over the phone but some prefer a brief face-toface meeting. If the assessment indicates a drug or alcohol problem, counselors
recommend a more in-depth evaluation.
Ciattion: https://www.ohio-dip.com/wp-content/uploads/2015/03/assessment-1024x819.jpg
Assessment Tools
Counselors have a variety of assessment tools from which to choose. Some focus
only on alcohol and some only on drugs, while others look at both substances.
MAST
According to Counseling Resource, counselors often use the MAST (Michigan
Alcohol Screening Test), a 22-question quiz, to assess whether a person has a
drinking problem.
DAST
Also according to Counseling Resource, counselors often use the DAST (Drug Abuse
Screening Test), a 20-question quiz, to assess a person’s drug use.
Getting an Assessment
You can take self-assessments online to help you determine whether or not you
need professional help or a professional counselor can assess you and advise you
about the best course of action. If you feel worried about your drinking or if your
loved ones tell you that you drink too much, an assessment is probably in order.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Where to Get an Assessment
Most communities have agencies that provide assessments and treatment for drug
and alcohol problems on an outpatient basis. Mental health agencies often provide
substance abuse services, as well. You can also use the Substance Abuse Treatment
Facility Locator online to find a treatment center that provides drug and alcohol
assessments.
What Is an Alcohol Evaluation?
It’s common for people who are heavily intoxicated to be admitted to an emergency
room for treatment. Upon arrival, an alcohol evaluation assessment is taken to
determine the person’s overall health status and treatment needs. Assessment
information can be gathered from the patient or from whoever accompanies him at
the time of admission. Three assessment models are used: MAST, CAGE and TWEAK
Citation: https://www.teenrehabcenter.org/wp-content/uploads/2016/07/teens-celebrating-
by-drinking-beer.jpg?x95931
MAST Evaluation
The Michigan Alcohol Screening Test (MAST) was developed in 1971 and is one
of the oldest assessment tools available. The test is designed to be a self-appraisal
of how the patient sees her drinking and how it affects her life. It’s a lengthy test
that addresses drinking behaviors over the course of the patient’s lifetime. Questions
address problems within a person’s family relationships, work relationships, work
performance and social life.
Alcohol
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CAGE Evaluation
The CAGE evaluation test is actually an acronym for the specific questions asked
during the assessment. The letter “C” represents the first question, which is whether
anyone has advised them to “cut” down on their drinking. The letter “A” represents
the second question, which asks whether the patient has ever been “annoyed” by
criticism regarding his drinking. The letter “G” represents questions regarding any
feelings of “guilt” the patient might have regarding his alcohol intake. The letter
“E” represents how often the patient drinks alcohol first thing in the morning (an
“eye-opener”) to calm the effects of a hangover or to calm his nerves.
TWEAK Evaluation
TWEAK also is an acronym for the questions posed by the evaluation. The letters
stand for tolerance, worried, eye-openers, amnesia and cut down. Questions about
tolerance address how many drinks the patient can hold. “W”, or worried, asks
whether relatives or close friends have expressed concern regarding the patient’s
drinking. Eye-openers refers to early morning drinking. Questions regarding amnesia
have to do with whether the patient has had blackouts. “Cut down” refers to whether
the patient has ever wondered whether she should cut down on drinking.
Citation: http://www.thecabinhongkong.com.hk/wp-content/uploads/2015/11/addiction-
cocain.jpg
Physical Assessment
By the time a person has reached the point where an alcohol evaluation is necessary,
other physical ailments are most likely present as well. As alcoholism is a progressive
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disease, it’s not uncommon for a person’s overall physical condition to decline over
time. Malnutrition, as well as vitamin and mineral deficiencies, is possible. Persons
admitted to the emergency room often undergo symptoms of withdrawal once
they enter a detoxification program. Withdrawal symptoms can include tremors,
hallucinations, fever and seizures.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Treatment
The information gathered from an alcohol evaluation provides clues as to what method
of treatment will work best. In cases of severe alcoholism, patients are admitted to
a detoxification program. Once all traces of alcohol are out of the patient’s system,
the patient might be prescribed anti-anxiety or anti-depressant medications to help
reduce any effects of withdrawal. Once detox is completed, patients might be
assigned to an after-care program where routine psychotherapy and group therapy
sessions can be attended. At this point, patients typically re-establish their normal
routines. Many regularly attend Alcoholics Anonymous meetings for support.
Early Recognition of Alcohol-related Problems
Alcohol-related problems are more likely to be identified early when the health
professional:
■ is aware that psychosocial problems occur before most physical problems
■ is willing to follow up with detailed enquiry and appropriate investigations
Four Key Assessment Steps
1. Establish patterns of use:
Techniques for incorporating use of alcohol into history taking include:
■ incorporating questions about general lifestyle issues, such as smoking,
diet, exercise, recreational activities
■ asking specific questions (type of drug/s, dose, frequency of use, duration
of use, recency of use, how used)
■ focusing on the current week’s patterns
■ use of a visual Standard Drinks Chart (e.g. www.dasc.sa.gov.au),
■ asking about concurrent use of other drugs, e.g. tobacco, amphetamines,
benzodiazepines, heroin
These strategies help prevent patients from giving general responses such as ‘you
only drink socially’.