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APRIL 2004

April: Alcohol Awareness Month
by Richard J. Frances, M.D. & Avram H. Mack, M.D.

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 and care.

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.

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