New Web Site Helps Predict Alcohol Problems

按照传统的说法，酗酒者只有在情况糟糕透顶之后才会有所好转。不过，这可能是一个漫长又缓慢的过程。如今美国有了一个名为“反思饮酒”(Rethinking Drinking)新的政府网站，其目的就是帮助人们更早地认识到饮酒的问题，由此悬崖勒马。美国国家酒精滥用与酒精中毒研究所(National Institute of Alcohol Abuse and Alcoholism, NIAAA)治疗与康复研究小组主任马克·韦兰博凌（Mark Willenbring）说“多数人都不知道何谓‘负责任饮酒’──他们认为就是不要酗酒。其实，饮酒多寡都会增加酒精造成的危险，就像高胆固醇会增加罹患心脏病的风险一样。”该研究所此番努力源于学界的一个新认识，那就是酒精滥用是有很多种程度的。有些专家希望能以此取代现有的“滥用”和“上瘾”标准。旧的标准来自对接受治疗的上瘾者的观察结果。针对一般人群的饮酒行为所进行的几项大型调研显示，其他一些饮酒方式显然也会在将来给饮酒者带来烦恼。该研究所称，如果男性每天饮酒量不超过4个标准容积女性不超过3个，那么以后产生严重问题的“风险很低”。听起来，安全饮酒的数量限制还挺高的，不过可不能每天都这么喝。一周的“低风险”饮酒量上限是男性14个标准容积，女性7个标准容积。超过每天或每周的饮酒上限，都极有可能会发展到滥用或上瘾的地步。登录www.rethinkingdrinking.niaaa.nih.gov网站，输入你的日常饮酒量，就可以看到你跟普通人群及问题酒徒的对比。这个输入是匿名的，所以你尽可输入不同的量，看看它们到底都意味着什么。网站提供的信息显示，大约有37%的美国人饮酒量在每日及每周上限之内，这些人每100个人当中只有两个人会进一步陷入严重的酒瘾问题。不过，也有19%的人超出了每日或每周上限，这些人当中有1/12已经发展到了酒精滥用或上瘾的程度。大约9%的人同时超过了每日和每周的饮酒上限，他们当中有半数面临酒瘾问题。大约有35%的人滴酒不沾。NIAAA女发言人安妮·布拉德利(Ann Bradley)说：“对于那些自己和周围的人都大喝特喝的人来说，这可真是大开眼界了。”网站指出，对那些患有躁郁症肝病心律异常慢性疼痛的人来说，即便是“低风险”的饮酒量也是很危险的。网站还链接了十几种与酒精混合会产生副作用的药物，包括治疗高血压高胆固醇疼痛及抑郁的药物。了解“标准”饮酒量及酒精浓度至关重要，因此网站上列出了一个酒精含量表及酒精含量计算器。有些鸡尾酒的酒精含量相当于三个标准饮量，一瓶红酒通常能装满5个5盎司酒杯。关于饮酒者是否要改变饮酒习惯何时改变的问题，“反思饮酒”网站的态度是开放的。网站有一个栏目是让大家讨论比较减少饮酒量同彻底戒酒的优劣。还有一个栏目列出了赞成和反对改变饮酒习惯的的理由──比如“我得找别的法子来放松了。”网站还列举了改变饮酒习惯的策略，从“步步为营”（每小时饮酒量不超过一个标准饮量）到“远离诱因”（找出诱使你饮酒的外部条件及内心情感）。在“追根溯源系统”(urge tracker)中，可以记录下自己想要喝酒的时间原因当时采取的行动，以及你当时还可采取的其他行动。“拒饮技巧”(refusal skills)专栏则教你如何为各种社交场合提前作准备。韦兰博凌博士希望该网站及其可下载打印的文本能够对医生牧师等为担心自身饮酒习惯的人士提供忠告的人员有所帮助。纽约律师协会协助律师处理物质滥用案例项目负责人艾琳·特拉维斯(Eileen Travis)说，大家这方面的意识似乎正在提高，“我们不停地接到这样电话，对方说觉得自己已经有问题了，希望在问题恶化之前悬崖勒马──这样的电话比以前多多了。”研究显示，只需同基础保健护理医生探讨5分钟，就能让那些饮酒量较大的人员把饮酒量减低25%。自己登录像“反思饮酒”这样的网站或许也会起到相同的作用。Melinda Beck（编者按：本文作者Melinda Beck是《华尔街日报》健康养生专栏“Health Journal”的专栏作家）


The conventional wisdom used to be that alcoholics had to hit bottom before they got better. But it can be a long, slow way down. A new government Web site called 'Rethinking Drinking' aims to help people recognize problem patterns earlier and catch themselves before they fall.'Most people don't know what 'drink responsibly' means -- they think it means not getting tanked,' says Mark Willenbring, director of treatment and recovery research at the National Institute of Alcohol Abuse and Alcoholism. 'But there are levels of drinking that raise your risk for alcohol problems just like high cholesterol raises your risk for heart disease.'Behind the NIAAA's effort is a new understanding that there is a spectrum of alcohol-use disorders, which some experts hope will replace the current criteria for 'abuse' and 'dependence.' The old definitions were based on observing addicts in treatment. Several large studies of drinking in the general population show that some patterns clearly pave the way for future problems.The NIAAA say you are at 'low-risk' for serious problems if you consume no more than four standard-size alcoholic drinks a day for a man or no more than three for a woman. That may sound like a lot, but you can't drink like that every day. The weekly 'low-risk' limit is no more than 14 drinks for a man or seven for a woman. Drinking more daily, or weekly or both carries higher risk of abuse or dependence.At www.rethinkingdrinking.niaaa.nih.gov, you can plug in your average consumption and see how you compare with the general population and problem drinkers. Since this is anonymous, you can try different amounts and see what they mean.Some 37% of Americans always stay within the daily and weekly limits, according to the site. Only two in 100 of them progress to serious alcohol problems.But 19% of Americans exceed either the daily or weekly levels; one in 12 of those people has already progressed to alcohol abuse or alcoholism. About 9% of Americans exceeds both the weekly and daily limits; half of them have alcohol problems.About 35% of Americans don't drink at all. 'That can be a real eye-opener for people who drink heavily and surround themselves with other people who drink a lot,' says Ann Bradley, an NIAAA spokeswoman.Even 'low-risk' drinking can be risky for people with bipolar disorder, liver disease, abnormal heart rhythm and chronic pain, the Web site notes. It also links to a list of dozens of medications that can react adversely with alcohol, including drugs for high blood pressure, high cholesterol, pain and depression.Knowing the size and strength of a 'standard' drink is critical, so the site has a size chart and a content calculator. Some cocktails contain as much alcohol as three standard drinks. A wine bottle usually holds five 5-oz. glasses.'Rethinking Drinking' leaves it up to you whether and when to change your habits. One section discusses the merits of cutting down versus quitting completely. Another lists pros and cons to consider -- including 'I'd need another way to wind down.'The site also lists strategies for changing drinking habits, from 'space and pace' (no more than one per hour) to 'avoiding triggers' (recognizing external situations and internal emotions that tempt you to drink). An 'urge tracker' lets you record times when you wanted a drink and why, what you did and what you might have done differently. A section on 'refusal skills' helps you plan ahead for social situations.Dr. Willenbring hopes the site, and a downloadable print version, help doctors, clergy and others who counsel people concerned about their habits. Awareness already seems to be rising, says Eileen Travis, director of a New York City Bar Association program to assist lawyers with substance abuse. 'We get calls all the time from people who say they think they have a problem and want to stop before it gets bad -- many more than in the past.'Studies show that just five minutes of discussion with a primary-care doctor can reduce heavy drinking by 25%. Exploring online all by yourself might be just as useful.Melinda Beck