Mental Health Matters: Does Tahoe have a drinking problem?
So, how much is too much? Over-water your favorite house plant, and it wilts. Take too much insulin, and you go into hypoglycemic shock. The right answer, in these and many other situations, is reasonably straightforward and predictable.
When it comes to money, on the other hand, not so fast. Some would argue that there should be no upper limit, that free markets are just that, allowing you the freedom to make and keep as much as you can.
Others argue that vast income inequality produces social unrest and, eventually, social upheaval. Here the answers are less self-evident and less susceptible to empirical or scientific inquiry.
What about alcohol consumption? How much is too much?
Again, there are no easy answer, except when drinking has become obviously problematic for you and others. Too much might be determined by the long-term health effects of moderate to heavy alcohol usage, or it might refer to one DUI. It might mean impairment in mental or physical agility.
It could mean an alcohol-fueled shouting match with someone you love or failing to get that promotion you were counting on. It might mean causing a child to worry about you or a parent seeing your grades drop, or a spouse’s silent worry that you shouldn’t be driving home tonight.
There are as many answers to how much alcohol is too much as there are people who drink too much.
Let’s settle on a general definition of alcohol abuse to start the conversation. An alcohol use disorder means that your use of alcohol is associated with significant distress or impaired function. There is a good deal of imprecision here, but the central point is that excess alcohol consumption leads to a variety of negative outcomes.
Here’s another way to look at the “too much” alcohol definition. A drink can be defined as 1.5 ounces of spirits, 5 ounces of wine, or 12 ounces of beer.
“Light” drinking is less than 1 or 2 drinks per day for men and one drink for women. “Moderate” drinking is a pattern of regular use of no more than 1 or 2 drinks per day for men and one drink for women. “Heavy” drinking is more than “moderate” drinking.
By the way, here’s a clinical tip: If you’re spending much time pondering just where you fit on this continuum, you likely have a drinking problem.
In general, one drink relaxes you: Your blood alcohol level is .02 after an hour. Two and 1/2 drinks produces a blood alcohol level of .05 after an hour; now you are high, judgment is effected, you may be loud and boisterous, you might be “disinhibited” or saying and doing things you usually wouldn’t. You have clearly entered the danger zone for drinking.
With five drinks in an hour, your blood alcohol content is .10; you are drunk, your judgment is markedly impaired as in “No problem. I can drive just fine,” and you earn a DUI. It will take five hours for alcohol to disappear from your system.
In America, the 12-month prevalence of alcohol abuse is a remarkable 4.6 percent for 12-17-year-olds and 8.5 percent for those over 18. That’s a lot of people.
In the context of all substance abuse, 8.8 percent of Americans 12 and over have serious drug or alcohol problems. Most, some 68 percent have alcohol problems, while 17 percent have drug problems and 14 percent have both.
While drugs and drug laws have received more public scrutiny, serious alcohol problems are far more common. More than 18 million Americans have serious alcohol problems: The vast majority of them are undiagnosed and untreated.
To counter the misapprehension that “problem” drinkers are “skid row” types or “down and out” alcoholics, some 95 percent of problem drinkers are employed or employable, and fewer than 5 percent are homeless.
Most people know that long-term moderate to heavy alcohol use leads to negative health consequences including decreased life span and diseases that effect most critical organ systems.
Less well-known is that upward of 20 percent of Intensive Care Unit admissions in urban hospitals are alcohol-related, and that 55 percent of fatal accidents are alcohol-related.
Which brings us to Lake Tahoe, a place of breathtaking beauty, resorts, casinos, bars, and lots of leisure time. It’s no surprise that people drink in bars and casinos. We also tend to drink more on vacation, and more, at least statistically, if we’re single or go to college.
Speaking of college, nationally, 81-85 percent of college students drink, and a very troublesome 41 percent have at least one incident of binge drinking, i.e. five or more drinks in 1-2 hours. Some 16.3 percent have five or more episodes of binge drinking. That’s a lot of dangerous alcohol consumption.
Does Tahoe have a “too much” drinking problem? Next time, in two weeks, I’ll answer that question. I might conclude that it really doesn’t matter because people in the region suffer from alcohol abuse as do their loved ones by bearing witness to the ravages of this problem.
We’ll also talk about how to reduce alcohol consumption in a community, and how to improve diagnostic and treatment resources.
Until next time, remember what Homer Simpson on the Simpsons said: “The answer to life’s problems aren’t at the bottom of a bottle, they’re on TV.”
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. He can be reached for comment at firstname.lastname@example.org.
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