Mental Health Matters: Truckee-Tahoe must work together to curb alcohol abuse | SierraSun.com

Mental Health Matters: Truckee-Tahoe must work together to curb alcohol abuse

A few weeks ago, I promised to answer the question, “Does Tahoe have a drinking problem?” in an effort to discuss community responses to alcohol abuse, and diagnostic and treatment issues.

A year ago, I called a restaurant owner in the region who was advertising “all you can drink” along with the food. Foolishly, perhaps, I considered it my obligation to ask about the wisdom of an “all you can drink” offer.

The response I receive was unprintable in a family newspaper, but it got me thinking about alcohol use in resort towns.

Recently, Kara Fox, writing in Moonshine Ink about Truckee for the March-April 2015 edition, noted that, “Statistics point to community wide alcohol abuse among adults and youth, and increasing DUI rates.”

Citing Truckee Police Chief Adam McGill and the Tahoe Forest Hospital 2014 Household Assessment Survey, it was noted that alcohol usage, binge drinking and youth drinking, were all far above California state averages.

It was not only a record year for DUI arrests in Truckee, but 46 percent of all Truckee arrests were alcohol-related. Nevada County Superior Court Judge Robert Tamietti added that nearly 40 percent of his caseload is DUI-related.

What about Incline Village/Crystal Bay, a community that’s had DUI issues in the past, including recording more than 270 DUI-related arrests back in 2007? Last I counted, there were some 28 establishments selling alcohol. While no one references an alcohol use crisis in the community, alcohol related issues consume a good part of sheriff deputy time, court time and Incline Hospital Emergency Services time.

Walk into Raley’s and you would swear it’s a world-class liquor store that also sells food. Someone is drinking all that alcohol. So what can a community do? How do you balance individual rights, a service industry, and tourism, with health and wellness?

Truckee, a town, has certain powers that Incline Village/Crystal Bay lacks.

Perhaps Truckee leaders need to reassess their current alcohol use policies: “Happy Hour” specials, “Beat the Clock” specials, bar closing times, enforcement of no open carry laws and more. These are uncomfortable and controversial issues, but “education” will only get you so far.

In IV/CB the community is bound by Washoe County rules and regulations. Still, wider circulation of data about alcohol usage in the village would help to better assess the scope of the issue.

I said I would talk about diagnosis. Alcohol abuse can be easy to hide, particularly in its earlier phase, in no small measure because the drinker may not be the best judge of usage.

For one thing, excess alcohol use negatively impacts brain function and judgment. For another, denial is frequently a feature of the disorder.

Back in the day, I did some teaching. My favorite pop quiz question was, “What’s the most overlooked diagnosis in medicine?” The right answer — alcohol abuse.

Physicians are on the front line here. They can sniff out a problem when others don’t, partly because there are physical stigmata of alcohol abuse, and laboratory tests that provide clues. But the main thing is the history.

If you see your physician and fill out a typical checklist form about your medical history, buried in there will be a question about how much you drink.

If the physician just takes your word for it, gently suggest that he or she should be asking a few other questions like: 1. Have you ever felt you should cut down on your drinking? 2. Have people annoyed you by criticizing your drinking? 3. Have you ever felt bad or guilty about your drinking? 4. Have you ever had an eye-opener first thing in the morning to steady your nerves or get rid of a hangover?

If you answer “no” to all four questions you are likely good to go. Otherwise, further inquiry is in order. Let’s say you do have an alcohol problem. What to do? Get help.

A basic premise: Treatment should be tailored to the individual with the problem. Any one-size-fits-all treatment program is poor care. A thorough diagnostic appraisal by a competent professional is the first step in appropriate treatment.

Treatment approaches that work for some, but not others, include Behavioral Coping Skills Therapy, Contingency Management, Family Therapy, Motivational Enhancement Therapy, Twelve-Step Facilitation Therapy, and Group Therapy.

Abstinence works for some, cutting back for others.

Medications can be helpful. The Food and Drug Administration has approved prescription drugs to treat alcohol problems. Initial research shows that they can decrease alcohol usage, a major achievement for problematic drinkers.

By all means, try AA — it’s free and has helped millions. There are also millions who are not helped by this approach.

An aside to the legal profession: Know that in some studies, AA approaches fail more than they succeed. Also that relapse is very common in the early phases of treatment and to punish people at this point contributes to further failure.

In sum, decreasing alcohol abuse in any community takes a concerted effort by multiple segments of that community. If the sole focus is on the alcohol abuser, expect little improvement.

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 adwhyman143@gmail.com.