Alcohol problem

donsterRN, ASN, BSN · Jun 7, 2008

Unfortunately, there isn't a textbook answer here. It's as individual as individual is.

A very dear friend of mine drinks one beer a day. One. Of course, that translates to 30 beers a month, and no matter how you say it, that sounds huge. His PCP several years ago told him that he was an alcoholic and would be dead in a year. Nonsense. One beer a day has less alcohol content than people who have a glass of wine for dinner and cocktails on the weekend.

There isn't an answer to your question about how much specifically is too much. A better question to be asking is what the alcohol consumption (dis)allows you to do.

My $.02.

Atheos · Jun 7, 2008

You know that question on doctor's office paperwork where it asks how much alcohol you consume? Well, what is that question about?!
When pt filled out paperwork, she left the question about monthly alcohol consumption blank. Then when the (student) nurse came in, the pt wanted to know how much is too much. And if there is some "magical line" that has a normal person on one side and alcoholic on the other.
Well I don't have any idea! But I wanted to keep the trust my pt had so I side-stepped the question and told her that it is just a question used to aid the Dr. with treatment and prescribing.
This happened a while ago and I am just now thinking that what I said was pretty stupid!!!
So how much is too much alcohol to consume in a month? I am looking for a textbook answer here.

I personally have never seen a 'textbook' answer to that and have not been able to find an answer online. I doubt you ever will. I would venture to say however it is not the amount of drug or even the drug a person takes that matters. It is almost certainly WHY that person uses that drug.

Case in point. From age 13 - 20ish I drank A LOT. At 17 I could polish off a fifth of Jack and a case of beer and not pass out, vomit or act silly. Yes, eventually this behavior would hurt me physically. However, the main ingredients of addiction were not there. I wasn't drinking to escape or out of depression or to numb some kind of pain. Because of this one day, probably due to maturity, I stopped and have no health problems from that behavior.

My point is that the amount and sometimes the drug used is purely subjective. You have to look at the patient's use and measure that with the other information that you have on the patient.

Did I drink to much? No. Was it a problem? Not at all. Seen friends become alcoholics and consume less alcohol than I have at my worst.

The MD probably just uses this as another way to assess the patient. I would be more worried about a person that drinks a 6 pack everyday or two than a person that gets absolutely loaded every weekend.

Last point I have. Being an alcoholic is not defined in the amount of alcohol used. Being an alcoholic is based on whether there is an addiction only. The amount will vary. The mother that absolutely needs a glass of wine at night or she will lose it is an alcoholic. So is the guy on the corner that is drunk all day.

SuesquatchRN, BSN, RN · Jun 7, 2008

The obvious answer is that it is likely that this particular patient *is* drinking to excess, hence the concern about "how much is too much?" Social drinkers don't worry about that.

Were it to come up again I would simply say that there is no standard answer and ask if she every worried about it. That *might* open up a dialog that would elicit some useful information about her ETOH consumption.

cnmbfa · Jun 7, 2008

Nutrition sources state that the "safe" (no adverse health affects) amount of alcohol that a woman can consume is one drink per day. That's not an average; you cannot drink 4 drinks one day and none for the next 3 and consider it OK.

Drinking more than 1 drink per day is associated with breast and other cancers,and with dementia as a person ages.

Atheos · Jun 7, 2008

Nutrition sources state that the "safe" (no adverse health affects) amount of alcohol that a woman can consume is one drink per day. That's not an average; you cannot drink 4 drinks one day and none for the next 3 and consider it OK.
Drinking more than 1 drink per day is associated with breast and other cancers,and with dementia as a person ages.

Hmmm.... what about men? And is this effect permanent or is it like smoking where a time starts to erase the damage? :no:

suanna · Jun 7, 2008

Alcohol consumption does not necessarily equate to alcohol problem-amount has little importance. If a person routinely drinks alcolol in any amount on a daily basis it will effect how they respond to sedatives, anesthesia, and many other meds. In addition some meds are incompatible with alcohol and this needs to be taken into account when prescribing. A frequent alcohol intake will change a number of lab values from liver enzymes to electrolytes. The only definition of "alcohol problem" isn't ammount or frequency but loss of control over the alcohol consumption. If you know you are driving home but have 6 drinks when you intended to have 1- you have an alcohol problem- even if it happens once a mos. If you stop in at a bar & grill for lunch and intend to have iced tea but end up leaving with a couple of beers on board to go back to work- you have a problem. It's not the amount that defines it.

UM Review RN, ASN, RN · Jun 7, 2008

We usually figure that if a person admits to one, the real number is 3.

You will get more honest answers if you explain the reason you're asking -- so that they can be appropriately medicated if they are in the hospital for more than a couple of days, if they're used to drinking oh, say, 16 oz of vodka per day and they weigh 85 pounds.

Because the next few questions have to do with street drugs (and don't assume anything, because we recently had a crackhead who was a late bloomer and was in his 80s), I always make a point that this information will not be shared with anyone and it will not get them into trouble with the law, but it was to protect them from withdrawal, which can be fatal in some cases.

coolpeach · Jun 7, 2008

I took nutrition last semester, and they actually said no amount is SAFE. An amount that will not have a health effect for one person is a major liver problem for the next.

That being said it did state what they consider to be a maximim consumption which is 1 drink per day for a woman,and 2 drinks for a man. They went on to state what one drink would be (I believe 1 beer, or glass of wine). That would mean that the hard stuff which contains more alcohol would be considered more than one drink even though its in one shot glass.

As one poster said above you cannot save up your drinks from day to day. In other words I CAN'T not drink all week and then have 6 on Sat.

I personally have trouble answering that question when I see it on medical forms. I will go a couple of months with no alcohol at all, and then have a glass of wine with dinner. Then a few weeks, and have a beer with my chicken wings at a resturant. Then a few months later a margarita with my mom at a mexican resturant. Then go 3 months, and drink 5 drinks out with girls for a night on the town.

So you can see I drank seldom, but did drink occasionally. At the same time once a year or so I did occasionally have more than a couple. At the same time I don't think that makes me an alcoholic for having 5 drinks in a row once a year.

gillytook · Jun 7, 2008

Part of the reason the question of alcohol consumption is being asked is to prevent withdrawal if the patient is hospitalized. Eventhough 1 beer a day isn't much, the body does become dependent on it. With small amounts the withdrawal my be mild, but it may interfere with healing and proceedures. The last thing you want for a post-op patient is a major case of alcohol withdrawal. That is why you will see some patients actually prescribed a beer, wine or cocktail with their dinner tray.

Daytonite, BSN, RN · Jun 7, 2008

your question was so how much is too much alcohol to consume in a month? i am looking for a textbook answer here. there is no textbook answer. this is an assessment ploy to collect information is all.

asking about alcohol consumption is designed to help collect information about the patient's history. however, these questions are also designed and worded in such a way to invite those who do make drinking a regular habit to feel comfortable in answering the question and more readily reveal the truth about their alcohol consumption.

you have to get over shyness about questioning people about these things. this issue also comes up when dealing with stds and sexual practices. i've heard some pretty frank questions asked when trying to get sexual assessment information from people with stds. we cannot help patients if we don't overcome our own discomfort with these subjects. you need to collect assessment data to make accurate decisions.

i worked on an alcohol detox unit. all of us who worked on this unit went through specialized training in working with alcoholic clients. as part of the assessment process we were taught not to ask "do you drink, and how much?" the answer you get is going to be what the patient thinks you want to hear. alcoholics are a very manipulative group of people, some with a lot of mental health problems after the stuff they've done during their years of drunkenness--so they are more than willing to hide the amount of alcohol they drink; social and occasional drinkers are not. instead, we were instructed by the doctors and nurse practitioners to ask, "how many 6-packs of beer do you drink a day?" or "how many 5th's can you drink over a day or a week?" these kinds of questions are designed to make the idea of consuming those amounts of liquor known and normal to the examiner and opens the door a little wider to get the patient to reveal their true drinking habits.

why is it important to know this? because if the patient is addicted to alcohol, there are going to be problems of withdrawal if the patient is suddenly denied access to it. believe me, i've seen enough patients who have gone into dts a few days after admission because they didn't disclose that they were regular consumers of alcohol that you really want to not have this happen. alcohol also interacts with other drugs the patient may be given. it also gives the doctor a heads up to treat any alcohol withdrawal symptoms before they occur if that situation ever arises.

when a patient asks "how much is too much", that, to me, is a red flag that there might be alcohol consumption going on or a worry the patient thinks they might have a drinking problem. the question then becomes one of ferreting out just how much drinking is occurring. i've questioned patients who knew alcoholics and thought that if they took one sip of champaign at someone's wedding that made them suspect to be an alcoholic as well and they sure didn't want to be labeled as an alcoholic! being branded as an alcoholic in our society carries great stigma. that's why you clarify what they answer to the question.

some patients, particularly the hard core alcoholics who want to avoid detox and treatment, think that if they are even found out as alcoholics that they will be denied pain medication if they need it when they are hospitalized. so they will lie about their alcohol consumption or outright deny it. "oh, i only have a couple of beers when i get home from work" is more often a couple of 6-packs. one of our doctors told us to double whatever the patient told us their alcohol consumption was because that was probably a more accurate estimate. but, think about it. if you were an alcoholic drinking a whole case of beer (i guess they don't sell it that way anymore, do they?) or 4-six packs a day on a regular basis, would you proudly admit that to a stranger?

MB37 · Jun 7, 2008

Yes, they still sell cases of beer, at least in the states I frequent. As for how much alcohol constitutes a problem, there is no answer. How could there be? Addicts need their substance, be it alcohol, opiates, gambiling, whatever - that's the difference. People who are not addicts may still drink an unhealthy amount, or be at risk for withdrawal if they enter the hospital. Many medications interact with alcohol, even OTCs - if someone drinks regularly, they should probably avoid tylenol, for example. The question should always be asked in a non-judgmental fashion. When a patient asks, "how much is too much?" It's your chance to open up a dialogue. There is no textbook answer to that question.