Alcohol Abuse vs. Alcoholism

Moderate alcohol use—up to two drinks per day for men and one drink per day for women and older people—is not considered harmful for most adults (a standard drink is 12-ounces of beer, a 5-ounce glass of wine, or 1.5 ounces of distilled spirits). Many people, however, exceed this level of consumption and get into serious trouble because of their drinking. Currently, nearly 17.6 million adult Americans abuse alcohol or are alcoholics. Several million more adults engage in risky alcohol-related practices, such as binge drinking.

Alcoholism, also known as "alcohol dependence," is a disease that includes four symptoms:

• Craving - a strong need, or compulsion, to drink.


• Loss of control - the inability to limit one's drinking on any given occasion.


• Physical dependence - withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking.


• Tolerance - the need to drink greater amounts of alcohol in order to become intoxicated.

The craving that alcoholics experience may cause them to continue to drink despite serious family, health, or legal problems. Alcoholism has been shown to run in families, although having a family history of alcoholism does not mean that someone is destined to become an alcoholic also. As with other chronic illnesses, alcoholism cannot be cured, but is instead "managed". This typically involves abstinence from drinking alcohol.

Alcohol abuse constitutes many of the same traits as alcoholism, but unlike alcoholics, alcohol abusers may feel less of a compulsion to drink and may not experience withdrawal symptoms when they don't drink. Common characteristics of alcohol abuse include: (1) failing to fulfill major work, school, or home responsibilities because of drinking; (2) drinking in situations that are physically dangerous, such as while driving a car or operating machinery; (3) recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk; and (4) having social or relationship problems that are caused by or worsened by the effects of alcohol.

If you've ever wondered whether your drinking crosses the line into alcohol abuse or alcoholism, ask yourself these questions:

1. If you are a man, have you ever had five or more drinks in a day (four if you're a woman)?


2. Have you ever felt you should cut down on your drinking?


3. Have you been annoyed by people criticizing your drinking?


4. Do you ever feel bad or guilty about your drinking?


5. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Answering yes to the first question alone, or two positive responses to questions 2 through 5, indicates that you may have a problem with alcohol that needs to be addressed.

The consequences of alcoholism and alcohol abuse are serious, and in some cases, life threatening. Heavy drinking increases the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx (voice box). It can lead to health problems, such as liver cirrhosis, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. In purely economic terms, alcohol-related problems cost society approximately $185 billion per year. In human terms, the costs cannot be calculated.

Colorectal Cancer - Screening works!

For some time it has been known that the earlier that colon cancer is detected, the better the survival rate. For example, when colon cancer is diagnosed at an early, localized stage, the five-year survival rate is 90 percent, as compared to a five-year survival rate of only 10 percent when diagnosis is delayed until the later stages. Additionally, the earlier the diagnosis, the less invasive and dangerous the treatment becomes. If the cancer is found at a very early stage, it may be able to be removed without having to enter the abdomen surgically. More advanced stages of colon cancer usually require removal of a portion of the colon and chemotherapy.

What has been suspected, but not proven until recently, is that detection and removal of colon polyps can significantly reduce the number of deaths from colon cancer. The explanation for this is that colon cancer usually begins as a non-cancerous polyp on the inner lining of the colon or rectum. From the time the first abnormal cells start to grow into polyps, it can take up to 10 to 15 years for them to develop into colon cancer. Removal of these polyps before they have the chance to change into cancer can, in many cases, prevent colon cancer altogether. This is particularly true with a type of polyp known as an "adenomatous" polyp.

The study that demonstrated this improvement in survival was published last month in the New England Journal of Medicine. Over 2600 patients who had undergone adenomatous polyp removal by colonoscopy were followed for an average of 16 years. Over this time, there was a 53% reduction in death from colon cancer compared to expected deaths in the general population of similar age and gender. Obviously, polyp removal in this study group did not result in a complete avoidance of the development of colon cancer, but the results are significant enough to encourage widespread colorectal cancer screening.

There are a number of ways to screen for colon cancer. Colonoscopy is considered the "gold standard" for screening, but there are other methods that can also be used. A major advantage of colonoscopy is that if polyps are found during the screening, they can be removed and analyzed at that time. In addition, other methods may require more frequent screening intervals. For example, if no abnormalities are found, a colonoscopy does not need to be repeated for another 10 years. Sigmoidoscopy, which takes a less extensive look at the colon, should be repeated every five years and coupled with annual stool tests for blood.

Most medical authorities, including the United States Preventive Medicine Task Force, the American College of Physicians, and the American Cancer Society recommend that screening for colon cancer begin at age 50. Those people in high-risk groups, including African Americans, individuals with a family history of colon cancer, and someone with a personal history of inflammatory bowel disease (e.g. ulcerative colitis), may require that their screening begin at an earlier age.

Colorectal cancer, the second leading cause of cancer-related deaths for men and women in the United States, is expected to take more than 51,000 American lives this year. March is National Colorectal Cancer Awareness Month. If you are of an appropriate age, are in a high risk group, or are due for a repeat screening, take the time this month to talk to your doctor about colon cancer screening. With the knowledge that, to a large degree, colon cancer is a preventable disease, it only makes sense.

The Decision to Decline Immunizations

The decision to postpone or decline childhood immunizations is one that has important implications for the child, his or her family, and others in the community. Recently, the Centers for Disease Control, along with the American Academy of Family Physicians and American Academy of Pediatrics, released a statement outlining the responsibilities of parents who decline to have their child vaccinated. Today's Health Tip summarizes some of the most important points from that statement.

Special considerations when an unimmunized child gets sick: When seeking medical attention for a sick child, it is essential that the health care profession learn of the child's vaccination status. This applies whether the child is seen in the doctor's office, an emergency department, or if the child is traveling in an ambulance. This is because vaccine-preventable diseases will need to be considered as a possible cause for the child's illness. Also, the child may need to be isolated to avoid spreading the disease to others. For example, an infant who is not yet old enough to be vaccinated or someone with a weakened immune system could be at risk of contracting the child's illness.

With an outbreak of a vaccine-preventable disease in the community: At the time of enrollment, a child's school or child care facility should be informed about the child's immunization status. Should a vaccine-preventable disease strike in the community, it may be necessary to remove an unvaccinated child from school or daycare. With some vaccine-preventable diseases, it may not be too late to receive protection by being vaccinated

When an unimmunized child is exposed to a vaccine-preventable disease: In this situation, the caregivers of the unimmunized child need to know the signs and symptoms of that disease. Medical attention should be sought at the first sign that the child has contracted the disease. In some cases, a medication may be available to treat the illness, such as the use of an anti-viral medication following exposure to influenza.

When traveling with an unimmunized child: Even though many vaccine-preventable diseases have become rare in the United States, they may still occur in foreign countries. For example, India, Nigeria and Pakistan continue to have polio outbreaks. Should an unimmunized child become ill with a vaccine-preventable disease, his or her parents should take measures to avoid spreading the disease to others. This could mean cancelling further travel until a doctor determines that the child is no longer contagious. Also, be aware that prior to admission into some countries, immunization against certain disease, such as Yellow Fever, may be required.

A few of the vaccine-preventable diseases that continue to cause infections in the U.S. include pertussis (whooping cough), hepatitis B, mumps, measles, and Haemophilis influenzae type B (Hib) meningitis. Before deciding to forgo immunizing their children, parents should consider the following facts regarding these vaccine-preventable diseases:

• Cases of whooping cough have been on the rise in the U.S. due to reduced immunization rates, due in part to parental concern regarding the safety of the vaccine. Prior to pertussis immunization, however, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.
  


• Approximately 20% of people who contract measles require hospitalization due to complications such as pneumonia. Before measles immunization, an average of 450 measles-associated deaths occurred each year.
  


• Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases.
  


• Before Hib vaccine became available, Hib meningitis killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.
  


• Of the 2 billion persons worldwide who have been infected with hepatitis B, around 350 million become life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.
  

In the U.S., vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants and children. Parents or caregivers should make the decision to postpone or decline immunizations for their children only after being fully informed of the risks and responsibilities. For more information on childhood vaccines visit the immunization section of the CDC website at www.cdc.gov/vaccines.