The Lure of Alcohol Use During the Holidays

Drinking during the holidays can cause a host of problems, including relapse for alcoholics, unsociable conduct, fights, poor decision-making, drunk driving or, worse yet, serious automobile accidents or criminal behavior. Seasonal alcohol consumption can even lead to health problems, such as alcohol poisoning or holiday heart syndrome, a condition characterized by heart rhythm problems after alcohol use during the holidays.

Top Drinking Holidays

Alcohol use increases during holidays and particularly during the winter holidays, according to 2014 statistics released by BACtrack, a company offering breathalyzers that connect to smartphones. In fact, 14 of the 15 biggest drinking days occur between December and March. The holidays with the highest blood alcohol content (BAC) were New Year’s Eve, Super Bowl weekend, the day after Valentine’s Day and St. Patrick’s Day. The only drinking holiday not occurring between December and March was Cinco de Mayo.

Holiday Drinking Triggers

Triggers are any form of stimuli that initiate the desire to engage in an addictive behavior. While triggers may vary between individuals, common triggers for alcohol consumption include:

• Alcohol-centered festivities
• Peer pressure to drink
• Family stress
• Depression

Clinicians and other healthcare professionals can help individuals identify triggers and develop strategies to avoid triggers or deal with them when necessary.

Tips to Avoid the Lure of Alcohol Use During the Holidays

Healthcare providers can provide tips to help individuals avoid using alcohol during the holidays. Some tips may include:

• Start each day with a plan to remain sober
• Evaluate each situation for its potential to become a “slip” back to alcohol use
• Bring your own non-alcoholic beverage
• Identify triggers that lead to alcohol consumption
• Eat nutritious meals before events; hunger often leads to temptation
• Manage stress
• Enlist the help of a sober friend
• Rehearse responses to offers of alcohol
• Distraction — cravings last only about 20 minutes

Assessing the Risk of Alcohol Use or Abuse During the Holidays

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) says that men who drink more than four standard drinks a day, or more than 14 in a week, have a higher risk for alcohol-related problems. Women who consume more than three alcoholic beverages in a day, or more than seven per week, also have an increased risk. Individual responses to alcohol varies, however, which means drinking can be problematic for some men and women who consume less alcohol.

Clinicians and other healthcare professionals are in a prime position to help patients avoid the lure of alcohol use during the holidays. The first step is to identify individuals at high risk for alcohol abuse with the use of reliable screening tools. Clinicians can now choose from among several hundred tools to identify patients with alcohol problems.

SBIRT

Substance Abuse and Mental Health Services Administration (SAMHSA) recommends using Screening, Brief Intervention and Referral to Treatment (SBIRT). Health professionals may use this evidence-based practice to identify, reduce and prevent problematic use, abuse and dependence on alcohol.

SBIRT consists of three main components:

• Screening: The use of standard screening tools to assess the patient for risky substance abuse behaviors
• Brief intervention: Engagement in a short conversation about alcohol use and the provision of feedback and advice
• Referral to treatment: Referral to brief therapy or other treatment

Two other tools are particularly popular for identifying alcohol problems in the general population — AUDIT and CAGE — while many clinicians rely on the T-ACE test to assess alcohol use among pregnant women.

In each test, the clinician asks the patient a series of questions. The names of the CAGE and T-ACE tests are acronyms for an important word or concept within each question.

CAGE

The CAGE test is a series of questions; each uses an important keyword. Practitioners can phrase the questions in their own words, as long as the questions include the important keyword.

C – Have you ever thought you should CUT DOWN on your drinking?

A – Has your drinking ever ANNOYED someone?

G – Do you ever feel GUILTY about your drinking?

E – Have you ever had an EYE-OPENER drink first thing in the morning?

The CAGE test helps healthcare providers identify alcohol problems over the patient’s lifetime. A positive test, consisting of two positive answers, warrants further assessment.

T-ACE

The T-ACE test also uses a series of questions with important keywords. Three of the four questions in T-ACE focus on the same keywords as the CAGE test.

T – TOLERANCE: How many drinks does it take to make you feel high?

A – ANNOYED

C – CUT DOWN

E – EYE-OPENER

AUDIT

AUDIT is an acronym that stands for Alcohol Use Disorders Identification. Created by the World Health Organization, there are two versions of the test, one for clinicians and another for self-reporting.

Each test features a series of 10 questions exploring the frequency of alcohol use, quantity of alcohol used when drinking, and problems resulting from alcohol use. Answers are in multiple-choice format.

Questions for both the clinician test and the self-reporting test include:

• “How often do you have a drink containing alcohol?”
• “How often during the last year have you been unable to remember what happened the night before because you had been drinking?”
• “How often during the last year have you found that you were not able to stop drinking once you had started?”
• “Have you or someone else been injured as a result of your drinking?”

For those who are at risk for drinking but show no signs of abuse or dependence, clinicians and healthcare professionals can provide brief intervention in the form of advisement and assistance. The practitioner should clearly state the conclusion that the patient is consuming more alcohol than is medically safe, and recommend the patient quit or cut down. The healthcare provider should then assess the individual’s readiness to comply with the recommendation and provide continuing support, even if the patient states that they are unwilling to commit to change. The clinician or healthcare professional should follow up after the holidays to find out if the patient was able to avoid alcohol consumption.

To learn more about identifying Alcohol Use Disorders (AUD), see our Substance Abuse Disorder training resources.