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Ask Us Anything About… Alcohol Use Disorder

Problem drinking that becomes severe is given the medical diagnosis of “alcohol use disorder” or AUD. An estimated 16 million people in the United States have AUD.

Would you know how to recognize AUD in a family member or friend? Would you know what to do if you suspect someone has AUD? Might you have AUD?

We pose these questions to William Milchak, an addictions counselor at Penn State Health.

View full transcript of video


Description – The video begins inside a conference room at Penn State Health. Two people are standing next to each other. Standing from left to right is, Scott Gilbert and Bill Milchak.

Scott Gilbert – From Penn State Health this is ask us anything about alcohol use disorder. I’m Scott Gilbert. Having a couple of drinks here or there is widely regarded as normal. There are even studies that say a glass of wine each day could be good for you right. Well for about 16 million Americans though drinking is a vicious habit that carries a medical diagnosis, that diagnosis is alcohol use disorder or AUD. Here to tell us more about it today, some of the warning signs and how it’s treated is Bill Milchak, he’s an addiction counselor here at Penn State Health. Bill, thanks for being here today.

Bill Milchak – Oh my pleasure, thank you.

Scott Gilbert – I want to start by asking where that line is between normal enjoyment of a drink and AUD. I mean it’s kind of a spectrum there I know but really how do you kind of distinguish between that?

Bill Milchak – Sure. Actually normal drinking, social drinking, responsible drinking is a little bit hard to define. A social drinker, a normal drinker is best defined as someone who’s not having problems. Once your drinking creates some problems for you then you moved over into problem drinking. So normal drinkers should not be having alcohol-related problems you know and we can talk about what some of those problems might be. So normal drinking you know what is social drinking, is it two drinks two or three times a week, is it one drink at night, is it three or four on occasion right?

Scott Gilbert – What’s the medical community’s opinion on that?

Bill Milchak – Well we like to talk about low-risk and high-risk drinking. So low-risk drinking for a male is no more than 4 drinks a day standard drinks and no more than 14 a week. For a female we like to say no more than three drinks at a sitting and no more than seven a week. So we say low-risk because if you’re drinking at that capacity you’re probably not going to have problems, you’re not going to be at the legal limit for drunk driving, probably not going to you know.

Scott Gilbert – Why are those numbers different for men and women?

Bill Milchak – Women don’t metabolize alcoholism as well as men. Yeah, yeah and that’s.

Scott Gilbert – Well you know we hear about the term alcohol use disorder, that may be new to some people and the term that we might be more familiar with as alcoholism. You know so-and-so is an alcoholic, those types of labels. What’s the difference there between the two?

Bill Milchak – Okay for about three decades diagnostically we looked at alcohol abuse or alcohol dependence and dependence you know was the same as addiction or alcoholism. Five years ago we changed the diagnostics to putting alcohol on a continuum and now call it alcohol use disorder. So we did away with the abuse or dependence and we look at it now on a continuum. So you have a mild alcohol use disorder, moderate or severe. And severe would play out just as alcoholism would or alcohol dependence, we just call it something different.

Scott Gilbert – Got it. You’re watching Ask Us Anything About Alcohol Use Disorder from Penn State Health. We welcome your questions for Bill Milchak, he’s an addiction counselor here at Penn State Health. So feel free to add those in the comment section below this Facebook post whether you’re watching this video live or after the fact and we’ll make sure we get you some answers. Alcoholism as it’s commonly referred to is something that everyone seems to have a connection to, possibly there’s a connection in your family and we welcome your questions today during this interview with Bill. So can someone not be a binge drinker and still have AUD? And I guess in order to answer that we have to start with what is defined as a binge drinker.

Bill Milchak – So a binge outing for a male would be five or more standard drinks. Some people say that’s across like several hours, some people would say five or more in a day would constitute a binge. For a female it’s four or more drinks. So if somebody is binge drinking, if they binge once a week, once a month, twice a year they would probably avoid a lot of alcohol-related problems that would put them on that spectrum. But frequency is important. If you’re binging two, three, four times a week you just kind of do the math you know. You can be you know hurting yourself health-wise, run the risk of you know DUIs and all those kinds of things.

Scott Gilbert – Well if you suspect a family member or a friend has AUD what’s a good first step toward trying to raise the issue? I imagine it could be a difficult conversation to have.

Bill Milchak – Yes, it is especially when you know they don’t recognize there’s a problem. And the sad thing about addiction is that you know everyone around the person is addicted. You don’t recognize it but often they don’t. So let’s say it’s a spouse and you’re concerned about your spouse’s drinking. Probably the best advice would be don’t approach the subject until you’re both rested, relaxed, in a good frame of mind, not in the midst of a drinking episode or somebody coming in and they’re intoxicated. And the other thing I think is really important is we don’t want to look at it sympathetically but more empathically you know. And then if you really suspect a problem you know there are interventions. You know there are actually professionals who are certified in doing interventions. I use them quite often. Where you can contract with them and they’ll just go out kind of like the TV model you know that we see but people that do, do that.

Scott Gilbert – Do you often find that some people may have AUD but not realize it?

Bill Milchak – Oh absolutely, yeah. You know there’s a lot of use of you know people minimize how much they’re drinking, how often, they rationalize, I don’t drink as much as my friends or you know I know someone who drinks more than I do or I only drink beer I don’t drink hard stuff.

Scott Gilbert – So they make up excuses in their mind to make it okay.

Bill Milchak – Absolutely. Or they project that you’ve got a wife like mine or a boss like mine or a husband like mine you’d good drink too.

Scott Gilbert – Joke it away yeah.

Bill Milchak – But you know you take it off yourself because once you own it and accept it then you got to do something about it you know.

Scott Gilbert – You’re watching Ask Us Anything About Alcohol Use Disorder from Penn State Health. Your questions for Bill Milchak, an addiction counselor here, are certainly welcome, just add them to the comment field below this Facebook post. About 16 million Americans are affected by alcohol use disorder and as Bill was just saying some of them don’t even realize it. What are some of the risk factors, what makes somebody most prone to fall victim to this?

Bill Milchak – That’s a great question because you know there’s a lot of unknowns in addictions. You know we still can’t fully get our arms around it. But with alcohol this we know that genetic loading is critical. So if I have a mother or father that has an alcohol problem, a dependence. You don’t, I’m four or five times more likely if I begin to drink to move on to a dependence than you are. The second greatest risk factor would be starting to drink before the age of 15. You know people just start to drink, kids before the age of 15 are about 50% more likely to develop an alcohol problem than their peers who don’t.

Scott Gilbert – Do we know why that is, is it just because those are formative years?

Bill Milchak – It could be, I think again it’s just you know something they’ve identified over the years and you know is a key risk factor.

Scott Gilbert – And when we talk about what ages are affected in most, is there a gender or an age group that is affected most by AUD?

Bill Milchak – There are certainly some age groups that seem to be at a little more risk, like you take the 18 to 35 group you know in transitions, you know the service, high school, college. I’ll give an example of it, college students if you look at their drinking a lot of them would actually meet the criteria in college for like a moderate or severe problem. But the good news is that the vast majority of them you know finish school, get on with life and set that aside. But we worry about that group, now we’re worrying a bit more about older adults you know. Actually one of the premiere rehabs in this area Karen Foundation has set up a boomer unit because they found a lot of the 60’s generation now retired and you know falling back on smoking marijuana and drinking again. And so they actually have a unit now for older adults.

Scott Gilbert – You know it may differ by a generation, in fact saw some really interesting numbers, some 623,000 adolescents, that is those between the ages of 12 and 17 were identified as having AUD in 2015. Do you find those numbers alarming or not so much?

Bill Milchak – I don’t know that, I’m not real sure about that number because I probably wouldn’t see it a lot in 12 to 17-year olds diagnostically. I don’t know how many of them would actually have a disorder. Maybe on the mild side but it’s unusual to see somebody that would be having you know withdrawal and you know tremors and seizures and things like that that young you know. So but drinking problematically and moving towards a problem absolutely you know. I don’t know how many of them would actually be diagnosed in that age range.

Scott Gilbert – You’re watching Ask Us Anything About Alcohol Use Disorder from Penn State Health. Feel free to share this post on your Facebook page if you’re finding the information useful as we do hope that you are. I’m wondering what some of the withdrawal symptoms are people may face if let’s say they may realize they have an issue and then they try to step away from alcohol. In a way it’s going to be like trying to quit a drug right.

Bill Milchak – Yeah. So it’s important to note that you know somebody who is that normal, social, responsible drinker would not be having withdrawal. Withdrawal for a lot of people, the first time they recognize it is when they start to have the morning shakes or tremors, we call it you know morning shakes. So maybe they haven’t drank in 6, 8, 10, 12 hours and in the morning they’re having tremors. And often you know the best recourse for that is to have a couple of drinks and take the edge off. And with more impairment people can have DTs, delirium tremens where they actually see things, see the snakes, the lizards, the elephants. They could have seizures. So withdrawal, it’s the only withdrawal actually when you think of drugs that’s probably lethal. You won’t die from heroin withdrawal, cocaine withdrawal, even marijuana withdrawal which I think there is a withdrawal but alcohol you can die.

Scott Gilbert – Yeah and when it comes to impact on the individual you know we’ve talked about some of the effects it can have on a person’s life but what about those around them, their family and friends?

Bill Milchak – Yeah, you know years ago we started looking at alcoholism as a family disease. I mean think of a family as a system and when one member is you know in trouble everyone’s impacted. So you know you think about it, there’s a lot written about adult children of alcoholics and children of alcoholics and the impact mom’s or dad’s drinking has upon them. You know Suzanne Somers years ago wrote a book called Keeping Secrets talking about what it was like to grow up in an alcoholic home, very insightful. So it impacts the kids you know in many ways and often we just don’t pick up on it.

Scott Gilbert – Anther one of those statistics that I found interesting is that they say about less than 10% of people with AUD actually seek treatment for it. Why is that number so low?

Bill Milchak – Yeah and you know I see 10, I see 20 and that’s true also of other drug problems than just alcohol. Again you know people got to recognize they have a problem, if they’re not ready to change why would they change you know.

Scott Gilbert – Then there’s dealing with the stigma too.

Bill Milchak – Yeah, absolutely. And the stigma is really important to keep in mind, we’re seeing that played out with opioids right now with heroin addicts, people that are addicted to pain pills. Stigma, we stigmatize based upon do we think somebody caused their problem and do we think they can control it. Okay when you think about diabetes and hypertension, you know, did they cause that, can they control it. But when you think about somebody that’s drinking a lot of folks still think that while they caused a problem and they can control it so that’s kind of how we get stigma.

Scott Gilbert – And so do you think that having this out there as a diagnosable disorder helps to, it helps people to realize that this is something that needs medical attention, it needs intervention from professionals, it’s not something that people can always deal with just on their own?

Bill Milchak – You know I think the AMA it was 53 or 54 you know called it a disease and I think a lot of people still in public struggle with that. I mean is it a bona fide disease as heart disease and diabetes you know I think that that’s still a sticking point for a lot of people.

Scott Gilbert – Well and let’s talk a bit about the treatment of AUD. You know okay if somebody comes forward or you know they’re able to get into treatment what does that treatment typically entail, especially for those who may be at the end of the spectrum with a more severe condition?

Bill Milchak – Sure. So we have levels of care and they kind of go from intensity. So somebody who has withdrawal where that’s a concern we have a hospital level of care, we have a hospital detox. Then we have residential treatment like your standard 28-day model you know they made a movie about the 28 days. So you can end up in a hospital or you can go to a 28-day freestanding rehab where you stay. And then we have partial where somebody will go five days a week but stay at home and just go in four, five or six hours a day. Then we have intensive outpatient where you go three times a week for three or four hours. And then we have standard outpatient where you go like you know one time a week and then course all the good 12-step programs like AAA. And there’s faith-based programs too which are really quite helpful.

Scott Gilbert – And so if people don’t seek treatment what are some of the possible long-term impacts of that?

Bill Milchak – Yeah. This is what I see in the hospital quite a bit is I get a lot of admissions with alcoholic pancreatitis, we see a lot of alcoholic liver disease. If you have diabetes, if you have hypertension and you’re abusing alcohol it just complicates everything, it throws you know all your chemistry off. So you know you can actually get organicity, you have some cognitive deficits from drinking. So it just impacts you know the whole of your body you know and even your thought as well.

Scott Gilbert – It’s having an impact on different parts of your body that you may not realize at the time.

Bill Milchak – Absolutely, yes. And you know the pancreas and liver I mean sometimes it results in people needing transplants and you know.

Scott Gilbert – You’re watching Ask Us Anything About Alcohol Use Disorder from Penn State Health. Bill Milchak is an addiction counselor here, he welcomes your question. Just make sure you drop them in the comment field below this Facebook post. Whether you’re watching this video live or if you’re watching on playback, we can certainly get you some answers. You know this is a time of year when people may be seeing members of their family who they haven’t seen in a while, possibly even since last holiday season. So this is a good time is it not for people to be on the lookout for family members who may exhibit symptoms of AUD?

Bill Milchak – Sure, sure. So you know in this country you know we common equate having a good time often with drinking. And you know you can do that and not binge drink and you know not drink to intoxication. But just because someone does do that, maybe a college kid home visiting friends and that happens a couple of times does not mean it’s a diagnosable disorder. But you know it’s the holidays again you know we equate you know holidays, sports, a lot of things with drinking. And I know at the hospital we’ll have a big rush of alcohol-related admissions right after the holidays and right after Super Bowl.

Scott Gilbert – And that’s no coincidence, I guess.

Bill Milchak – I don’t think so, you can predict it.

Scott Gilbert – Yeah, I’ll be darned. And so again just to reiterate if someone does feel that there’s a bigger issue than just maybe a couple, too many beers around a holiday what are those first steps to take? What do you do to encounter that family member in a way? And we talked about this a bit earlier but you know maybe give some folks some ideas or some tools to use to approach them.

Bill Milchak – Well oftentimes I’m a big fan of employee assistance programs you know employees at Penn State have one, most employers you know medium, large size will where you can just encourage somebody hey look you get a free service at work, you go in you can meet with somebody two or three times and kind of flesh this out, see where to go. Again you know a family member it’s a challenge you know bringing that up, you know you run some risk when you step out there and bring these issues up. But you know if you do it when you’re at a calm and things and what you do is you know you talk about the good times, do you remember when we used to do this and when we were able to do that, and you remember your health you know before this kind of drinking. And just sort of ease into some dialogue.

Scott Gilbert – Take them on that journey, tell them some stories, conjure up those memories.

Bill Milchak – Sure, absolutely.

Scott Gilbert – Well Bill, this has been some great advice. Any parting words as we close down the interview here, anything else we didn’t touch on?

Bill Milchak – No, I don’t think so, I think you covered it well.

Scott Gilbert – Well Bill Milchak thanks very much for your time.

Bill Milchak – My pleasure.

Scott Gilbert – Bill is an addiction counselor here at Penn State Health he’s been our guest. Thank you very much for watching as well, Ask Us Anything About Alcohol Use Disorder from Penn State Health.

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