The unit used here is milligrams of alcohol per 100 ml of blood, abbreviated "mg%." This is the unit
commonly used by pharmacologists, and has the additional convenience of being a whole number rather than a
decimal (less confusing for some clients). If you or your client wish to compare this with the usual decimal
expressions of BAC, simply move the decimal point three places to the left. Thus:
80 mg% = .08
100 mg% = .10
256 mg% = .256
and so on
Note that the "normal social drinking" range is defined as from 20-60 mg% in peak intoxication. In fact,
the vast majority of American drinkers do not exceed 60 mg% when drinking. Although 500 mg% is a lethal dose
of alcohol for most adults, some alcohol dependent clients have been known to survive much higher levels, with
some even continuing to drink and drive at 700 mg%. We have used 700 mg% as a cut-off for estimates, even
though somewhat higher levels can be survived.
The behavioral effects as shown in "Understanding Your Personal Feedback Form" can be understood as
the ordinary effects of various BAC levels. Because of tolerance, people may reach these BAC levels without
feeling or showing the specific effects listed. The presence of a high BAC level, especially if accompanied by a
reported absence of apparent or subjective intoxication signs, is an indication of alcohol tolerance.
Tolerance. Discuss tolerance with your client as a risk factor. This is counterintuitive for many clients,
who believe that an apparent absence of subjective impairment means that the person is in less rather than more
danger. In fact, people with a high tolerance for alcohol have a greater risk of being harmed and developing serious
problems from drinking. Tolerance level here is estimated from the maximum BAC level reached by the client
during the pre-treatment assessment period. A few points to cover (in language appropriate for your client) are:
1. Tolerance is partly inherited, partly learned.
2. For the most part, tolerance does not mean being able to get rid of alcohol at a faster rate (although this occurs
to a small extent). Rather it means reaching high levels of alcohol in the body without feeling or showing the
3. Normal drinkers are sensitive to low doses of alcohol. They feel the effects of 1-2 drinks, and this tells them
they have had enough. Other people seem to lack this warning system.
4. One result of tolerance is that the person tends to take in large quantities of alcohol - enough to damage the
brain and other organs of the body over time - without realizing it. Thus the drinker is harmed but does not
“feel” it, creating a false sense of safety or impunity. An analogy would be a person who loses all pain
sensation. While at first this might seem a blessing, in fact it is a curse, because such a person can be severely
injured without feeling it. The first sign that your hand is on a hot stove is the smell of the smoke. Similarly, for
tolerant drinkers, the first signs of intoxication are not felt until rather high BAC levels are reached.
Alcohol Dependence Level. Explain the concept of alcohol dependence to your client. Many will be
familiar with physical withdrawal signs, and may equate these with dependence. In fact, dependence is much
broader than physical withdrawal, and involves alcohol progressively dominating more and more of the person’s
life. A few points to cover (in language appropriate for your client) are:
1. Dependence is not limited to physical withdrawal, but is a behavioral pattern in which drinking becomes
increasingly central and important in one’s life.
2. Dependence occurs gradually, and many people do not realize it is happening.
3. It is not an all-or-none thing; dependence varies in severity.
4. There are seven signs of dependence on any drug. The current standard, to make a diagnosis of alcohol
dependence, is meeting at least three of these. You had _____ out of 7 signs. [If appropriate, it is okay to review
the symptoms, which briefly stated are:
2. Withdrawal (physiological dependence)
3. Using (drinking) more or longer than intended
4. Persistent desire or failed efforts to cut down or quit
5. Much time spent in obtaining, using, and recovering from the drug
6. Giving up important social, occupational, or recreational activities
7. Continued use despite persistent problems
5. Your assessment report will contain the specific symptoms of dependence which are positive for your
client, although the format varies across sites. You should not give this information to your client; it
is provided for your information only.
2. Other Drug Use
Here the client’s personal use of drugs in several categories is being compared with national norms, as
established by the household survey of the National Institute on Drug Abuse. The survey is conducted quite
carefully, with full confidentiality, and proper measures are taken to sample households representatively (e.g., not
only those with telephones).
Explain what the percentile (%) scores mean that have been written on this first sheet. A 95 in this column,
for example, means that the client’s use of this drug is greater than 95 out of 100 American adults (over the age of
12). Said another way, fewer than 5% of adults use this drug as much as the client does.
These numbers will often seem quite high to a client. The reason is that the vast majority of U.S. adults do
not use these drugs at all, a fact that is often surprising to clients whose social circle is comprised primarily of users.
The client’s recent negative consequences of drinking (as scored from the DrInC-2R) are shown on page 2
of the PFR. The client’s raw scores for the total scale and for five specific subscales are printed in the boxes at the
bottom of the profile form (note that there are separate norms for men and women). These same raw scores are
circled in the column corresponding to each scale, to show the client’s elevation relative to individuals currently
seeking treatment for alcohol dependence. Be sure to point out that the normative reference group has changed
from page 1, where drinking and drug use were being compared with the general population. Here a “low” score is
low relative to people entering treatment for alcohol dependence, which may still be a rather high score in the
general population. (This is the only normative base currently available, and comes from Project MATCH.)
Explain that this shows the extent to which the client has experienced negative consequences (problems)
related to his or her drug use, in comparison with people who are being treated for such problems.
Here is some basic information to help you interpret the subscales. This information is also on the client’s
form, Understanding Your Personal Feedback Report.
This score reflects unpleasant physical effects of alcohol use such as hangovers, sleeping problems,
and sickness; harm to health, appearance, eating habits, and sexuality; and injury while drinking
Interpersonal These are personal, private negative effects such as feeling bad, unhappy or guilty because of
drinking; experiencing a personality change for the worse; interfering with personal growth,
spiritual/moral life, interests and activities, or having the kind of life that you want.
These are negative consequences more easily seen by others. They include
Responsibility work/school problems (missing days, poor quality of work, being fired or suspended), spending
too much money, getting into trouble, and failing to meet others’ expectations.
Interpersonal These are negative effects of drinking on important relationships. Examples are damage to or
the loss of a friendship or love relationship; harm to family or parenting abilities; concern about
drinking expressed by family or friends; damage to reputation; and cruel or embarrassing actions
This is a group of other negative consequences of drinking that have to do with
self-control. These include: overeating, increased use of other drugs, impulsive actions and risk-
taking, physical fights, driving and accidents after drinking, arrests and trouble with the law, and
causing injury to others or damage to property.
4. Reasons for Drinking
A fourth general domain of interest is your client’s stated reasons (motivations) for drinking. These are
derived from the Desired Effects of Drinking questionnaire, which you administered in Session 1. Simply circle
the client’s total score for each of the subscales. Feedback here is not normed, but reflects the absolute level of
each reported reason for drinking. The nine scales are:
to feel more creative or mentally alert; to think, work or concentrate better
Positive Feelings to change mood or feel good, to relax or celebrate
to relieve tension, forget problems, avoid painful memories
Social Facilitation to be sociable and comfortable in social situations, to meet and enjoy people
to get drunk, get over a hangover, to sleep, or stop shakes or tremors
to feel more powerful or courageous, to express anger
Sexual Enhancement to feel more romantic and sexually excited, enjoy sex more, be a better lover
Negative Feelings to feel less depressed, angry, ashamed, or fearful
Self-Esteem to feel better about oneself, less guilty, disappointed, or angry with oneself
5. Preparation for Change in Drinking
This section contains four different variables that may be important indicators of how prepared your client
is for change in drinking. Low scores on these four scales reflect potential obstacles to change.
Readiness. The first of these is the client’s self-reported level of readiness for change, a summary index scored
from the URICA by adding together the contemplation, preparation, and action items and subtracting the
precontemplation items. The decile norms here are from Project MATCH, and compare your client’s readiness
score with those from clients entering treatment for alcohol dependence. High scores indicate high self-reported
readiness for change.
Support. What is being measured here (from the IP interview) is the degree to which your client’s social
network supports continued drinking. Note that the deciles are inverted here, with 10 at the bottom. Vertically
low scores (higher deciles) suggest a potential obstacle to change: namely, that the client’s social network favors
continued drinking. Vertically high scores (lower deciles) reflect low social support for continued drinking.
Confidence. High scores here reflect a high degree of confidence (self-efficacy) to abstain from drinking.
Clients with low scores are not reporting much confidence in their ability to abstain.
Temptation. This scale, like Support, is also inverted, with high deciles at the bottom. Clients with vertically
low scores (higher deciles) are reporting a lot of temptation to drink in their social environment. Clients with
vertically high scores (lower deciles) report low levels of temptation to drink.
Remember that vertically low scores on all these scales represent potential obstacles to change. Vertically high
scores on all these scales represent preparation for change.
6. Mood States
This section reflects your client’s mood state during the week before pretreatment evaluation. These mood
states fluctuate widely, and thus the scores may or may not represent the client’s mood at the time of your feedback
session. The scale names are fairly good descriptors of the adjectives contained in each factor. Norms here are
based on U.S. adults.
7. Blood Tests
These four serum assays can be elevated by excessive drinking, and thereby reflect in part the physical
impact of alcohol on the body. It is noteworthy that many heavy and problematic drinkers have normal scores on
these assays. The physical damage reflected by elevations on these scales may emerge much later than other types
of problems. Also, normal scores on these tests cannot be interpreted as the absence of physical damage from
drinking. The destruction of liver cells near the portal vein where blood enters, for example, can occur well before
liver enzymes reflect a warning. When these scales are elevated, then, it is information to be taken seriously.
Be sure to clarify that, as a nonmedical professional, you are not qualified to interpret these findings in
detail. The medical staff will review elevations with your client, if they have not already done so. Clients who are
concerned and want more information should be advised to discuss their results with medical staff (such as the MM
The following information will help you explain to clients the basic processes underlying these assays, and
what they may mean:
AST and ALT. AST (aspartate animotransferase, previously called SGOT) and ALT (alanine transferase;
previously called SGPT) are enzymes that reflect the overall health of the liver. The liver is important in
metabolism of food and energy, and also filters and neutralizes poisons and impurities from the blood. (The
analogy to an oil filer is helpful for some.) When the liver is damaged, as happens from heavy drinking, it becomes
less efficient in these tasks, and begins to leak enzymes into the bloodstream. Elevated levels of these enzymes are
general indicators of compromised liver function.
GGT. Serum gamma glutamyl transpeptidase (GGT or GGTP) is an enzyme found in liver, blood, and
brain, which is more specifically sensitive to alcohol's effects. If drinking continues, elevations of this enzyme
predict later serious medical problems related to drinking, including injuries, illnesses, hospitalizations, and deaths.
This enzyme is often elevated first, with AST and ALT rising into the abnormal range as heavy drinking continues.
GGT is also sensitive to recent drinking, and an elevation may reflect a recent heavy drinking episode.
MCV. This is not a liver function measure, but rather is mean corpuscular volume, the average size of red
blood cells. Heavy drinking causes blood cells not to have enough hemoglobin which is necessary to carry oxygen
around the body and brain. Trying to make up for less hemoglobin, the blood cells grow larger. While there are no
serious immediate consequences of this enlargement, it reflects harmful effects of drinking that in the long run can
damage circulation and brain cells.
Elevations on serum test scores can occur for reasons other than heavy drinking. GGT, for example, can be
elevated by cancer or hormonal changes. In this population, however, the most likely cause of an elevation is heavy
drinking. These test values tend to return toward normal if the person stops drinking. Reductions in GGT (by
changed drinking) have been shown to be associated with substantially reduced risk of serious health problems.
Understanding Your Personal Feedback Report
The Personal Feedback Report summarizes results from your pretreatment evaluation. Your counselor has
explained these to you. This information is to help you understand the written report you have received, and to
remember what your counselor told you about it.
Your report consists of three sheets. They summarize information from interviews, questionnaires, and
blood tests completed as part of your pretreatment evaluation.
Section 1: Alcohol Use
The first line in this section shows the average number of drinks per week that you reported having
during the months before entering this program. Because different alcohol beverages vary in their strength, we
have converted your regular drinking pattern into standard "one drink" units. In this system, "one drink" is equal to:
10 ounces of beer
(5% alcohol) or
4 ounces of table wine
2.5 ounces of fortified wine (sherry, port, etc.) (20% alcohol)
1.25 ounces of 80 proof liquor
(40% alcohol) or
1 ounce of 100 proof liquor
All of these drinks contain the same amount of the same kind of alcohol: one-half ounce of pure ethyl alcohol.
This first piece of information, then, tells you how many of these standard "drinks" you were consuming
per week of drinking, according to what you reported in your interview. (If you have not been drinking for a period
of time recently, this refers to your pattern of drinking before you stopped.)
To give you an idea of how this compares with the drinking of American adults in general, the second
number in Section 1 is a percentile figure. This tells you what percentage of U.S. men (if you are a man) or women
(if you are a woman) drink less than you reported drinking on average. If this number were 60, for example, it
would mean that your drinking is higher than 60% of Americans of your sex (or that 40% drink as much as you
reported, or more).
Your total number of drinks per week tells only part of the story. It is not healthy, for example, to have ten
drinks per week by saving them all up for Saturday. Neither is it safe to have even a few drinks and then drive.
This raises the important question of level of intoxication.
A second way of looking at your past drinking is to ask what level of intoxication you were reaching. It is
possible to estimate the amount of alcohol that would be circulating in your bloodstream, based on the pattern of
drinking your reported. Blood Alcohol Concentration (BAC) is an important indication of the extent to which
alcohol would be affecting your body and behavior. It is used by police and the courts, for example, to determine
whether a driver is too impaired to operate a motor vehicle.
To understand better what BAC means, consider this list of common effects of different levels of
COMMON EFFECTS OF DIFFERENT
LEVELS OF INTOXICATION
This is the "normal" social drinking range.
NOTE: Driving, even at these levels, is unsafe.
Memory, judgment, and perception are impaired.
Legally intoxicated in some states.
Reaction time and coordination of movement are affected.
Legally intoxicated in all states.
Vomiting may occur in normal drinkers; balance is often impaired.
A "blackout" may occur, loss of memory for events occurring while intoxicated.
300 mg% Unconsciousness in a normal person, though some remain conscious at levels in excess of 600-700mg%
if tolerance is very high.
450 mg% Fatal dose for a normal adult, though some survive much higher levels if alcohol tolerance is substantial.
The number shown as level of intoxication is a computer-calculated estimate of your highest (peak) BAC
level during the months preceding your entry to this program.
It is important to realize that there is no known "safe" level of intoxication when driving or engaging in
other potentially hazardous activities (such as swimming, boating, hunting, and operating tools or machinery).
Blood alcohol levels as low as 40-60 mg% can decrease crucial abilities. More dangerously, the drinker typically
does not realize that he or she is impaired. The only safe BAC when driving is zero. If you must drive after
drinking, plan to allow enough time for all of the alcohol to be eliminated from your body before driving.
Section 1 also shows a level of alcohol tolerance based on your BAC peak. Tolerance refers to the ability
to “hold your liquor,” to have alcohol in your bloodstream without showing or feeling the normal signs of
impairment for that level of intoxication. Some have the impression that a high level of tolerance means that a
person can drink more safely than others, but in fact the opposite is true. A person with a high tolerance for alcohol
simply does not feel or show the level of intoxication, and as a result may expose his or her body to high and
damaging doses of alcohol without realizing it.
Finally, in Section 1, is your score for level of alcohol dependence. Although many people think of
dependence as having physical withdrawal from alcohol, alcohol dependence is actually much broader. In fact, one
can be alcohol dependent without experiencing withdrawal symptoms when drinking is stopped. Alcohol
dependence is a pattern of one’s life becoming more centered on drinking. In essence, drinking (and recovering
from its effects) gradually dominates more and more of one’s time and life. There are seven signs of alcohol
dependence, and the score that is circled here shows how many of these signs you reported. Three signs are
required for a diagnosis of alcohol dependence.
Documents you may be interested
Documents you may be interested