Addiction

[Danoff]

Here's a little food for thought on the subject:

https://www.psychologytoday.com/us/...e-7-hardest-addictions-quit-love-is-the-worst

That article rates food and love addiction as being harder to quit than cigarettes, which is over heroin, which is over alcohol, which is over cocaine. Heroin can be easier to quit than some people think, and the article talks about how any recounting of that is shouted down. Cocaine is apparently much easier than some of the others. Sugar has been compared to cocaine in terms of addiction, and does have some withdrawal symptoms (though not the same) when it comes to quitting. Caffeine is a physical addiction that most of us manage day-to-day knowing that we're addicted. For example I know that if I quit caffiene right now cold turkey that I'd go through a withdrawal period, and I'd probably want to take drugs to cut the withdrawal effects.

Adam Carolla explained at some point that he maintains a casual relationship with cigarettes, smoking and handful in a month, maybe one a week. And many many people have quit smoking successfully without medical assistance.

The Grand Tour cast obviously has some level of alcohol addiction, and they seem to be aware of it and at least attempt to manage it. I personally know a number of people who have broken a serious alcohol addiction.

I also have at least one relative that had an eating disorder (which can be thought of as an addiction of sorts). She'd describe almost blackout eating binges, where she couldn't remember what she had eaten afterward. She eventually beat it and dropped 100 lbs, currently maintaining almost 120lbs day to day (and has been for years).

So the question is this, how out of control do you think we are when it comes to addiction? Bring your stories of addiction that has ruined lives, and bring medical opinions on how the body physically gets altered by drugs to crave it. I'd like to explore all aspects of addiction of any sort (psychologically and physiologically) in this thread.

 

[Eunos_Cosmo]

I'm probably addicted to caffeine. I've tapered it off from time to time by drinking less caffeinated beverages, but eventually, I didn't see the point in not being addicted and sailed right back into it. I get pretty bad headaches if I don't drink it. But that only lasts for a few days. I could probably quit if I wanted to (I think) but I don't want to. So....addict?

[I'm drinking coffee while typing this]

I witnessed a lot of my classmates take up smoking during college to cope with stress or take up taking adderall usage to help with focus, but I stuck with naps & coffee. Served me pretty well. My father was a serious alcoholic, so I grew up with kind of a strong example of what not to do. I'd like to live past 62. He didn't.

 

[ImaRobot]

I'm definitely addicted to coffee, and I can understand that love can be an addiction as well.

I drink coffee every day, except weekends usually(which sounds kind of backwards when I say it). I have tried to quit a couple of times but as soon as I smell someone firing up a pot at work, that smell pulls me right back in. I've gone for a week at times, a couple on other occasions, but I don't think I've lasted more than a month with out it, to be honest. The only time I can do without it is when I have a cold, or some similar infection as it just doesn't mingle well with it and just leaves me feeling uncomfortable. Like @Eunos_Cosmo mentioned, when I thought about it, I couldn't really think of a reason to quit the addiction. I didn't feel my life was in jeopardy by keeping this habit up(yet?)

I haven't really felt any withdrawal affects if I don't have it for a day, or even a week at a time, though.

Cigarettes on the other hand, I've had no problem stopping them even after smoking daily for years on hand. I pretty much stopped it cold turkey. That one was a bit tricky, though, because practically everyone I know smokes. I think what made this easier to drop was because at the time I had went through some issues with breathing every once in a while, and thought I had messed up my lungs. Eventually it boiled down to an anxiety problem, which was still most likely caused by the cigarettes and stress combined.

Having an actual reason in this case, I think, made it much more easier to drop than coffee. Plus at the time I also wanted to be healthier(to an extent) in general. So far its been about 5-6 years since I've smoked a cigarette, and haven't picked up one since.

At one point during my life, alcohol was probably something I was most addicted to. It is also the only one that I can think that was actually ruining my life as well, and others around me. It was making me overweight, I would have an anger problem while overly intoxicated(nothing physical), I was a slob and was generally drinking just about every day. I don't really know why it picked up like it did, I didn't really have any problems in life that were so severe that might have caused it, it just kinda happened. Then kept happening, up until a point that my other half actually had to talk to me about it. It was shameful and embarrassing when hearing about it from someone else, especially someone you love.

I outright quit for about 6 months, not just for me, but for my girlfriend - I was given an ultimatum, and it was one I completely understood and was willing to take on. I definitely went through some withdrawals with this - headaches, easily agitated, so much so that I didn't like going out and kind of disappeared from my friends lives for a while. I picked up drinking again after that 6 months, but I've learned to keep it to a minimum, and learned to acknowledge my own limit while drinking as well. Now I save drinking for Fridays and/or Saturdays(depending on how busy of a weekend it is) and the occasional Sunday if my other half feels like she wants a mid afternoon beer. Though, it was up to her on the days outside of that if we drank, and sometimes I didn't even on those occasions. Funnily enough(or not), one of my friends just this past weekend mentioned that they haven't seen me get so drunk in a long time.

Like cigarettes, I had a reason( a really good reason..) to quit. If it wasn't for her, I don't think it would have stopped any time soon at that point, and I likely would have been a very different person.

Now, Love is not one that I would have thought of initially, but I can definitely get on board with that. It is so much needed in my life that it outright got me to reevaluate my life with what I just mentioned. To go on with that, recently me and my other half have been wanting to move into a much bigger place. We've been searching for a long time, and while we have the income, we don't have good enough credit to back it. It has been increasingly difficult with both of us on paper with me having bad credit and her having no credit. The reason we were trying to find a bigger place is that I moved in with her mid 2018 because she had broken her hand and was out of work for months, leaving her with little income, so I helped her out with bills and living expenses.

We were originally living separated(but still a couple) because we had some issues that have since been worked out, that I'm not willing to get into detail about, but when you're with someone for over 12 years things just happen sometimes. That moment of living together again for those months really made it hard to be back living on my own again, and it's something I had to do because it was easier for me to get a place on my own than it was together until we fix our credit. The only reason I didn't stay there is because her apartment is barely big enough to sustain one person(small studio), let alone 3 cats and me added to the pile. Neither of us had our space. We didn't have alone time. If we were mad at each other, there was no quick escape other than outright leaving. Our working schedule was completely opposite so I would either be waking her up all the time or the other way around. It's always the little things that add up to a big headache in my opinion.

So I moved out on my own for now, and man this is the loneliest I think I've ever felt to the point that my mind races before bed sometimes. Sometimes it causing anxiety. At least before when we had our problems and I initially moved out, I was with family, so I wasn't technically "alone." It'll pass in time, as I've only been at my new apartment a week and a half, but it is definitely hitting me hard in this move in period. Fortunately I have this goofball to keep me company.

Oddly enough, I never really talk about any of these things so apologies if its all over the place. To go back to how out of control I think it can be, I think in my case, the actual addictions that have been detrimental to my health, I think I was completely out of control. It took an outside force to make those changes. Coffee, even if it's the thing I'm most addicted to at this point, I feel like I can quit it with enough effort, but like mentioned, I never really felt like I had to.

 

[HenrySwanson]

Further to the posts in the America thread, is an addiction a personal choice if it is a disease?

https://en.wikipedia.org/wiki/Disease_theory_of_alcoholism
https://www.aa.org/pages/en_US/is-aa-for-you

Yes I'm linking to wiki but it's a good overview.

 

[Danoff]

Further to the posts in the America thread, is an addiction a personal choice if it is a disease?

https://en.wikipedia.org/wiki/Disease_theory_of_alcoholism
https://www.aa.org/pages/en_US/is-aa-for-you

Yes I'm linking to wiki but it's a good overview.

Good question.

I personally don't buy it as a disease. I think that people can be predisposed to certain kinds of addiction based on genetics, but I don't consider that a genetic disease. For example, we're all predisposed to basically all of these addictions based on genetics. I don't count a shift in thinking as a disease either, that's a psychological effect.

 

[TexRex]

I personally don't buy it as a disease. I think that people can be predisposed to certain kinds of addiction based on genetics, but I don't consider that a genetic disease. For example, we're all predisposed to basically all of these addictions based on genetics. I don't count a shift in thinking as a disease either, that's a psychological effect.

I don't consider it a disease per se, but to continue with the analogy, what of those who through experience--akin to exposure to pathogens--may have more difficulty fending off addiction than those who lacked those experiences? Even without actively looking to self-medicate, those who have suffered physical and/or emotional abuses--and/or those who have experienced significant loss without an inherent ability to cope with it or assistance with coping with it--may well lack the strength of will to take a step back when confronted with what's likely to become a full-blown addiction.

Edit: That's a big chunk of text and I'm tired, so I sure hope I made some sense.

 

[kikie]

That proofs it. I have very strong willpower, something I always thought I had. If food is one of or the most difficult addiction to beat, then I will be able to beat everything.

Early 2000, I decided to stop eating refined white sugar and chocolate. I successfully stopped eating these two products from the first day I decided to stop eating these foods. I'm talking about adding this stuff to my food (sugar, not the chocolat).

I'm not addicted to any foods anymore and when I eat 100% raw cacao paste or powder I can easily stop eating it, even though my body says, eat it, get, buy it.

This is maybe the reason why I was able to easily quite my dependence on Lorazepam (6mg a day) in 2017. Even though the withdrawal was hell.

It is maybe thanks to this magnificent willpower that I have beaten 6 very severe clinical depressions as well.

 

[imported_rik19]

This is the biggest addiction I have ever seen.....Yes the internet is good, im looking at it now on my comp, I dont have or want a phone....

You dont need to walk down the street, or go to shops, drive a car, inter netting , Ive never seen any addiction like it...Imagine thinking you cannot leave the house with out taking a phone with you, so you can have the internet with you.....

 

[Famine]

Imagine thinking you cannot leave the house with out taking a phone with you, so you can have the internet with you...

It's a box with the sum of all human knowledge, myriad consumer resources, all the people you've ever known and cared about, a dynamic map, and endless hours of entertainment. There's almost nothing you can't know with a smartphone and a data/wifi connection.

I'm more amazed that people don't look at their phones...

​

 

[imported_rik19]

These pictures sum it up to me, some guy made these, so perfect..

 

[PocketZeven]

I have gambled, smoked, drank alcohol, used various drugs, play videogames and have concluded I am not prone to addiction.
My theory is that some people are prone to it no matter what kind of addiction. I have seen people going from addiction to addiction. They however succesfully kicked one addiction only to fall into another addiction. The key however is that its better to be addicted to something that isnt harmfull to yourself and others.

 

[Famine]

These pictures sum it up to me, some guy made these, so perfect..

They're literally the wrong way round. The entire universe comes out of the phones.

As for the people taking selfies with things like the Mona Lisa in the background... never seen people's holiday photo albums from back in the day of 36-photo rolls of 35mm film? We now have the technology to very easily take, preview and sort digital photographs of our experiences... with us in them, making them very clearly our memories. You know who doesn't appear in all the photo albums (expensively photographed and developed, with very many ruined and rejected pictures) from family holidays from the earliest days of photography right up to the smartphone era? The photographer - and that's usually the same person. Now they do.

 

[Danoff]

They're literally the wrong way round. The entire universe comes out of the phones.

As for the people taking selfies with things like the Mona Lisa in the background... never seen people's holiday photo albums from back in the day of 36-photo rolls of 35mm film? We now have the technology to very easily take, preview and sort digital photographs of our experiences... with us in them, making them very clearly our memories. You know who doesn't appear in all the photo albums (expensively photographed and developed, with very many ruined and rejected pictures) from family holidays from the earliest days of photography right up to the smartphone era? The photographer - and that's usually the same person. Now they do.

...and that's a shame, because we can still see the Mona Lisa, but we can't see our young great grandmother standing in front of it.

 

[HenrySwanson]

They're literally the wrong way round. The entire universe comes out of the phones.

As for the people taking selfies with things like the Mona Lisa in the background... never seen people's holiday photo albums from back in the day of 36-photo rolls of 35mm film? We now have the technology to very easily take, preview and sort digital photographs of our experiences... with us in them, making them very clearly our memories. You know who doesn't appear in all the photo albums (expensively photographed and developed, with very many ruined and rejected pictures) from family holidays from the earliest days of photography right up to the smartphone era? The photographer - and that's usually the same person. Now they do.

Good points, but does that mean @imported_rik19 is wrong in saying it's an addiction?

 

[Danoff]

Good points, but does that mean @imported_rik19 is wrong in saying it's an addiction?

I think there is a distinction between an addiction and a habit. Or an addiction than simply what you do. Addiction really implies a strong psychological or physiological response when you're deprived of that activity. So while I'm sure that there are many people who are addicted to using their phones, I'm not sure that it accounts for most of the people you see using them in public - which was the implication.

If we're judging whether people are addicted by what they do all day, well I'm addicted to working at my computer (also GTPlanet).

 

[Joey D]

I'm sure you can be addicted to your phone, but I think it'd be pretty hard to be. There are things on your phone that can be addictions though. A prime example is social media, but that's not the phone's fault. If you didn't have a mobile device, you'd just use a computer to satisfy your social media addiction.

I dont have or want a phone....

Wait you don't have a mobile phone? I'm not even sure how someone can get on in modern society without one now. Hell, even my 85-year-old grandma has a mobile phone.

I get not wanting to use a phone for social media, games, media, etc. but why anyone bothers with a landline is beyond me. Also, text messaging is one of the greatest things to happen to communication in modern times. I no longer need to call and disturb anyone for something simple. I can just send a quick message and they can get back to me when they have a moment.

There are also maps, which make life so much easier. I'm not sure if you remember the days before smartphones but you used to have to resort to printing off and attempting to read directions from MapQuest. Or even worse, attempting to navigate via a paper map found in your glovebox. Now you put in your destination and let the phone tell you where and when to turn. You keep your attention on the road instead of trying to read directions from a piece of paper.

 

[MatskiMonk]

I'll beat my alcohol addiction when life stops making me have it...

.. Which it won't ..

 

[Exorcet]

I don't really consider addiction to be an issue unless it causes a specific problem. Like @Eunos_Cosmo mentioned, if there's no reason to quit, why try? At the same time though, I try to avoid addictive substances, at least if they don't provide any benefits. I don't think there is anything that I'm addicted to, not even caffeine.

Wait you don't have a mobile phone? I'm not even sure how someone can get on in modern society without one now.

A bit off topic, but this is what actually made me want to post. I see the above said often with respect to many things, but I feel like it's a significant exaggeration. Mobile phones are undoubtedly useful, but I wouldn't consider them necessary.

There are also maps, which make life so much easier. I'm not sure if you remember the days before smartphones but you used to have to resort to printing off and attempting to read directions from MapQuest. Or even worse, attempting to navigate via a paper map found in your glovebox. Now you put in your destination and let the phone tell you where and when to turn. You keep your attention on the road instead of trying to read directions from a piece of paper.

Maps are one of the things that I consider a strong plus for smart phones, although it turns out that I don't use phone maps very often. My in car GPS gets more use as I feel like I'm more likely to get lost when going long distances rather than short, but even when using the GPS I research routes ahead of time on a map (usually on my computer) to look for landmarks, streets near my destination, and perhaps rest areas.

There are plenty of reasons to just use a phone instead, but the none phone options aren't that bad unless you start off in a place that you aren't familiar with and don't have any other means of finding a route.

Either way though I'm not convinced that there is a phone addition epidemic. Phones are popular because they're entertaining and useful.

 

[PocketZeven]

Addiction does come in different degrees. I know some people who use drugs (cocaine or marijuana) or drink almost daily who function very well and also still sociable. Would I say they are addicted? Yes. Does it have negative consequences on their surroundings? No. But I cant honestly say how it impacts their health though.

 

[TexRex]

Is daily drinking--in and of itself--alcoholism (or an addiction to alcohol, as it were)?

I used to drink very nearly daily--more than six days a week, I'd say. It occurred to me that my having a drink had become a bit of a foregone conclusion, where I'd get home, get comfortable and then fix myself a cocktail. There was absolutely no dependency*; I just did it without really thinking about it.

Now...I haven't quit by any stretch of the imagination, and there may be a week during which I have a drink of some sort (I'm talking any kind of alcoholic beverage) every single day, but I'm actively deciding whether I want one or not.

I don't consider either to be addiction.

 

[PocketZeven]

Is daily drinking--in and of itself--alcoholism (or an addiction to alcohol, as it were)?

I used to drink very nearly daily--more than six days a week, I'd say. It occurred to me that my having a drink had become a bit of a foregone conclusion, where I'd get home, get comfortable and then fix myself a cocktail. There was absolutely no dependency*; I just did it without really thinking about it.

Now...I haven't quit by any stretch of the imagination, and there may be a week during which I have a drink of some sort (I'm talking any kind of alcoholic beverage) every single day, but I'm actively deciding whether I want one or not.

I don't consider either to be addiction.

I dont think so. It is an addiction if you cant go without a drink a day or 2.

 

[MatskiMonk]

Is daily drinking--in and of itself--alcoholism (or an addiction to alcohol, as it were)?

I used to drink very nearly daily--more than six days a week, I'd say. It occurred to me that my having a drink had become a bit of a foregone conclusion, where I'd get home, get comfortable and then fix myself a cocktail. There was absolutely no dependency*; I just did it without really thinking about it.

Now...I haven't quit by any stretch of the imagination, and there may be a week during which I have a drink of some sort (I'm talking any kind of alcoholic beverage) every single day, but I'm actively deciding whether I want one or not.

I don't consider either to be addiction.

Our health service classes pretty much anything above 140ml of alcohol (14 units) a week as alcohol misuse, around 14 single shots of 40% ABV Liquor or 7 pints of weakish beer.... and again, that's a week.

Beyond that, whether it's classed as an addiction, or alcoholism etc. is fairly moot, the effects on the body don't really care what the word for it is.

I've accrued quite a bit of experience with alcoholism, enough for me to fully deserve dying because of it, and to me - there's no simple definition. If people want a label, then fine, but understanding the patterns, reasons, surrounding behaviour and demonstration of risk perception is far more beneficial than knowing whether it can be classed as an addiction, or if it should be called alcoholism.

I think if you use either of these terms, then there's a pre-conceived notion that goes with it... you lost your job, you beat your wife, you lost your drivers license, etc. etc... and I don't think any of those things automatically apply... it's why I feel like a total drama queen if I admit to being an alcoholic... in my case, none of those things are true... so it's almost like, until they are true, then I'm just hamming it up for attention... which is of course a great way of ignoring the problem.

 

[TexRex]

Our health service classes pretty much anything above 140ml of alcohol (14 units) a week as alcohol misuse, around 14 single shots of 40% ABV Liquor or 7 pints of weakish beer.... and again, that's a week.

Beyond that, whether it's classed as an addiction, or alcoholism etc. is fairly moot, the effects on the body don't really care what the word for it is.

I've accrued quite a bit of experience with alcoholism, enough for me to fully deserve dying because of it, and to me - there's no simple definition. If people want a label, then fine, but understanding the patterns, reasons, surrounding behaviour and demonstration of risk perception is far more beneficial than knowing whether it can be classed as an addiction, or if it should be called alcoholism.

I think if you use either of these terms, then there's a pre-conceived notion that goes with it... you lost your job, you beat your wife, you lost your drivers license, etc. etc... and I don't think any of those things automatically apply... it's why I feel like a total drama queen if I admit to being an alcoholic... in my case, none of those things are true... so it's almost like, until they are true, then I'm just hamming it up for attention... which is of course a great way of ignoring the problem.

"Alcohol misuse" is a peculiar term; is it really misuse if you're ingesting it? It reminds me of "death by misadventure".

Jokes aside, I'm well aware of the physiological toll alcohol consumption takes and that, as far as the body is concerned, alcohol is alcohol.

I'm also, sadly, plenty aware of the toll that abuse can take on someone's life and the lives of those around them. I'm 47 and have had an active social life for the vast majority of that time, and so I've had friends who have confronted their own substance abuse. I know people who have, for all intents and purposes, "won" their fight, but I've also known those who have lost it...either losing their life as it once was or just plain losing their life.

I consider dependence more than volume, though, and for what it's worth, the post of mine that you quoted was in part intended to highlight ambiguity in the terminology.

 

[Dennisch]

I'll put this here.

So big pharma that is responsible for a lot of addicts are scottfree?

Pretty sure most people aren't forced to take pills or powder. Perhaps doctors are a bit too quick with handing out the pills, but still, you can say no, or stop after the recommended time of treatment.

Once you decide you need heroin, you're at the bottom. It is that simple. How you get there is pretty much always the result of your own decisions.

 

[TexRex]

Perhaps doctors are a bit too quick with handing out the pills, but still, you can say no, or stop after the recommended time of treatment.

I mean...

Purdue Pharma L.P. is a privately held pharmaceutical company owned principally by descendants of Mortimer and Raymond Sackler. In 2007 it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges. Although the company has shifted its focus to abuse-deterrent formulations, Purdue continues to market and sell opioids, and continues to be involved in lawsuits around the opioid crisis.

...

In May 2007, the company pleaded guilty to misleading the public about Oxycontin's risk of addiction and agreed to pay US$600 million in one of the largest pharmaceutical settlements in U.S. history. The company's president (Michael Friedman), top lawyer (Howard R. Udell) and former chief medical officer (Paul D. Goldenheim) pleaded guilty as individuals to misbranding charges, a criminal violation, and agreed to pay a total of US$34.5 million in fines.

...

In May 2018, six states — Florida, Nevada, North Carolina, North Dakota, Tennessee and Texas — filed lawsuits charging deceptive marketing practices, adding to 16 previously filed lawsuits by other U.S. states and Puerto Rico. By January 2019, 36 states were suing Purdue Pharma. Massachusetts attorney general Maura Healey complains in her lawsuit that eight members of the Sackler family are "personally responsible" for the deception. She alleges they "micromanaged" a "deceptive sales campaign."

In March 2019, Purdue Pharma reached a $270m settlement in a lawsuit, filed by Oklahoma, which claimed its opioids contributed to the deaths of thousands of people.

And then there's this:

In January 2017, the city of Everett, Washington sued Purdue based on increased costs for the city from the use of oxycontin as well as Purdue not intervening when they noted odd patterns of sale of their product, per agreement in the 2007 suit noted above. The allegations include not following legal agreements to track suspicious excess ordering or potential black market usage. False clinics created by unscrupulous doctors using homeless individuals as 'patients' to purchase oxycontin, then sell to the citizens of Everett was the factual basis of the suit. The blackmarket sale of the drug out of legal pharmacies based in Los Angeles with distributions points in Everett is also part of the experience of the city. No intervention was made by Purdue to contact the DEA for years despite knowing of the practice and the overuse and sale of their product. The suit is asking for a yet to be determined reimbursement related to costs of policing, housing, health care, rehabilitation, criminal justice system, park and recreations department, as well as to the loss of life or compromised quality of life of the citizens of the city directly.

How culpable is a public when a company engages in unscrupulous tactics cited in these lawsuits? If a drug is marketed as something that it isn't, are people responsible for taking something they had no reason to believe was something else? Yeah, you should seek a second opinion, but when pharmaceutical companies target multiple doctors to peddle their wares, are you supposed to keep asking until you find a doctor they didn't get to and who advises against taking that drug?

 

[Dennisch]

Now see, that is an informative post.

I knew about shady business going on with payments towards prescription writing happy doctors, but that one is a new one for me.

 

[TexRex]

Now see, that is an informative post.

I knew about shady business going on with payments towards prescription writing happy doctors, but that one is a new one for me.

Of course there absolutely is a degree of culpability on the part of the public, and as such I inquired about the degree rather than asking whether there is or not.

There are doctors who set aside any oaths they took (or even concern for their patients) in favor of grabbing more cash, [presumably] frequently from a public seeking certain drugs, in addition to what's represented above.

 

[Dennisch]

There are doctors who set aside any oaths they took (or even concern for their patients) in favor of grabbing more cash, [presumably] frequently from a public seeking certain drugs, in addition to what's represented above.

Dr. Nathan Kuemmerle, or Doc Hollywood was quite the dealer.

 

[PocketZeven]

Now see, that is an informative post.

I knew about shady business going on with payments towards prescription writing happy doctors, but that one is a new one for me.

A humorous take on the crisis. Warning for offensive language to external link.

 

[HenrySwanson]

Is daily drinking--in and of itself--alcoholism (or an addiction to alcohol, as it were)?

I used to drink very nearly daily--more than six days a week, I'd say. It occurred to me that my having a drink had become a bit of a foregone conclusion, where I'd get home, get comfortable and then fix myself a cocktail. There was absolutely no dependency*; I just did it without really thinking about it.

Now...I haven't quit by any stretch of the imagination, and there may be a week during which I have a drink of some sort (I'm talking any kind of alcoholic beverage) every single day, but I'm actively deciding whether I want one or not.

I don't consider either to be addiction.

Good way of screening is the AUDIT questionnaire:

https://patient.info/doctor/alcohol-use-disorders-identification-test-audit