Underwriting the Habits Risk of Alcohol Use Gregory Ferrara New York Life Underwriting January, 2013

Transcription

1 Underwriting the Habits Risk of Alcohol Use Gregory Ferrara New York Life Underwriting January, 2013 The Company You Keep 1

2 Antitrust 2 New York Life adheres to the letter and spirit of the antitrust laws. The information in this lecture is intended to advance the knowledge and improve the risk assessment skills of the participants. Under no circumstances shall this lecture be used as a forum for the pricing of specific products, determining how they are marketed, or for any other anticompetitive purpose. Copyright 2010 New York Life Insurance Company. All rights reserved.

3 Agenda 3 The Basics Definitions Case Study The Vague Reference Binge Drinking Alcoholics Anonymous/Self Help Studies Miscellaneous Research Recap Questions

4 The Basics 4 Why is this important? CDC Website from 2001 ~ 2005 there were approximately 80,000 deaths attributed to excessive ETOH use annually in the US. ETOH is the 3 rd leading lifestyle-related cause of death for the nation in 2000 can you guess what the # 1 and #2 lifestyle related cause of deaths were? In the NIAAA 2005 Guide to Clinicians All heavy drinkers have a greater risk of hypertension, gastrointestinal bleeding, sleep disorders, major depression, hemorrhagic stroke, cirrhosis of the liver and several cancers.

5 The Basics 5 In 2007, a national survey estimated that 15% of the US workforce (19,000,000 workers) consumed enough alcohol to lead to workplace impairment!

6 Case Study The Vague Reference 6 Have you seen this on an APS Advised to cut down on drinking Drinks too much Alcohol Abuse Heavy Drinker No further mention No follow up No referral No details Number of drinks not given How it s affecting the client

7 The Vague Reference cont. 7 The NIAAA website indicates that in the 1990 Institute of Medicine s report physicians are recommended to screen for the full spectrum of problems that can accompany ETOH use. On the CDC website How do I know if I have a drinking problem?...if it causes trouble in your relationships, in school, in social activities, or in how you think and feel.

8 The Vague Reference cont. 8 Screening Methods In a 1998 study in the Journal of Family Practice that a positive response to 1 screening question has an 82% accuracy rate for identifying patients who meet the criteria for at-risk drinking or ETOH abuse/dependence On any single occasion during the past 3 months, have you had more than 5 drinks containing ETOH?

9 The Vague Reference cont. 9 CAGE Questionnaire (proven effective) C Have you ever felt you should cut down on your drinking? A Have people annoyed you by criticizing your drinking? G Have you ever felt bad or guilty about your drinking? E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? 2 positive responses are considered a positive test and indicate further assessment is warranted. Michigan Alcohol Screening Test (MAST) 25 questions useful to identify ETOH dependence Alcohol Use Disorders Identification Test (AUDIT) 10 questions useful to identify problems with ETOH, not dependency

10 Biochemical Markers 10 Interviews and questionnaires have greater sensitivity and specificity than blood tests for biochemical markers. GGTP chronic drinking of 4 or more drinks per day for 4 to 8 weeks raises levels. 4 to 5 weeks of abstinence are required for return to normal levels. CDT elevated earlier in response to prolonged excessive drinking (lower sensitivity in women and adolescents) MCV red blood cell size increases with excessive ETOH after 4 to 8 weeks. AST/ALT for very heavy drinkers of value.

11 Definitions 11 What is a Drink? 14 grams/.6ounces of pure alcohol 1 twelve ounce beer 8 ounces of malt liquor 5 ounces of wine 1.5 ounces of 80 proof liquor

12 Definitions cont. 12 Low-Risk Drinking No more than 14 standard drinks per week for men, 7 standard drinks per week for women Heavy Drinking Typically consuming an average of more than 2 drinks per day for men, more than 1 drink per day for women ETOH Abuse Pattern of drinking that results in harm to one s health, interpersonal relationships, or ability to work

13 Definitions cont. 13 ETOH Dependence (alcohol addiction/alcoholism) A chronic disease with symptoms such as craving, loss of control, physical dependence, tolerance (NIAAA website) Binge Drinking Pattern of ETOH consumption that brings the blood alcohol concentration (BAC) level to 0.08 or more. Usually 5 or more drinks on a single occasion for men, 4 or more for women generally within a 2 hour period (NIAAA website).

14 What to Look For 14 Concrete Information Number of Drinks Non-Specific Factors Any Conditions associated with increased risk for substance abuse? Depression, anxiety,add,adhd Health problems that might be ETOH related? Accidents, injuries, STDs, abnormal eating or sleeping pattern, gastrointestinal disturbances, chronic pain Substantial Behavioral Changes Significant mood changes, loss of interest in activities, marital, social, economic concerns Chronic Illnesses that aren t responding to medication as expected Chronic pain, depression, diabetes, CAD, GERD

15 Binge Drinking 15 1 in 6 adults binge drink about 4 times a month (8 drinks per sitting) More than ½ of the ETOH consumed by adults is in the form of binge drinking There are approximately 1.5 billion episodes of binge drinking (ages 18 and older) annually in the US In 2008, more than ½ of the adult US population drank ETOH in the past 30 days. Approximately 5% drank heavily. 17% of the population binge drank (Behavioral Risk Factor Surveillance System Survey) More than 90% of adult binge drinkers are not alcohol dependent

16 Alcoholics Anonymous/Self Help Groups 16 In the NIAAA 10/2000 Alcohol Alert Bulletin more than 700,000 Americans receive alcoholism treatment on any given day. AA appears to produce positive outcomes in many of its members, its efficacy has rarely been assessed in randomized clinical trials. AA in combination with professional treatment showed better results regarding abstinence than any other modality. Positives with AA Replacement of prior social network for a group who can motivate and support Development of coping skills Acknowledgement of a problem

17 Alcoholics Anonymous/Self Help Group 17 Many people do not use treatment services until they are forced to. They tend to have the most serious problems such as co-morbid health, mental health, and psychosocial concerns 2009 Study of AA Effectiveness in the National Institute of Health website showed: The abstinent percentage after 18 months of treatment to be 2 times higher with AA than without. The higher the frequency and duration of attending the meetings, the higher the abstinence rate Combination of AA with outpatient services showed a higher percentage of abstinence 8 years out than without.

18 Miscellaneous Research 18 NIAAA 2007 Study people who are dependent on ETOH are 3 times more likely than the general population to be smokers. People who are dependent on tobacco are 4 times more likely to be dependent on ETOH than the general population Evidence indicates that involvement of a nonalcoholic spouse in a treatment program can improve patient participation rates and increase the likelihood that the patient will alter their drinking behavior

19 Recap 19 Look at the whole picture Behavioral Changes Health Problems that are ETOH Related Conditions associated with increased risk for substance abuse Smoking Cardiac/Hepatic/Pancreatic conditions Social Concerns Neurologic Concerns Patterns? Number of Drinks/Frequency Given?

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