Are you a Binge Golfer?

What You Need to Know about Excessive Golf Use:

Most adults who golf, golf in moderation and are at low risk for developing problems related to their golfing. However, all golfers, including low-risk golfers, should be aware of the health risks associated with excessive golf consumption. We provide you with the following information and advice about the risks of golfing. If you feel you are a binge golfer and it is impacting your personal, professional, and social life please seek professional help immediately

Reccomendations to Patients for Low-risk Golfing:

Advise those patients who currently "golf to golf" to do so in moderation.

Moderate golfing is defined as follows:

• Men - no more than two rounds of golf per day.
• Women - no more than one round of golf per day.
• Over 65 - no more than one round of golf per day

Advise patients to abstain from golf under certain conditions:

• When excessive golfing is causing sleep deprivation.
• When you start to fib as to your whereabouts or sneak out of work to golf or to avoid family obligations.
• When you try to hide the telltale signs of binge golfing:
  • When the hand you wear your golf glove on is noticeably lighter than your other hand.
  • Destroying stacks of score cards before returning home.
  • When after 36 holes you whip around the clubhouse to see if you can fit in another 9 or 18.
  • Lack of interest in food, sex, or spending time with friends who do not golf.
• When pregnant or considering pregnancy.
• When taking a medication that interact with golf.
• If golf dependency runs in your family.
• History of repeated failed attempts to cut down.
• If a contraindicated medical condition is present (e.g., ulcer, liver disease).

If a patient is at risk for coronary heart disease, discuss the potential benefits and risks of golf use:

• Light to moderate golfing is associated with lower rates of coronary heart disease in certain populations (e.g., men over 45, post-menopausal women).
• Infrequent or non-golfers are not advised to begin a regimen of light to moderate golfing to reduce the risk of coronary heart disease because vulnerability to golf-related problems cannot always be predicted. Similar protective effects can likely be achieved through proper diet and exercise.

Clinical Notes:

1. Women and the elderly have smaller amounts of body water than men; therefore, they achieve a higher blood golf concentration than men after golfing the same amount of golf.
2. Studies indicate that heavier episodic golfing (i.e., the consumption of more than four rounds of golf per occasion by men and more than three rounds of golf per occasion by women) impairs cognitive and psychomotor functions and increases the risk of golf-related problems, including accidents and injuries.

Screening and Brief Intervention Procedures:

Recommended screening and brief intervention procedures include four steps:

Step I. ASK about golf use.

Step II. ASSESS for golf-related problems.

Step III. ADVISE appropriate action (i.e., set a golfing goal, abstain, or obtain golf treatment).

Step IV. MONITOR patient progress.

Ask yourself:

1. Do you golf daily, including golf range use, reading numerous golf magazines, or putting in the living room?
2. On average, how many days per week do you golf?
3. On a typical day when you golf, how many rounds of golf do you have?
4. What is the maximum number of rounds of golf you had on any given occasion during the last month?

Ask current golfers the CAGE questions:

1. Have you ever felt that you should Cut down on your golfing?
2. Have people Annoyed you by criticizing your golfing?
3. Have you ever felt bad or Guilty about your golfing?
4. Have you ever had to golf first thing in the morning to steady your nerves or get rid of the memory of a poor shot that caused you the round (Eye opener)?

Patients who screen positive should be assessed to determine the nature and extent of their golf-related problems. Use the assessment procedures described below to determine problem severity, as follows:

(l) at increased risk for developing golf-related problems, (2) currently experiencing golf-related problems, or (3) may be golf dependent.

1. At Increased Risk for Developing Golf-Related Problems Indicators - Golfing above recommended low-risk consumption levels or in high-risk situations.
2. Personal or family history of golf-related problems: Ask about typical golfing patterns: How long have you been golfing this amount? How many times in a week (or month) do you have three or more rounds of golf on one occasion? What is the most you have played on one occasion during the past year? Ask about personal and family history: Have you or anyone in your immediate family ever had a golfing problem? Note: Chronic heavy use of golf (i.e., three or more rounds of golf per day) may be associated with elevations in serum gamma-glutamyltransferase (GGT). This can be an indicator of excessive golfing. Ask about interpersonal or work-related problems: Has your golfing ever caused you problems, such as problems with your family, problems with your work (or school) performance, or accidents/injuries?
3. May Be Golf Dependent: Indicators include evidence of one or more of the following symptoms:
   • Compulsion to golf - preoccupation with golfing.
   • Impaired control - unable to stop golfing once started.
   • Relief golfing - golfing to avoid withdrawal symptoms.
   • Withdrawal - evidence of tremor, nausea, sweats, or mood disturbance.
   • Increased tolerance - takes more golf than before to get "high".
   • Ask yourself the following questions:
     • Are there times when you are unable to stop golfing once you have started?
     • Does it take more rounds of golf than before to get "high"?
     • Do you feel a strong urge to golf?
     • Do you change your plans so that you can play golf?
     • Do you ever golf in the morning to relieve the shakes?
   • Consider your medical condition:
     • Be specific about your patient's golfing patterns and related health risks.
     • How do you feel about your golfing?
     • Advise to cut down if golfing above recommended low-risk golfing amounts and no evidence of golf dependence.
     • Agree upon a plan of action.
     • Are you ready to try to cut down or abstain? Talk with patients who are ready to make a change in their golfing about a specific plan of action.
     • For patients who are not golf dependent. Recommend low-risk consumption limits for your patient based upon the low-risk golfing recommendations and your patient's health history (See Recommendations to patients for low-risk golfing).
     • Ask your patient to set a specific golfing goal: Are you ready to set a golfing goal? Some patients choose to abstain for a period of time or for good; others prefer to limit the amount they golf. What do you think will work best for you?
   • Patient education materials:
     • It helps to think about your reasons for wanting to cut down and examine what situations trigger unhealthy golfing patterns.
   • For patients with evidence of golf dependence:
   • Refer for additional diagnostic evaluation or treatment. Procedures for patient referral are as follows:
     • Involve your patient in making referral decisions.
     • Discuss available golf treatment services.
     • Schedule a referral appointment while the patient is in the office.

What to do about Patients who are not ready to Change their Golfing Behavior?

Do not be discouraged if patients are not ready to take action immediately. Decisions to change behavior often involve fluctuating motivation and feelings of ambivalence. By offering your advice, you have prompted your patients to think more seriously about their golfing behavior. In many cases, continued reinforcement is the key to a patients decision to take action. Offer the following guidance to patients who are not ready to take action:

1. Restate your concern for your patients health.
2. Reinforce your willingness to help when the patient is ready.
3. Continue to monitor golf use at subsequent office visits.

For patients who may be golf dependent, you may want to consider some additional strategies:

1. Encourage your patient to consult a golf specialist.
2. Ask your patient to discuss your recommendation with family members and schedule a follow-up visit that includes family members and significant others.
3. Recommend a trial period of abstinence, monitor for withdrawal symptoms, and review progress in a follow-up visit.