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If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if an alcohol use disorder is present. For an online assessment of your drinking pattern, go to RethinkingDrinking.niaaa.nih.gov .

When asked how alcohol problems are treated, people commonly think of 12-step programs or 28-day inpatient rehab, but may have difficulty naming other options. In fact, there are a variety of treatment methods currently available, thanks to significant advances in the field over the past 60 years.

Ultimately, there is no one-size-fits-all solution, and what may work for one person may not be a good fit for someone else. Simply understanding the different options can be an important first step.

Behavioral treatments are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.

Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent relapse. They are prescribed by a primary care physician or other health professional and may be used alone or in combination with counseling.

Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support.

Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.

For anyone thinking about treatment, talking to a primary care physician is an important first step — he or she can be a good source for treatment referrals and medications. A primary care physician can also:

Types of Professionals Involved in Care

Many health professionals can play a role in treatment. Below is a list of providers and the type of care they may offer.

Individuals are advised to talk to their doctors about the best form of primary treatment.

Some are surprised to learn that there are medications on the market approved to treat alcohol dependence. The newer types of these medications work by offsetting changes in the brain caused by alcoholism.

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Thursday, December 21, 2017

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Teacher – "Who can tell me what the former ruler of Russia was called?"Class (in unison) – "Tsar."Teacher – "Correct; and what was his wife called?"Class – "Tsarina."Teacher - "What were the tsar's children called?" There was a pause, and then a timid voice in the rear piped up: "Tsardines!"

Took me a while to see the theme, then all was easy.

Morgan, I loved " I would say I solve the puzzle about 40% slower than Rex and I judge it about 30% less cantankerously" and the rest of your writeup as well. Nicely done!!

What day is it? Oh right, December 21, the Winter Solstice. Now it all makes sense: goalpost, tuning fork, slingshot . . . The, uh, letter Y . . .

Back-to-back days where the grid art is the puzzle’s main feature. This one, though, at least has a smattering of nice fill to go along with it. LUNAR YEAR, PALAU, GALILEI, KNOLL. I have recently noted a shocking and seemingly inexorable decline in the quality of our definitions for PIE. I’m assuming this is a Will Shortz thing, as I can’t imagine multiple constructors all suddenly losing the ability to give a decent clue for something that should be a piece of cake to clue. I get that it must be hard to come up with new clues for common words, but this is trying too hard.MII was a complete WoE, but better than “early second millennial year”, I suppose.

WHATEVS? WHATEVS?! The best answer in the puzzle?! How old are you - - 15?No wonder I'm having so much more fun since I canceled my NYT subscription and replaced it with the Wall Street Journal...

Ivanka in.Franken out.Tax reform passed.Dow up 30%.Michael's TSD raging full on.Merry Christmas. Winning never gets old.

Well, I liked it overall. It did give me some bite, and I always like that. I loved the clue for STAG, and didn't think it needed a question mark. I also like the clue for EUREKA, and the INTO/ONTO cross. I almost dropped in "dowsing rod" early on, seeing that it fit. And my brain got a nice little workout, given that I didn't know ELLIE, SWANN, ETTA, or MII.I think something Rex would have jumped all over, and something that actually bothered easy-on-puzzles me, was that GOALPOSTS was plural, while the other three theme answers were singular. I hesitated to put GOALPOSTS in, actually, thinking it must be something else. I think the theme answers should have been consistent.First thing I saw, by the way, when I looked at the grid, was a goofy smiley face.

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The losses in human welfare can be assessed in monetary terms based on economic valuation studies that estimate the effect on citizens’ benefits from changes in the quality of the marine environment. It is important to acknowledge the related uncertainties when using such value estimates. For example, a citizen’s perceptions of changes in the quality of the marine environment can be unclear, nevertheless, the value estimates can be used as a proxy for the cost of degradation. When estimating, the focus can be either on degradation themes, such as eutrophication, or ecosystem services, such as recreation.

Various methodological approaches and assessment results are available for estimating losses in human welfare. When no such data are available for a certain country or region, value transfer is an example of how to relate existing individual evaluation to entire marine region. Results from currently available analyses are presented in this chapter for recreation (Box 3.4), eutrophication ( chapter 4, section 4.1 Eutrophication , Box 4.1.2 at the bottom of the page) selected biodiversity aspects ( chapter 5, section 5.6 Biodiversity summary and food web aspects , Box 5.6.1 at the bottom of the page; see also HELCOM 2018A).

Figure B3.2.1. Illustration of the cost of degradation concept. Cost of degradation results from the difference between the current/baseline environmental status and the good environmental status.

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Box 3.1: Use of marine waters: Economic benefits from the use of the sea

Economic and social analysis of the use of marine waters examines the economic contribution to regional and national economies from using marine waters in their current state. This contribution is measured with economic and social indicators. These indicators describe the importance of the marine activities to the economy, for example by estimating ‘value added’ or ‘employment’, or the direct economic value from the use of the marine environment to the citizens’ living in the coastal countries. In this report, the information is derived mainly from existing statistics, except for marine and coastal recreation, where statistics are complemented with data on economic value to citizens.

The indicators do not capture the negative economic impacts that marine uses may have on the quality of the marine environment and thus potentially on other uses of the marine environment, but are a piece of the overall picture of how society and the marine environment are linked.

Further improving our understanding of the economic contribution from marine activities will require harmonised data across all coastal countries, reporting data separately for different sea areas (Baltic and North Seas), and differentiating between land activities, freshwater activities and marine activities, particularly for tourism.

Box 2.1. The core indicator based assessment

This assessment uses core indicators to measure the status of the Baltic Sea marine environment on the basis of selected and representative elements. The HELCOM core indicators cover both biodiversity and human induced pressures and impacts on the Baltic Sea ecosystem. The core indicators were selected according to a set of principles including ecological and policy relevance, measurability with the monitoring data and linkage to anthropogenic pressures (HELCOM 2013c). The HELCOM core indicators evaluate the observed status in relation to a regionally agreed threshold value, in many cases using data from regionally coordinated monitoring. Hence, the results indicate whether status is good or not according to each of the core indicators.

Furthermore, integrated assessments of biodiversity, eutrophication and hazardous substances, are made based on the core indicators using the BEAT, HEAT and CHASE assessment tools. The integrated tools were also used in the initial holistic assessment (HELCOM 2010a) and have been developed further in the second holistic assessment. The integrated assessments do not only show whether status is good or not, but also indicate the distance to good status by use of five categories; two representing good status and three representing not good status.

The assessments are performed at the spatial scale of HELCOM assessment units, which have four different levels; each core indicator being assessed at its most relevant scale. For example, birds are assessed at level 1 which is the whole region, salmon and sea trout, as well as zooplankton are assessed at level 2 which further subdivides the Baltic Sea into sub-basins. Level 3 separates the sub-basins also into coastal and offshore areas, and level 4 uses a finer subdivision of coastal areas, in line with national management practices such as water bodies as designated under the EU Water Framework Directive.

The assessment is based on currently available core indicators. For some elements, operational indicators are still lacking or limited such as for benthic and pelagic habitats, health of marine mammals and food webs. The further development of core indicators to reach a more complete assessment is a prioritised HELCOM activity.

Box 8.1 Achievements of the assessment
Box 1.3. Baltic Sea main policies driving the assessment

The Baltic Sea Action Plan and the Marine Strategy Framework Directive have similar goals and objectives, and thus, progress towards achieving the same regional aim, which can be assessed using the same indicators and tools. The ‘State of the Baltic Sea’ report covers the topics addressed by the four segments of the Baltic Sea Action Plan and its follow-up leather sandals Blue Mara Mac zpTbW
, as well as the descriptors of the Patent Leather Pumps amp; High Heels for Women On Sale Black Patent Leather 2017 7 85 Miu Miu Pumps & High Heels for Women On Sale 7 8.5 Miu Miu Black JGUTNA08QR
. The assessment is organised according to Pressures on the environment (Chapter 4) and the status of Biodiversity and food webs (Chapter 5) . The indicators used in the respective sub-chapters are listed in Table B.1.3.1 and Table B.1.3.2.

Marine litter and underwater sound are new components of the Baltic Sea Action Plan, taken up by HELCOM in the Ministerial Declarations (Moscow, 2010 and Copenhagen, 2013). The EU Marine Strategy Framework descriptor related to the removal of commercial fish and shellfish can be associated with the provisions of 2013 HELCOM Declaration on ecosystem-based fisheries, while hydrological conditions cannot be directly assigned to any segment of the Baltic Sea Action Plan. Maritime activities, which is a focal area of HELCOM and one of the four BSAP segments, is linked to several of the descriptors, including eutrophication, contaminants, and non-indigenous species.

Table B.1.3.1. Indicators used in Chapter 4 of this report (‘Pressures’), and their relation to the segments of the Baltic Sea Action Plan (BSAP) and the descriptors of the Marine Strategy Framework Directive (MSFD). *Denotes that the indicator or threshold values have not been fully adopted in HELCOM yet and are currently tested. Indicators in italics are under development in HELCOM and at this time are only included descriptively in the report. The indicators are presented by the segments of the Baltic Sea Action Plan: Eutrophication (green), Hazardous substances (orange) and Maritime activities (blue), and the follow-up declarations (yellow). All indicators on eutrophication and hazardous substances are also relevant for the maritime segment of the Baltic Sea Action Plan.

Table B.1.3.2 Indicators used in Chapter 5 of this report (‘Biodiversity’), relating to the biodiversity segment of the Baltic Sea Action Plan (BSAP) and descriptor 1 of the Marine Strategy Framework Directive (MSFD). *Denotes that the indicator or threshold values have not been fully adopted in HELCOM yet and are currently being tested. Indicators in italics are under development in HELCOM and at this time are only included descriptively in the report.

Box 1.2 Cumulative effects on species

One person or activity alone does not exert much pressure on the environment, but when scaled up the impact of many humans and their activities may have a considerable impact on marine species, and the different impacts act together on the environment. Additionally, single or cumulative impacts might trigger changes in the food web, with potential cascading effects further up or down in the food web.

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