Alcoholism Health Article

Signs and tests

Those at risk for developing alcoholism include:

• Men who have 15 or more drinks a week
• Women who have 12 or more drinks a week
• Anyone who has 5 or more drinks per occasion at least once a week

(One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.)

All doctors should ask their patients about their drinking. The health care provider can get a history from the family if the affected person is unwilling or unable to answer questions. A physical examination is done to identify physical problems related to alcohol use.

The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:

• Do you ever drive when you have been drinking?
• Do you have to drink more than before to get drunk or feel the desired effect?
• Have you felt that you should cut down on your drinking?
• Have you ever had any blackouts after drinking?
• Have you ever missed work or lost a job because of drinking?
• Is someone in your family worried about your drinking?

Tests for alcohol abuse include:

• A toxicology screen or blood alcohol level (this can tell whether someone has recently been drinking alcohol, but it does not necessarily confirm alcoholism)
• Complete blood count (CBC)
• Folate tests
• Liver function tests
• Serum magnesium
• Total protein
• Uric acid

Treatment

Those who are dependent need to stop drinking alcohol (abstinence). Those who are problem drinkers may be successful with moderation. Because many people refuse to believe that their drinking is out of control, trying moderation can often be an effective way to deal with the problem. If it succeeds, the problem is solved. If not, the person is usually ready to try abstinence.

Three general steps are involved in treatment once the disorder has been diagnosed:

• Intervention
• Detoxification
• Rehabilitation

INTERVENTION

Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be confronted about their drinking problems, but now research has shown that compassion and empathy are more effective.

The ideal approach is to help people realize the negative impact alcohol abuse is having on their life, and on the lives of those around them. They can aim for a personal goal of leading a more fulfilling and sober life.

Studies find that more people enter treatment if their family members or employers are honest with them about their concerns, and try to help them see that drinking is preventing them from reaching their goals.

DETOXIFICATION

Withdrawal from alcohol is done in a controlled, supervised setting in which medications relieve symptoms. Detoxification usually takes 4 to 7 days.

Examination for other medical problems is necessary. For example, liver and blood clotting problems are common.

Eating a balanced diet with vitamin supplements is important. Complications can occur with alcohol withdrawal, such as delirium tremens (DT's), which could be fatal. Depression or other mood disorders should be evaluated and treated. Often, alcohol abuse develops from efforts to self-treat an illness.

REHABILITATION

After detoxification, alcohol recovery or rehabilitation programs can help people stay off alcohol. These programs usually offer counseling, psychological support, nursing, and medical care. Therapy involves education about alcoholism and its effects.

Many of the staff members at rehabilitation centers are recovering alcoholics who serve as role models. Programs can be inpatient, where patients live in the facility during the treatment. Or they can be outpatient, where patients attend the program while they live at home.

Medications are sometimes prescribed to prevent relapses.

• Acamprosate is a new drug that has been shown to lower relapse rates in those who are alcohol dependent.
• Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
• Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injected form.

You cannot take these medications if you are pregnant or have certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.