Alcoholism Health Article

Symptoms

Men who consume 15 or more drinks a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or more drinks per occasion at least once a week are all at risk for developing alcoholism. (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).

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

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

Some of the symptoms associated with alcoholism include:

• Drinking alone
• Making excuses to drink
• Need for daily or frequent use of alcohol for adequate function
• Lack of control over drinking, with inability to discontinue or reduce alcohol intake
• Episodes of violence associated with drinking
• Secretive behavior to hide alcohol related behavior
• Hostility when confronted about drinking
• Neglect of food intake
• Neglect of physical appearance
• Nausea and vomiting
• Shaking in the morning
• Abdominal pain
• Numbness and tingling
• Confusion

Alcohol withdrawal symptoms vary from mild to severe and may include:

• Rapid heart rate and sweating
• Restlessness or agitation
• Loss of appetite, nausea, or vomiting
• Confusion or hallucinations
• Tremors and seizures

Signs and tests

All physicians should ask their patients about their drinking. A history may be obtained from family if the affected person is unwilling or unable to answer questions. A physical examination is performed to identify physical problems related to alcohol use.

• A toxicology screen or blood alcohol level confirms recent alcohol ingestion, which does not necessarily confirm alcoholism.
• Liver function tests can be elevated. GGPT (glutaryl transaminase) is often elevated more than other liver function tests.
• CBC (complete blood count) - MCV can be elevated (mean corpuscular volume or size of the red blood cells).
• Serum magnesium, uric acid, total protein, and folate tests may be abnormal.

Treatment

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 denial of their drinking problems, but now research has shown that compassionate and empathetic counseling is more effective.

Three general steps are involved in treating the alcoholic once the disorder has been diagnosed: intervention, detoxification, and rehabilitation. Research finds that the traditional confrontational intervention - where the employer or family members surprise the alcoholic and threaten consequences if treatment is not begun - is NOT effective. 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 to see that drinking is preventing them from reaching their goals.

Once the problem has been recognized, total abstinence from alcohol is required for those who are dependent; for those who are problem drinkers, moderation may be successful. Since many alcoholics initially refuse to believe that their drinking is out of control, a trial of 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. Because alcoholism affects the people closely related to the alcoholic person, treatment for family members through counseling is often necessary.

Detoxification is the first phase of treatment. 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. A balanced diet with vitamin supplements is important. Complications associated with the acute withdrawal of alcohol may occur, such as delirium tremens (DT's), which could be fatal. Depression or other underlying mood disorders should be evaluated and treated. Often, alcohol abuse develops from efforts to self-treat an illness.

Alcohol recovery or rehabilitation programs support the affected person after detoxification to maintain abstinence from alcohol. Counseling, psychological support, nursing, and medical care are usually available within these programs. Education about the disease of alcoholism and its effects is part of the therapy. Many of the professional staff involved in rehabilitation centers are recovering alcoholics who serve as role models. Programs can be either inpatient, with the patient residing in the facility during the treatment, or outpatient, with the patient attending the program while they live at home.

Medications are sometimes prescribed to prevent relapses.

• Naltrexone (Vivitrol) is an opioid antagonist that decreases alcohol cravings. In April 2006, the U.S. Food and Drug Administration approved an injected form of the drug.
• Disulfiram (Antabuse) works by producing very unpleasant side effects if even a small amount of alcohol is ingested within 2 weeks after taking the drug.
• Acomprosate is a new drug that has been shown to lower relapse rates in those who are alcohol dependent.

These medications are not given during pregnancy or if the person has certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.

Alcoholics Anonymous is a self-help group of recovering alcoholics that offers emotional support and an effective model of abstinence for people recovering from alcohol dependence. There are more than 1 million members worldwide, and local chapters are found throughout the United States.

Al-Anon is a support group for spouses and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of alcoholics. See alcoholism - support group.

For those who don't like the 12-step approach, there are several other support groups available. It is important that people dealing with alcohol problems know about these other groups because in the past, those who did not find AA helpful or were troubled by its requirement of submission to a "Higher Power" had no alternatives.

SMART recovery uses research-based cognitive techniques to help alcoholics recover. LifeRing recovery and SOS are two other secular programs. Women For Sobriety is a self-help group just for women - many female alcoholics have different concerns than men. Moderation Management is a program for problem drinkers seeking to moderate their drinking - it recommends abstinence for those who fail at such attempts.