Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis
The term “alcoholic” has been used to describe any number of patterns of alcohol abuse. However, it is important to distinguish two separate groups of individuals who use alcohol excessively. The first group includes those individuals who drink regularly on a chronic basis and who experience withdrawal signs when the alcohol is discontinued abruptly. These individuals obviously suffer from serious social and occupational consequences of their drinking behavior and are truly physiologically addicted to alcohol. The term alcoholic is often used to describe that population. A less talked about but probably larger group of individuals are those who experience problems with
their drinking, but who may not be physically dependent on alcohol. They may drink sporadically, but when they do drink, they may have legal, marital, and occupational consequences that stem from alcohol use. These individuals are generally referred to as “problem drinkers.” Therefore some authors prefer to talk about two worlds of alcohol problems: the first is characterized by heavy drinking and the immediate problems of intoxication; the second is characterized by severe dependence, continuous drinking, and the consequences of long-term drinking. It may be that these two populations need a different treatment approach if we are to be successful. Alcohol is one of the most widely used drugs in the world. Its consumption is very high in the United States, and various studies have suggested that there are between 9 and 15 million alcoholics in this country. Because the drug is so popular, there has grown up a complete industry associated with alcohol abuse, and along with nicotine, alcohol is one of the most commonly abused drugs in the United States. In the United States, alcohol abusers are more likely to be men. Studies suggest that only a third of men describe themselves as abstainers from alcohol, whereas about 50% of women do so. Certainly, men are more likely to go to treatment centers for alcohol abuse. Black and Hispanic populations are more likely to abstain from alcohol than are whites, and about two thirds of black and Hispanic women describe themselves as abstaining.

Living With Your Diagnosis
There are obviously a number of consequences of drinking, and these include a variety of social, legal, and medical problems. Alcohol-related deaths account for about 5% to 7% of all deaths, ranking it as one of the four most common causes of death in the United States. The health hazards of alcohol
abuse are well known and primarily involve diseases of the liver, such as cirrhosis and hepatitis; ulcer disease, including esophagitis; heart disease, including cardiomyopathy and congestive failure; and mental disorders, such as Wernicke-Korsakoff and alcohol dementia and delirium tremens (DTs) or alcohol withdrawal delirium. Alcohol abuse appears to run in families, especially on the father’s side. Because of this, the children of alcoholic fathers should be counseled never to drink even socially, because their potential for becoming alcohol abusers is much greater than that of the average individual. In fact, there is a sevenfold risk of alcoholism in first-degree relatives of alcohol-dependent individuals, and the greatest risk is for male relatives of alcohol-dependent men. There are, however, other environmental and social factors that also play a role in the development of alcoholism. To diagnose alcohol dependence, there must be a pattern of drinking that causes problems, and evidence of tolerance and withdrawal. Withdrawal is a typical pattern of symptoms related to the abrupt discontinuation of alcohol. Alcohol dependence is characterized by the consumption of alcohol in larger amounts or over a longer period than the individual intended; by a persistent desire to cut down or control drinking (going on the wagon); by a great deal of time spent either drinking or recovering from drinking; by the reduction or relinquishing of important social, occupational, or recreational activities because of drinking; and by the
continuation of drinking despite the individual’s knowledge of having a persistent physical or psychological problem that is most likely secondary to
alcohol abuse. If these criteria are met, the diagnosis of alcohol dependence is made. Alcohol abuse, on the other hand, only requires a recurrent drinking
that results in a failure to fulfill a major role obligation like school or work, recurrent drinking in situations in which it is physically hazardous, recurrent alcohol-related legal problems, and continued drinking despite having persistent or recurrent social or interpersonal problems that are caused by drinking. The diagnosis of alcoholism is usually made on the basis of the history. In addition, there are different tests that are given to screen for alcohol abuse. xamples of these tests are the Michigan Alcohol Screening Test (MAST) and CAGE questions. The CAGE survey measures repeated efforts to cut down ((C) amount of alcohol consumed, annoyance (A) when others comment on your drinking, feeling guilty (G) about drinking and trying to hide it and needing alcohol as an “eye opener” (E) to get started in the morning. Of course, the first thing that should be done when diagnosing alcohol abuse is creating a setting where the individual can become abstinent and then, in that setting, performing a complete examination to identify any health problems caused by alcohol abuse. After that, the alcoholic will probably need detoxification. This is accomplished using a variety of drugs, including vitamins such as thiamine and folic acid, and the benzodiazepines such as Librium, Valium, and Ativan for slowly tapering the individual off the alcohol. Discontinuing large amounts of alcohol after a persistent pattern of drinking can be dangerous and can produce delirium tremens (DTs), and seizures which can be fatal. Health problems during this period that should be screened for include the consequences of malnutrition such as muscle wasting, the presence of infectious diseases (alcohol lowers the individual’s ability to fight off infections), hepatitis, pancreatitis, gastritis, and head trauma (secondary to fights and other behavior exhibited while drinking), and signs of alcohol-related mental disorders, especially brain damage from alcohol. Women drinkers tend to begin heavy drinking much later than men do, and tend to exhibit the consequences of heavy drinking much faster, so they may exhibit the medical complications of drinking at an earlier age than men do. The concept of telescoping has been used to describe the course of symptom progression in women who, despite beginning heavy drinking later than men, begin to experience alcohol-related problems and seek treatment sooner than men do. Also, compared with men, women with alcohol abuse are more likely to drink alone, and are at greater risk for using other drugs in addition to alcohol. Both of these tendencies may partly explain why women seek treatment sooner than men do for alcohol abuse. Although it is beyond the scope of this chapter, we should mention that perhaps even mild alcohol use during pregnancy can lead to serious consequences, namely, the fetal alcohol syndrome. In the United States, this birth defect has an incidence of between 1 case per 1,000 and 1 case per 300 live births and can lead to serious physical deformities and mental retardation. We should also mention the elderly, because this is a population that has been often overlooked when examining alcohol abuse. Certainly elderly patients who complain of frequent falls or exhibit frequent hip injuries should be evaluated for alcohol dependence and abuse. Older alcoholics, not unexpectantly, have far more medical problems and have more inpatient medical days than do the elderly who do not drink. In addition, there is much more likelihood of a drug-alcohol
interaction occurring because many of these elderly patients are taking medications, some of which are sedating and can interact in an additive way with the alcohol. Many times the elderly attempt to selfmedicate depression and loneliness with alcohol.

The treatment of alcohol abuse most often involves adherence to a 12-step recovery plan. The initial objective is abstinence, followed by education,detoxification, and peer support group treatment. The hallmark of the 12-step program is that alcoholism is a disease which cannot be cured merely by willpower, and that individuals, in fact, are powerless over their drinking. This is the first of 12 steps. While in the recovery program with Alcoholics Anonymous (AA), individuals attend a number of meetings where they are surrounded by other people who abuse alcohol, and they are charged with obtaining a sponsor who has a significant degree of sobriety and whom the individuals feel will have a compatible personality. The goals of alcohol treatment are:
1. Stabilize the acute medical condition, including withdrawal.
2. Increase motivation for recovery.
3. Initiate treatment for chronic medical and psychiatric conditions, especially in those individuals who may have a dual diagnosis.
4. Assist the patient in locating suitable housing. This very often requires transfer to a so-called halfway house as a transitional move before going home.
5. Enlist social support for recovery such as introducing the patient to 12-step programs and AA, and getting the family involved in support groups for families of alcohol abusers.
6. Teach the patient coping skills to use instead of drinking, and work on changing old habits, such as drinking with friends and going to places where alcohol use was formerly a major order of business.
7. Improve occupational function.
8. Promote maintenance of recovery through ongoing participation in AA, gradually involving more leadership roles. These are the goals of alcohol treatment. It should be pointed out, however, that there is a very high rate of relapse for alcoholics. It is very important that alcoholics who relapse not get totally down on themselves. They must accept that relapse is part of the disease and work toward maintaining an abstinence state again. For depressed individuals alcohol is an additional depressant which will make an existing sadness much more intense. Alcohol should not be used as a treatment for depression. There are several medications that are used during alcoholism treatment. The benzodiazepines, clonidine, and vitamins are used during the immediate withdrawal phase of alcohol abuse. Occasionally, long-term drugs are used, such as naltrexone and disulfiram (Antabuse). Naltrexone significantly decreases the craving for alcohol after someone is detoxified, whereas Antabuse interacts with any alcohol that the individual may have taken to produce serious physical symptoms, including chest discomfort and shortness of breath. In this way, Antabuse serves as a deterrent to drinking. Antabuse can also be used in particularly vulnerable times, such as anniversaries of deaths, during premenstrual syndrome (PMS), or at the anniversary date of sobriety when chances for relapse are high.

The DOs
Avoid medication during drinking binges, and of course, never drink and drive. It is also important to find other friends and become part of a community.

The DON’Ts
Don’t drink. Do not see those friends who drink. Alcohol abusers should also not have any alcohol in the house. Anyone who cares for the abuser will understand that.

When to Call Your Doctor
Call your doctor if you are having any significant medical consequences of alcohol abuse, including nausea, persistent vomiting, constant diarrhea, heartburn or tightness in your chest, blood in the stools, especially dark red blood, and vomiting blood. These are all life-threatening conditions that should be reported to your physician. In addition, because alcohol is a depressant, suicidal thoughts and suicidal behavior are very common among alcohol abusers, so you should discuss with your doctor any suicidal thoughts you may be having. Most important, do not lie to your doctor when he asks about alcohol abuse and if he does not bring it up, you should.

National Association of Children of Alcoholics
Information about AA:
Listings for your local AA chapters can be found at: