Although two thirds of American men and one half of American women drink alcohol, three fourths of drinkers experience no serious consequences from alcohol use. Among those who abuse alcohol, many reduce their drinking without formal treatment after personal reflection about negative consequences. Physicians can help prevent the serious effects of alcohol-related problems by stimulating such reflection and moving patients toward a healthier lifestyle.

Family physicians should be on the alert for signs of drinking problems because alcohol-related problems are prevalent in patients who visit family practices. Heavy alcohol use contributes to many serious health and social problems; and physicians can successfully influence drinking behaviors. One study of 17 primary care practices found a 16.5 percent prevalence of “problem drinkers,” and another study found a 19.9 percent prevalence of alcohol-use disorders among male patients.

Consequences of alcohol abuse or dependence affects nearly every organ system and every aspect of a patient’s life. It will cause liver disease, pancreatic disease, cardiovascular disease, gastrointestinal problems, neurologic disorders, reproductive system disorders, psychiatric disorders, legal problems, employment problems, family problems and effects their children.

Many of these problems may be avoided by early screening and intervention by family physicians. A 40% reduction in alcohol consumption in nondependent problem drinkers has been demonstrated following physician advice to reduce drinking.

Family physicians should have screening questions for alcohol related problems when patients come in for an appointment, i.e., how often do you drink alcohol, how many drinks per day, etc. Physicians should be on the alert for certain medical complaints, i.e., headaches, depression, chronic abdominal or epigastric pain, fatigue and memory loss. The first signs of heavy drinking may be social problems. The compulsion to drink causes persons to neglect social responsibilities and relationships in favor of drinking. It can lead to accidents, occasional arrest or job loss. In the early stages of alcohol-related problems, the physical examination provides little evidence to suggest drinking problems so the questionnaire is a good tool to use. Significant signs of alcohol overuse, include gastrointestinal disorders, enlarged and sometimes tender liver, spider angiomata, varicosities and jaundice; neurologic signs such as tremor, ataxia or neuropathies; and cardiac arrhythmia’s. If a patient arrives at the doctor’s office inebriated, one should suspect a long-standing drinking problem.

Men who have more than 14 drinks per week or more than four drinks per occasion are considered “at risk” for developing problems related to drinking. Women who have more than 11 drinks per week or more than three drinks per occasion are “at risk.”

The physician should direct intervention efforts based on consideration of two important factors: the severity of the alcohol problem and the patient’s readiness to change the drinking behavior. In patients who show evidence of alcohol dependence, the therapy should be abstinence from alcohol and referral to a specialized alcohol treatment program. Decisions about inpatient or outpatient treatment depend on the patient’s likelihood of alcohol withdrawal, resources, employment status, family support system, access to treatment programs and motivation. Patients who do not like formal treatment may prefer peer-directed groups, such as those offered by Alcoholics Anonymous, in conjunction with physicians counseling and support. Al-Anon groups are available for adult family members of alcohol-dependent individuals. In patients who are at risk for developing alcohol-related problems or who have evidence of current problems, the therapy should be drinking at low-risk limits: for men, no more than two drinks with alcohol per day; for women or older persons ( over 65) no more than one drink per day.

Burge, Sandra K., PH.D., and Schhneider, David M.D., M.S. P. H. (1999) Alcohol- Related Problems: Recognition and Intervention. American Family Physician. 367-375.

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