ALCOHOLISM

As we approach the New Year, it is important to step back and assess our holiday celebration. In the United States, it is a New Year’s Eve tradition to celebrate with parties, great food, and alcohol. The New Year should not be escorted in with tragedy, which may include a loss of life, permanent disability, or legal problems, so it is essential that alcohol intake be monitored –especially if someone is driving. Let’s revisit some issues with increased alcohol intake and problematic drinking.

What is alcoholism? Alcoholism is defined as one’s inability to control intake. A person may suffer from a constant preoccupation with drinking, which can lead to personal, medical, professional, and financial problems. There are also different degrees of alcohol intake – with an individual suffering a range of impairment varying from intermittent loss of control to substantial physical and mental impairment. Death may be the end result.

In the United States, about 18 million people suffer from alcoholism and about 100,000 deaths occur each year due to alcohol related medical problems. About half of all traffic deaths are related to alcohol as well. In the emergency department, not a shift passes without me treating a patient for alcohol related complaints. Personally, the most difficult situations for me to deal with are those associated with a traffic related alcohol death. Many times I must treat injured family members, as well as the offender.

What are the symptoms? The following are general behaviors that may indicate a problem with alcohol:
• routinely drinking alone
• consuming alcohol at all times of the day
• becoming angry when drinking habits are questioned
• persistent drinking behaviors that lead to loss of memory or blackouts

As the problem progresses, a loss of interest in family, friends, and hobbies may occur. Eventual problems with employment may be seen, especially with increased absenteeism. Physical signs of withdrawal include altered personality, shaking, irritability, sweating, and seizures.

What are the causes? Research has shown that alcohol addiction is a physical problem. A variety of brain chemicals are altered with increased alcohol intake. It has also been shown that people’s chemical responses to alcohol are different – genetics play a strong role in the disease process. Drinking at an early age also places one at risk for becoming an alcoholic, as does one’s sex – men have a greater disposition than women toward alcoholism.

Individuals who are diagnosed with mental illness have an increased incidence of alcohol problems because brain chemicals, in a mental illness such as depression, are altered. Alcohol has been shown to worsen some psychological problems as well.

What is the treatment? Identifying the problem may be difficult. As an example, it is common for patients with alcoholic tendencies to deny alcohol intake when they are admitted for a surgical procedure. It is only within the controlled environment of the hospital (in which alcohol is unavailable) that withdrawal symptoms will become evident and medical personnel may identify the problem.

If there is concern for alcoholism, screening should occur. Alcoholism can cause numerous medical problems, affecting all body systems such as the brain, heart, liver, gastrointestinal and musculoskeletal systems, and sexual function.

Once the problem has been identified, a variety of therapeutic modalities may be recommended. If there are no underlying medical problems, outpatient counseling and abstinence are recommended. A variety of support groups are available and quite effective in maintaining sobriety. This may require a life long commitment.

When there are medical problems with associated physical addition, admission to the hospital may occur. Medications will be given to combat the physical withdrawal, which can be life threatening. Once medically stabilized after a few days, a patient may choose to pursue an inpatient detoxification program. The length of these programs may vary depending on the severity of the problem.

This past month, a recent study indicated that Gabapentin, an anti-seizure medication, may help with alcohol abstinence. Other medications are also available to assist severe alcoholics who relapse.

As you celebrate the New Year, please drink sensibly. And, as always, never drink and drive because the consequences may be with you for a lifetime.

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