Fast Five Quiz: How Much Do You Know About Alcoholism?

Stephen Soreff, MD

Disclosures

January 26, 2017

The first step in treatment is brief intervention. The physician states unequivocally that the patient has a problem with alcohol and emphasizes that this determination stems from the consequences of alcohol in that patient's life, not from the quantity of alcohol consumed. Emphasizing the effects on family, friends, and occupation, as well as any physical manifestations, is important. Pointing out that loss of control and compulsive use indicate alcohol dependence also is important.

Treatment of alcoholism involves the following:

  • Brief physician advice is the first step.

  • While a trial period of controlled drinking with careful follow-up might be appropriate for a diagnosis of alcohol abuse, this approach increases a physician's professional liability. Complete abstinence is the only treatment for alcohol dependence. Emphasize that the most common error is underestimating the amount of help that will be needed to stop drinking. The differential diagnosis between alcohol abuse and dependence can be a difficult judgment call.

  • Hospitalize patients if they have a history of delirium tremens or if they have significant comorbidity. Consider inpatient treatment if the patient has poor social support, significant psychiatric problems, a history of relapse after treatment, and risk for suicidal or homicidal behavior.

  • Strongly recommend Alcoholics Anonymous (AA).

  • Encourage hospitalized patients to call AA from the hospital. AA will send someone to talk to them if the patient makes the contact. Patients need to attend meetings regularly (daily at first) and for a sufficient length of time (usually 2 years or more) because recovery is a difficult and lengthy process.

  • At the beginning of treatment and perhaps ongoing, patients should remove alcohol from their homes and avoid bars and other establishments where strong pressure to drink may influence successful abstinence.

  • If the patient has an antisocial personality (ie, severe problems with family, peers, school, and police before age 15 years, as well as total disregard for others and authority and before the onset of alcohol problems), recovery is less likely. If the patient has primary depression, anxiety disorder, or another potentially contributory disorder (the other disorder must antedate the problems with alcohol or it must be a significant problem during long periods of sobriety), treat both problems aggressively.

Consultation with a psychiatrist might be indicated in cases in which questions of suicide, violence, or comorbid psychiatric disorders might be present.

For more on the treatment of alcoholism, read here.

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