Alcoholism Health Article

Diagnosis

Two different types of alcohol-related difficulties have been identified. The first is called alcohol dependence, which refers to a person who literally depends on the use of alcohol. Three of the following traits must be present to diagnose alcohol dependence:

• tolerance, meaning that a person becomes accustomed to a particular dose of alcohol, and must increase the dose in order to obtain the desired effect
• withdrawal, meaning that a person experiences unpleasant physical and psychological symptoms when he or she does not drink alcohol
• the tendency to drink more alcohol than one intends (once an alcoholic starts to drink, he or she finds it difficult to stop)
• being unable to avoid drinking or stop drinking once started

Symptoms Of Co-Alcohol Dependence

Psychological distress manifested in symptoms such as anxiety, aggression, anorexia nervosa, bulimia, depression, insomnia, hyperactivity, and suicidal tendency Psychosomatic illness (ailments that have no biological basis and clear up after the co-alcoholism clears up)

Family violence or neglect

Alcoholism or other drug abuse

• having large blocks of time taken up by alcohol use
• choosing to drink at the expense of other important tasks or activities
• drinking despite evidence of negative effects on one's health, relationships, education, or job

Alcohol abuse requires that one of the following four criteria is met. Because of drinking, a person repeatedly:

• fails to live up to his or her most important responsibilities
• physically endangers him or herself, or others (for example, by drinking when driving)
• gets into trouble with the law
• experiences difficulties in relationships or jobs

Diagnosis is sometimes brought about when family members call an alcoholic's difficulties to the attention of a physician. A clinician may begin to be suspicious when a patient suffers repeated injuries or begins to experience medical problems related to the use of alcohol. In fact, some estimates suggest that about 20% of a physician's patients will be alcoholics.

Diagnosis is aided by administering specific psychological assessments that try to determine what aspects of a person's life may be affected by his or her use of alcohol. Determining the exact quantity of alcohol that a person drinks is of much less importance than determining how his or her drinking affects relationships, jobs, educational goals, and family life. In fact, because the metabolism of alcohol (how the body breaks down and processes alcohol) is so individual, the quantity of alcohol consumed is not part of the criteria list for diagnosing either alcohol dependence or alcohol abuse.

One very simple tool for beginning the diagnosis of alcoholism is called the CAGE questionnaire. It consists of four questions, with the first letters of each key word spelling out the word CAGE:

• Have you ever tried to Cut down on your drinking?
• Have you ever been Annoyed by anyone's comments about your drinking?
• Have you ever felt Guilty about your drinking?
• Do you ever need an Eye-opener (a morning drink of alcohol) to start the day)?

Other, longer lists of questions exist to help determine the severity and effects of a person's alcohol use. Given the recent research pointing to a genetic basis for alcoholism, it is important to ascertain whether anyone else in the person's family has ever suffered from alcoholism.

Physical examination may reveal signs suggestive of alcoholism: evidence of old injuries; a visible network of enlarged veins just under the skin around the navel (called caput medusae); fluid in the abdomen (ascites); yellowish-tone to the skin; decreased testicular size in men; and poor nutritional status. Lab work may reveal an increase in the size of the red blood cells; abnormalities in the white blood cells (cells responsible for fighting infection) and platelets (particles responsible for clotting); and an increase in certain liver enzymes.