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Saturday, July 24, 2010

How Is Alcoholism Diagnosed?

How Is Alcoholism Diagnosed?

Even when people with alcoholism experience withdrawal symptoms, they nearly always deny the problem, leaving it up to coworkers, friends, or relatives to recognize the symptoms and take the first steps toward treatment. Family members cannot always rely on a physician to make an initial diagnosis. Although 15% to 30% of people who are hospitalized suffer from alcoholism or alcohol dependence, physicians often fail to screen for the problem. In addition, doctors themselves often cannot recognize the symptoms. In one study, alcohol problems were detected by the physician in less than half of patients who had them. It is particularly difficult to diagnose alcoholism in the elderly, where symptoms of confusion, memory loss, or falling may be attributed to the aging process alone. Heavy drinkers may be more likely to complain to their doctors about so-called somatization symptoms, which are vague ailments such as joint pain, intestinal problems, or general weakness, that have no identifiable physical cause. Such complaints should signal the physician to follow-up with screening tests for alcoholism. Alcoholism is particularly less likely to be recognized in elderly women. In fact, only 1% of older women who need treatment for alcoholism are diagnosed accurately and treated appropriately. Instead, they are often diagnosed with depression and may even be prescribed anti-anxiety drugs or antidepressants that can have dangerous interactions with alcohol. Even when physicians identify an alcohol problem, however, they are frequently reluctant to confront the patient with a diagnosis that might lead to treatment for addiction.

Screening for Alcoholism.

A physician who suspects alcohol abuse should ask the patient questions about current and past drinking habits to distinguish moderate from heavy drinking. If alcohol abuse or dependency is indicated, the physician will usually perform a screening test. Many are available for diagnosing alcoholism, usually either standardized questionnaires that the patient can take on their own or that are conducted by the physician. Because people with alcoholism often deny their problem or otherwise attempt to hide it, the tests are designed to elicit answers related to problems associated with drinking rather than the amount of liquor consumed or other specific drinking habits. The quickest test takes only one minute; it is called the CAGE test, an acronym for the following questions: (C) attempts to Cut down on drinking; (A) Annoyance with criticisms about drinking; (G) Guilt about drinking; and (E) use of alcohol as an Eye-opener in the morning. This test and another called the Self-Administered Alcoholism Screening Test (SAAST), however, appear to be most useful in detecting alcoholism in white middle-aged males. They are not very accurate for identifying alcohol abuse in older people, white women, and African- and Mexican-Americans. A more effective test for such individuals may be the Alcohol Use Disorders Identification Test (AUDIT), which asks three questions about amount and frequency of drinking, three questions about alcohol dependence, and four questions about problems related to alcohol consumption. Other short screening tests are the Michigan Alcoholism Screening Test (MAST) and The Alcohol Dependence Scale (ADS) .

Laboratory and Other Tests.

Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. A mean corpuscular volume (MCV) blood test is sometimes used to measure the size of red blood cells, which increase with alcohol use over time. A test for a factor known as carbohydrate-deficient transferrin may prove to be fairly accurate indicator of heavy drinking. A physical examination and other tests should be performed to uncover any related medical problems. Sometimes the results of tests that detect other problems, such as blood tests reporting liver damage or low testosterone levels in men, can persuade alcoholics to seek help.

Getting the Patient to Seek Treatment.

Once a diagnosis of alcoholism is made, the next major step is getting the patient to seek treatment. One study reported that the main reasons alcoholics do not seek treatment are lack of confidence in successful therapies, denial of their own alcoholism, and the social stigma attached to the condition and its treatment. Studies have found that even a brief intervention (e.g., several fifteen-minute counseling sessions with a physician and a follow-up by a nurse) can be very effective in reducing drinking in heavy drinkers who are not yet dependent. However, the best approaches are group meetings between people with alcoholism and their friends and family members who have been affected by the alcoholic behavior. Using this interventional approach, each person affected offers a compassionate but direct and honest report describing specifically how he or she has been specifically hurt by their loved one's or friend's alcoholism. Children may even be involved in this process, depending on their level of maturity and ability to handle the situation. The family and friends should express their affection for the patient and their intentions for supporting the patient through recovery, but they must strongly and consistently demand that the patient seek treatment. Employers can be particularly effective. Their approach should also be compassionate but strong, threatening the employee with loss of employment if he or she does not seek help. Some large companies provide access to inexpensive or free treatment programs for their workers. The alcoholic patient and everyone involved should fully understand that alcoholism is a disease and that the responses to this diseaseneed, craving, fear of withdrawalare not character flaws but symptoms, just as pain or discomfort are symptoms of other illnesses. They should also realize that treatment is difficult and sometimes painful, just as treatments for other life-threatening diseases, such as cancer, are, but that it is the only hope for a cure.

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