,,First you take a drink, then the drink takes a drink, then the drink takes you’’
Today is the national screening test for alcoholism in US and is a very good idea for us also, to raise awareness about this subject.
I will make some references to the smoking subject in the sense that, the people who have problems with drinking, will surpass also some steps in order to recognize they have a problem and looking for help.
When a patient is confronted with the idea that he is an alcoholic, the first reaction is denial. It is common sense for him. Even though the family is there and stresses the importance to get help,he will deny the fact, he has a drinking problem. The doctor with patience and diplomacy must to seed in the patient mind that it is a help available, in case he is interested in.
How can we know if the person has really a problem with drinking?
A CAGE questionnaire helps us know if the patient is addicted and the questions below are just the most important from the questionnaire.
►Did you feel the need to cut down drinking?
►Did you feel annoyed when others people speak about your habit?
►Do you feel guilty about your drinking habit?
►Did you feel the need to drink first time in the morning after waking you up?
Having the score for this type of questionnaire, we will know if the person has a problem of dependency, meaning alcoholism.
We can also know if the person consumes alcohol on a regularly basis, making some blood analysis, looking for liver tests or making an ultrasound and seeing an enlarged and very bright liver in hepatic steatosis or a granular liver and ascitis in cirrhosis.
There are many manifestations we can see on them:
Red spots on the skin, a yellowish skin, itchy skin, a tremor of the hands called asterixis, we can see caput medusae on the abdominal skin, which means a dilatation of the portal and umbilical vessels, a sensibility on abdominal palpation, breast growth in men and impotence, hemorrhoids and varix, bleeding tendencies, capillary fragility. Not to mention, unsteady gait with large base of support, confusion, agitation, sometimes amnesia and confabulation (lying because they don't remember facts). The risks are higher for the pregnant women, their children suffering by fetal alcoholic syndrome.
In our society, there are a lot of occasions to drink; there are people who drink in order to dare speaking in public, to let the shyness or the panic behind, but also people who cannot stop this habit.
We as individuals, we haven’t the same quantity of alcohol dehydrogenase in the bloodstream, an enzyme we are born with and which is necessary to metabolize the alcohol in the body. That’s why, we react differently to the same amount of alcohol. Some can tolerate well the alcohol, but some are not, because they don’t have enough enzyme to metabolize the alcohol. We must also have this particular aspect in mind, before judging or stigmatizing someone. If a person becomes drunk very rapidly, it is because of this enzyme, which is low in their bloodstream.
Also the heredity is important, in the sense that, people with low enzyme will have offspring’s with the same problem.
It is also a problem of education, meaning the example of the parents is important when a teenager became alcoholic. We say about an obese family, that they all eat on the same table but we can enlarge the definition, saying they drink also on the same table.
It is like a vicious circle in the same family or in the same entourage, which must to be broken.
At some point, the effects of alcohol will be present medically and also present in the social or professional life of our patients. They will look for help and then, the role of the family and the doctor and why not of the entourage will be a crucial one.
We must to intervene before hepatic steatosis will become cirrhosis, the first one being reversible in nature instead of second one which necessitates a liver transplant.
Treatment will be followed in clinics of rehab, with AAA meetings, passing 12 steps, taking treatment with Naltrexone and Antabuse, which modifies the behavior in front of alcohol, sedatives for a while to prevent seizures in withdrawal, peers group sessions, motivational sessions, psychologically aid, ergo therapy, sessions of relaxation, yoga classes, all that help people to relax and let behind this habit. Not to forget the medical and psychological follow-up, because some of them will recur.
The alcoholism it’s an illness and must to be treated in consequence!