Fighting Fear

Confronting phobias and other fears

Diagnosing Alcoholism at an Early Stage

An important clue.

Alcoholism is defined usually as the abuse of alcohol to the extent that it interferes to a varying degree with physical health and with the social aspects of life, including work. It is compulsive and potentially addictive. It can present in different ways. Some individuals never drink during the day, but drink every night to the point of oblivion. Others binge drink only occasionally, but severely, to the point where they can no longer remember how they behaved when they were drinking. Others drink regularly during meals or in the evening. If they travel in circles where drinking to excess is common, they may not see themselves as alcoholics. And, after all, in certain settings, such as college, practically everybody has drunk to the point of getting sick once or twice without being an alcoholic.

Someone who drinks excessively for many years can suffer a number of physical complications extending from gastritis to cirrhosis of the liver to a great number of neurological complications, including, most commonly, a peripheral neuropathy, but also disturbances of the central nervous system including psychosis. When alcoholism is severe, it is devastating to career and to family life. It can constitute a true addiction so that sudden withdrawal is life-threatening. It is considered by most people familiar with the condition to represent a life-long illness. For that reason, the members of Alcoholics Anonymous, regard themselves as “recovering,” even though they may not have had anything to drink for twenty years or more. Being abstinent for a long time does not mean that an alcoholic can feel secure against relapse. Experience demonstrates otherwise. Although the thought of drinking can fade from attention in many alcoholics who have been sober for years, the possibility of drinking compulsively once again is real and “only one drink away.”

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The picture of an alcoholic as a derelict is misleading. Most alcoholics are at a stage of drinking where their problem is not readily recognized. They can participate in family life, and they can work. Most of the physical complications of the condition appear only after years of drinking. Unfortunately, most alcoholics will not agree that they have the condition until they find themselves in trouble repeatedly because of their drinking, not uncommonly because they have been arrested for driving while drunk. Since it takes a certain amount of convincing for them to enter treatment, it would be advantageous for them to contemplate at an earlier stage the possibility of their having the problem.

I treat patients for any number of different emotional conditions. Sometimes, despite the fact that they may have come to me with a depression or an anxiety disorder, it is plain that they also are drinking too much.  Often I am the first person to suggest that they may be alcoholics. Sometimes it is only years later that they come to agree.  In fact, I think it is often possible to diagnose alcoholism in adolescence even when that person has been drinking for only a short time.

It is generally accepted that there is a hereditary, that is, genetic, component to alcoholism. Alcoholism runs in families, although not always. Even when children have grown up hiding from a violent, alcoholic parent and also hiding that parent’s condition from friends, they will discover to their dismay that they too are drinking uncontrollably. For that reason, it is sensible to have a high index of suspicion that a child of an alcoholic may grow up to be an alcoholic. Of course, not everyone who has a vulnerability to alcoholism will become an alcoholic. In fact, there is a higher incidence of teetotalers among the families of alcoholics, probably because some of these grown-up children are frightened enough never to try drinking. Still, I look for early signs of alcoholism when a parent has that condition.

I am not sure there is a general agreement among professionals about what I am going to say here, but there are some studies supporting my idea; and it is consistent with my experience: Alcoholics metabolize alcohol differently than other people, and the result is apparent after only a few drinks. An ordinary person who has a drink becomes more relaxed and less inhibited. That is the reason why people drink. After a second drink, or beer, he or she begins to feel a little sleepy. And a third or fourth drink is unpleasant because the sleepy feeling becomes overpowering. The reason why most people can resist drinking to excess is that the experience is unpleasant, even when they have not gone further and become unequivocally drunk and sick.

Those who are genetically predisposed to alcoholism, however, do not become sleepy when drinking too much. They are likely to keep drinking until they pass out. So, a young man or woman who can manage to drink seven or eight beers even only on occasion is likely to have a vulnerability to alcoholism. If I point this out to a college student, that young person is likely to deny drinking any more than anybody else in his or her social group. First of all, that assertion is not likely to be true. Usually, looking more carefully, it will turn out that he, or she, is drinking more than the others. But it is also true that a few of the other students will, in fact, be drinking just as much. Alcoholism, unfortunately, is a common disorder.  

It may be that there are some who as adults drink ten or twelve drinks only on rare occasions and would not, therefore, be regarded as alcoholics; but they are few. Such a person may not wish to consider himself, or herself, vulnerable to this condition; but they should consider that possibility before they find themselves drinking to that extent frequently.  (c) Fredric Neuman  Author of the novel "Come One, Come All." Follow Dr. Neuman's blog at fredricneumanmd.com/blog/

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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