Alcohol

Excessive drinking of alcohol can cause several clinical manifestations. Identification of the alcohol-affected person is complicated by the tendency of some to hide, underestimate or understate the extent of their intake.

In order to diagnose and classify alcohol-dependent people, the family doctor has to rely on a combination of parameters that include clinical symptoms and signs, available data on quantity consumed, clinical intuition, personal knowledge of the social habits of patients, and information (usually unsolicited) from relatives, friends or other health workers.

A checklist of pointers to the adverse effects of chronic alcohol abuse is presented in Table 18.1 . In a study by the author the outstanding clinical problems are the psychogenic disorders (anxiety, depression and insomnia) and hypertension. 4 Susceptibility to work and domestic accidents were also significant findings.

The challenge to the family doctor is early recognition of the alcohol problem. This is achieved by developing a special interest in the problem and a knowledge of the early clinical and social pointers, and being ever alert to the tell-tale signs of alcohol dependence (refer to Chapter 106 ).

Table 18.1 Checklist of pointers of alcohol abuse

Psychosocial features

• concern about drinking by self, family or others

heavy drinking—more than six glasses per day

• early morning drinking

• reaching for the bottle when stressed

• regular hotel patron

skipping meals/poor diet

• cancelling appointments

• increased tolerance to alcohol

• alcohol-related accidents

• frequent drinking during working day

marital problems

• behavioural problems in children

• driving offences

• criminal offences

• financial problems

• absenteeism from work/loss of job

• heavy smoking Clinical features

• characteristic facies

• alcohol foetor by day

• morning nausea and vomiting

• traumatic episodes

dyspepsia—gastritis/ulcer

palpitations

• insomnia/nightmares

• anxiety/depression

• hypertension

• hepatomegaly

• pancreatitis

• personal neglect, 'vagabond' look

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