Book menuALCOHOL - Full extract 

Mike is a friend of mine from university days. After he finished dentistry he shifted to Queensland. I hadn't seen him for a few years when I got a phone call to say he was back living in Melbourne. 

A couple of weeks later Mike's wife, Sarah, came into the surgery. She was there ostensibly to discuss a sore ankle, but after a few minutes she became quite upset. 
" Mike's got an alcohol problem," she said. " And I don't know where to turn." Apparently he had several arguments with his partners, and lost his licence on a drink-driving charge. They had also been losing a lot of friends and both felt that it was time to make a fresh start. 

It hadn't been as easy as Mike hoped, and many of his old contacts seemed either unable or unwilling to help. Sarah said that Mike was already drinking again. When I asked whether Mike felt that he had a problem and needed help, Sarah said she that she really did not know. " In fact, I feel sometimes that I don't know him at all." I suggested that I could only see Mike if he felt that I could be of any help. He rang the following day and we went out for lunch to catch up on old times. 

The lunch started okay but things were fairly strained. When I asked him about work, he said that he would be joining a suburban practice as an assistant the following week. According to Mike everything was just dandy. I couldn't bring up the alcohol issue that day. Somehow it did not seem right. 

At Sarah's suggestion, Mike came to the surgery a couple of weeks later for a check-up. His blood pressure was slightly elevated and his liver was enlarged. He also smelt of alcohol and had a slight tremor. Several routine blood tests were arranged. These showed abnormal liver function, consistent with alcoholic liver damage. When I discussed the tests he became quite aggressive.
 " Sure, I enjoy a drink. Who doesn't ? " he said. " But if you're insinuating I'm a pisspot, forget it. I'm stuffed if I know why I came to see you anyway." I offered to refer him to a specialist to discuss the tests in more detail, but he declined. 

Sarah and her older son attended Al Anon for several months and it helped them gain some insight into what alcoholism is all about. Mike is currently unemployed and living by himself. I rang him several times and left a message. He has not returned my call. 

People have been enjoying their grog from the time of the Babylonians, and Australians have done more than their share in continuing the tradition. 

Australians drink more alcohol per head than any other English-speaking country. It is said that about 3500 Australians die each year from accidents or illnesses related to alcohol. Figures from New South Wales suggest that alcohol is a factor in up to 70% of major crimes. Although alcohol intake is decreasing in most age groups, it is still a major problem in our community. 

When working in a casualty department, I quickly became accustomed to the smell of alcohol and blood mixed together. It may have been someone one with a lacerated scalp after a fall downstairs or a punch-up. Sadly, it was often some young person with multiple injuries from a car smash, someone who just happened to have too much to drink on a Saturday night. 

On the other side of the ledger, a cold beer after some hard work has to be one of life's pleasures. And there is evidence to suggest that a couple of drinks per day may actually have a positive effect on your health, perhaps even reduce your risk of coronary artery disease. Sometimes it's hard to reconcile all this with the misery that alcohol can cause. 

There has been a dramatic change in attitudes towards drinking in the last couple of decades. The arrival of light beer has been a great success. And waiters no longer look aghast if you ask for a jug of iced water at a restaurant. More importantly, " No. I'm not drinking " has finally become an acceptable statement. The random breath tests, Transport Accident Commission  advertisements and stiffer penalties for drink-driving have all made people more wary. But alcohol and driving is just one facet of alcohol abuse. There are many other ways that a drinking problem can crop up in a consultation with the GP... 

  • High blood pressure in a young male patient. 
  • A blackout or memory loss episode.
  • Hangovers and acute alcoholic gastritis.
  • Domestic violence and marital disharmony. 
  • Work accidents and job loss. Falls and injuries. 
  • Abnormal liver function tests on a routine blood test.
  • Symptoms of restlessness and withdrawal when in hospital for another reason and while not drinking the usual amount. 
  • Anxiety and depression. 
  • Unplanned sex. Sexually transmitted diseases and pregnancy. 
  • Experimenting with other drugs while drinking. 

Often it is a combination several factors. It is surprising how long some people can compensate at work and at home with a severe drinking problem, while other people unwittingly cover up for the person and delay treatment. 

The effects of long-term excessive alcohol intake can be seen in virtually every part of the body but they are usually only seen after many years. Most people with a drinking problem look perfectly normal. Although it may become quite clear to others that a drinking problem exists, denial may prevent the actual person accepting there is a problem at all. 

Although it is difficult to define what a drinking problem is, the following guidelines are useful. A man who has four to six standard drinks (40-60 gm. absolute alcohol) per day is drinking at a hazardous or risky level. More than six drinks per day is regarded as harmful. For women, two to four drinks is hazardous, greater than four drinks harmful. Hormonal factors and a different proportion of body fat to water mean that women reach higher blood alcohol levels than men at the same intake. The alcohol intake of women in the 15-25 age-group is on the increase; about 28% are currently drinking at a hazardous level. It is of interest that this is the same group where smoking has also been on the increase. 

About one in 20 adults develop alcoholism. This is when a physical or psychological dependence on alcohol has occurred, and the person will encounter severe physical, social and emotional problems. For every one alcoholic there are about four or five people who have a drinking problem. 

Once people recognize that they have a drinking problem, the opportunity exists for them to change their behavior. The GP can be a good starting point for the whole family. Simple discussion will often help people understand why they drink to excess, and the specific triggers that operate in their own particular case. In some cases, medication may be suggested to help the person remain off alcohol. Support groups and specialist referral can also be arranged if necessary.

A person with severe alcoholism can also be helped but it is more difficult. In the acute stage, detoxification in a specialized unit may be necessary. Then a multidisciplinary approach with doctors, social workers and other health professionals might be able to help the person regain control of his or her life. For some people, groups like Alcoholics Anonymous can be of great assistance.

 

Health tips 
* Avoid using alcohol to relieve stress. This is when dependence is most likely to occur. 

* There is no doubt that early intervention is the best approach. If you feel that you or a family member has an alcohol problem see your doctor for advice.


 Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001