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| Alcoholism is one of the most common psychiatric disorders with a prevalence of 8 to 14 percent. This heritable disease is frequently accompanied by other substance abuse disorders (particularly nicotine), anxiety and mood disorders, and antisocial personality disorder. Although associated with considerable morbidity and mortality, alcoholism often goes unrecognized in a clinical or primary health care setting. Several brief screening instruments are available to quickly identify problem drinking, often a pre-alcoholism condition. Problem drinking can be successfully treated with brief intervention by primary care physicians. Alcohol addiction is a lifelong disease with a relapsing, remitting course. Because of the potentially serious implications of the diagnosis, assessment for alcoholism should be detailed. Alcoholism is treated by a variety of psychosocial methods with or without newly developed pharmacotherapies that improve relapse rates. Screening for problem drinking and alcoholism needs to become an integral part of the routine health screening questionnaire for adolescents and all adults, particularly women of child-bearing age, because of the risk of fetal alcohol syndrome. (Am Fam Physician 2002;65:441-8,449-50. Copyright© 2002 American Academy of Family Physicians.) |  |
Alcohol misuse is associated with considerable morbidity and mortality (100,000 deaths annually), social and legal problems, acts of violence, and accidents. Alcoholism is among the most common psychiatric disorders in the general population: the lifetime prevalence of alcohol dependence, the severe form of alcoholism, is 8 to 14 percent.1 The ratio of alcohol dependence to alcohol abuse is approximately two to one. The incidence of alcoholism is still more common in men, but it has been increasing in women, and the female to male ratio for alcohol dependence has narrowed to one to two.2 Serious drinking often starts in adolescence; approximately 40 percent of alcoholics develop their first symptoms between 15 and 19 years of age.3
Alcoholism often goes undiagnosed; the rate of screening for alcohol consumption in health care settings remains lower than 50 percent.4 Some patients also may withhold information because of shame or fear of stigmatization. This can lead to missed information about medical and psychiatric conditions, potential surgical complications, unexpected alcohol withdrawal symptoms, drug interactions, and lost opportunities for prevention, including intervention during pregnancy to prevent damaging effects of alcohol on the fetus. All too often, patients, particularly the elderly, continue to be treated symptomatically for alcohol-related conditions without recognition of the underlying problem (Table 1). There are many reasons why there is a worldwide tendency for physicians to neglect or be unaware of symptoms and signs of alcohol abuse, but inappropriate attitudes, insufficient medical school training in this subject, and subsequent low confidence to treat are key elements.
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