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How to Detect and Address the Early Signs of Alcoholism in Your Patients

If you were to base your opinions solely on the answers your patients give you, you'd probably be surprised to learn that one in six adults binge drinks about four times a month. And these adults are consuming an average of about eight drinks in a sitting.

Are your patients glossing over their binge-drinking habits? Or are you among the lucky few whose patients all abstain from alcohol? Not likely.

As a doctor, you know what it's like to be on the other end of the stethoscope. Even if you feel comfortable with the doctor who is asking about your drinking habits, you want to tell them what they want to hear. Even when you know the doctor just wants to help, you fear judgment.

So, as a doctor, how do you know when your patients are telling the truth?

The key may be to ask different questions. If you ask someone how many drinks they have a week, they may tell you two when it's really four. Small fibs like this are mostly harmless. But when patients are hiding the fact that they drink 20 drinks or more a week, it's a problem that is going to have an impact on their health.

Here are some follow up questions to consider:

  1. Have you ever had a DUI? Someone could make one poor choice that leads to an arrest. This doesn't necessarily mean they have a drinking problem, but someone who does have a problem is more likely to have alcohol-related trouble with the law. When someone who is underage gets a DUI, it is a sign that he or she is developing unhealthy habits and this should always be addressed.
  2. How often have you been hungover in the past month? This question is very direct, but it may throw people off-guard enough for them to answer honestly.
  3. How do you unwind after a stressful day? If someone responds that they have a glass of wine or beer (or other alcoholic beverage), it could be a sign of an underlying problem. Many drinking problems begin with a glass or two to unwind after work.
  4. How many glasses of wine or beer would you need to drink to get drunk? When someone drinks often, they have a higher alcohol tolerance and so they may respond with a large number. If someone truly doesn't know the answer, that's okay. In fact, it's a good sign that they aren't drinking to get drunk.
  5. Does anyone in your life think you drink too much? If your patient is lying about his or her intake, they may fib about this one too. But there's a chance your patient may mention an "overreacting" mother or friend. If they do, there may be a reason why this person is concerned. Continue asking questions to learn more.

What to do if you suspect your patient has a drinking problem

If your patient is showing physical signs of alcoholism, such as liver damage, it's time to have a serious conversation about getting sober. Strongly recommend that they have a family member in the room for the conversation about their health and treatment plan.

Most doctors are clear on how to handle cases where they see physical signs of alcoholism. But when 56 percent of people drink at least once a month, it's reasonable to believe that at least some of your patients have an unhealthy relationship with alcohol.

Choose one or two of the questions from the list above to gauge your patient's answers. If a patient's answer raises a red flag, try asking another question. One or more red flags is enough to warrant a discussion about the dangers of alcohol.

How to approach alcoholism

Every doctor will have his or her own approach, but these conversations usually go better when they are more of a discussion than a lecture. Here are some ideas:

Talk about liver function – If someone is really just having a few too many, cirrhosis may seem too distant to be scary. They may not even be ready to admit they have a problem. But you may reach them by talking about how the liver works and what happens when the body processes alcohol.

Alcohol is a toxin, and processing it through the body can damage enzymes in your liver. The liver does have an extraordinary ability to repair itself, but you must give it time to do so. This is why a few drinks every night can be very damaging. If the liver has been damaged long-term, it may reach a point where it is beyond repair.

Talk about appearance – If the person seems to care about looks, focus on how an alcoholic's physical appearance can change. Their skin may become rosy with spider veins, the hair can become brittle and the eyes can have a cloudy appearance. This happens gradually over time and can lead to premature aging.

Talk about dependence – It's difficult for most people to admit they have a problem. So instead of talking about your patient's potential dependence, talk about the path to dependence in general terms. Maybe you have a story you can tell about how a patient or friend began binge drinking in college, often experiencing alcohol blackouts, and later went on to use alcohol as a coping mechanism before he realized that he couldn't stop. The hope is that your patient will relate to a point in the story and want to avoid following the same path.

If you think a patient may have an unhealthy relationship with alcohol, the best thing you can do is start an open dialogue. Ask the right questions to find out what is going on in their lives, and suggest a course of action, including specific support groups, to help get them back on the right path. 

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