The alcoholic patient

Abstract

I thank the college for inviting me to make this presentation on how I manage aIcohol related problems in my practice. The hypothetical case is one of a middle-aged businessman who, during one of his rare visits, complains of symptoms of anxiety and difficulty in sleeping, attributed to pressures at work. During questioning he avoids my probing into his aIcohol intake, but does reveal that his wife is being treated by another doctor for depression. Notwithstanding the patient's reluctance, it is essential that one should investigate the quantity and quality of alcohol intake and the relationship of the suspected abuse of aIcohol to the patient's social, family and personal problems. lt is important to assess whether aIcohol intake is in fact excessive, and thus the daily quantity drunk should be determined. A critical level which may trigger dependence is approximately 150 ml per 24 hours, or approximately 1/2 a bottle of spirits, 1 1/2 bottles of wine, or 4 to 7 pints of beer. Pointed questions should be asked to look for specific features which, if present, indicate a tendency to alcohol dependence. It may be very difficult to differentiate heavy social drinking from aIcoholism, but the presence of these features is indicative.