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It is important for you to know that alcoholism is an illness. alcoholism has a certain set of signs and symptoms. No one asked to become chemically dependent. It's not your fault if you or your loved one is involved in alcoholism. You should not feel guilty. That would be unduly hard on yourself. You wouldn't blame someone for having cancer, or heart disease, even though some of their behaviors may have contributed to their disease. If you eat a certain way, or smoke cigarettes, you increase your chances of disease. If you drink or use drugs, you increase your chances of becoming addicted. ALCOHOLISM IS NOT A MORAL PROBLEM Dorland's Medical Dictionary 1965 defines disease as, "A definite morbid process having a characteristic train of symptoms; it may affect the whole body or any of its parts, and its etiology, pathology, and prognosis may be known or unknown." In the late 1940s, E.M. Jellinek began to study alcoholism in over two thousand members of Alcoholics Anonymous. He found that alcoholism had a characteristic set of signs and symptoms, and it had a definite progressive course. In 1956 the American Medical Association formally recognized alcoholism as a disease. Up until that time, medical science, and society in general, thought that someone who was chemically dependent was a person with a moral problem or someone with a weak will. ALCOHOLISM IS NOT DUE TO A WEAK WILL Please do not think that a weak will has anything to do with alcoholism. We find that alcoholics and drug addicts are strong and resourceful people. Over ninety percent of chemically dependent persons are able to keep functioning even when they are deathly ill. You know how it goes, you come to work and you've got this incredible hangover, your head is throbbing, you feel like you are going to throw up. Your co-worker comes in and asks how you're doing. "Fine," you say cheerfully. You are there, you feel terrible, but you made it to work. That takes a person with a strong will. ALCOHOLISM HAS STRONG GENETIC LINKS There is no major psychiatric disease that does not have genetic links. We are all genetically predisposed to certain physical and mental illnesses. We are more likely to acquire the same diseases as the members of our family have had. Cancer and coronary artery disease run in families, depression and anxiety run in families, and alcoholism runs in families. For example, cells are programmed at birth to do certain things when alcohol is in the body. Many son's of alcoholics drink more before they feel intoxicated. They have a programmed need to drink more before they get the same effect. If you are chemically dependent you may have noticed in your drinking or drug use that you could use more than other people could. This is because some people who are predisposed to alcoholism metabolize drugs differently. It seems that many people who are chemically dependent were predisposed to the illness before they were born (Anthenelli and Schuckit 1994; Woodward 1994). ALCOHOLISM IS A SOCIAL PROBLEM To be chemically dependent you need to use chemicals. This is a psychosocial issue. In some societies, drinking and drug use is not tolerated. Muslims and Mormons, for example, have a strong religious belief against the use of drugs. They consider use to be a sin. There is less drug abuse in these groups. In France, drinking is a regular part of life. It is not uncommon for a Frenchman to have wine with breakfast, lunch, and dinner. Understandably then, France has a higher incident of alcoholism. DRUG ABUSE IS A PSYCHOLOGICAL PROBLEM Certain psychological factors have to also come into play. There is no specific alcoholic personality, but people do have to drink to become alcoholic. Alcohol is reinforcing to some people and to some people it is not. You have to like drinking to drink. Drinking behavior naturally increases if it is reinforced. Drug abuse is a biopsychosocial disease. It has biological components, psychological components, and social components. Two or more of these elements appear to be necessary for drug abuse to exist. Someone has a drug problem if they continue to use a drug despite persistent physical, psychological, or social problems associated with that drug. Anyone who continues to use despite persistent problems is an abuser. Obviously if you get into trouble when you use chemicals you shouldn't use chemicals. DRUG ABUSE IS A PHYSIOLOGICAL PROBLEM Tolerance and withdrawal symptoms characterize chemical dependency. As you use cocaine, the cocaine tells your brain to wake up. The cells of your body gradually catch onto this abnormal wake up signal, and they produce chemicals that tell the brain to go to sleep! The cells counteract the drug. Ultimately it will take more of the drug to produce the same effect. As you take in more of the drug, the cells counteract even further. This is a vicious cycle called tolerance. You will find that you were using more of the drug now than when you started. People, who are having a chemical problem, at least on some level, know it, and they try to cut down. They may change from beer to wine or from hard liquor to beer. They may decide to only use after five o'clock, only on weekends. They may even move or change jobs. But the result is more of the same, more substance use. THE OBSESSION People who are having problems with chemicals will find that more and more of their time is taken up using the substance. People on cocaine for example, first only use recreationally. They occasionally use at parties. As their illness progresses, however, they find themselves using more often, during the week, even when they are alone. More and more of their time is spent in getting cocaine, using cocaine, and withdrawing from cocaine. The more they use, the more they need. The more they need the more they use. It's the same with all mood altering drugs. People who are chemically dependent find themselves intoxicated or hungover when they need to do something else. The homemaker may be high when she is supposed to be taking care of the children. She may be drunk at work. She may have to call in sick because she is too hungover to work. More and more, usually over a long period of time, the disease takes over. The drug becomes the center of the universe. Dinner time revolves around those first drinks. There begins a morning hungover ritual and an evening get high ritual. Eventually the person gives up normal activities. They don't go fishing. They don't go camping. They quit school or get fired. Sexual activity decreases. Recreational activity decreases. Time with the children decreases. Any activity can go but the drug stays and grows more and more important. THE PROBLEMS Sooner or later, problems begin to develop. There are social consequences caused by the drug use. Problems with the spouse, the law, at school, with friends, with parents, the problems mount but the chemically dependent person keeps dealing with the problems in the same way. They get relief, the only way they know how, with their drug of choice. The drug becomes their best friend. It's the only thing they can count on. It always helps to ease the pain. It works, and it works every time. By this time, people around the chemically dependent person are complaining. They are warning that something is wrong. Someone may even have the unmitigated gall to talk about the problem. When someone does this, the chemically dependent person hammers him or her. "It's not my problem," they shout. "It's your problem." The lies escalate and the addict begins to get caught in the lies. People challenge the addict with the truth. All of this leads to more drug use, and the cycle goes on. Finally, some crisis brakes through the lies, some glimmer of the truth seeps in, and the addict comes into treatment. They are still in denial, still lying to themselves, still can't see the full impact of the disease. Drug abuse is the third leading cause of death in this country. Most people who are chemically dependent die of it, very few make it into treatment. Of those who do make it into their first treatment, most will achieve a stable program of recovery. You either abstain from drugs and alcohol or you die. If you or someone you know has an alcohol, drug or gambling problem call 1-800-992-1921 for a free assessment. Search for books on addiction at
1. Have you ever tried to cut down on your drinking? 2. Have you ever felt annoyed when someone talked to you about your drinking? 3. Have you ever felt bad or guilty about your drinking? 4. Have you ever had a drink in the morning to settle yourself down? 5. Have alcohol or drugs ever caused you family problems? 6. Has a physician ever told you to cut down on or quit use of alcohol or drugs? 7. When drinking/using drugs have you ever had a memory loss (blackout)?
If the patient answers any one of these questions yes that’s a red flag for alcoholism. If they answer two questions yes, that’s probable alcoholism. Make sure you don’t just ask the patient. Remember alcoholics live in a series of carefully constructed lies designed to keep them from feeling the fear of the truth.
Red flags for Adult Alcohol/Drug Abuse: 1. Tremor/perspiring/tachycardia. 2. Evidence of current intoxication. 3. Prescription drug seeking behavior. 4. Frequent falls; unexplained bruises. 5. Diabetes, elevated BP, ulcers; non-responsive to treatment. 6. Frequent hospitalizations. 7. Inflamed, eroded nasal septum. 8. Dilated pupils. 9. Track marks/injection sites. 10. Gunshot/knife wound. 11. Suicide talk/attempt; depression. 12. Pregnancy (screen all)
Laboratory Red Flags for Alcohol/Drug Abuse 1. MCV-over 95 2. MCH-High 3. GGT-High 4. SGOT-High 5. Bilirubin-High 6. Triglycerides-High 7. Anemia 8. Positive UA for alcohol or illegal drugs.
Red Flags for Adolescent Alcohol/Drug Abuse 1. Physical injuries; MVA, gunshot/knife wound, unexplained or repeated injuries. 2. Evidence of current use, e.g. dilated/pinpoint pupils, tremors, perspiring, Tachacardia, slurred/rapid speech. 3. Persistent cough (cigarette smoking is a risk factor) 4. Engages in risky behavior, e.g. unprotected sex. 5. Marked fall in academic/extracurricular performance. 6. Suicide talk/attempt; depression. 7. Inflamed, eroded nasal septum. 8. Track marks, injection sites. 9. Sexually transmitted diseases. 10. Staph infection on face, arms, legs. 11. Unexplained weight loss. 12. Pregnancy (screen all)
Laboratory Red Flags for Adolescent Alcohol/Drug Abuse 1. Positive UA for alcohol illicit drugs. 2. Hepatitis A-B-C. 3. GGT-High 4. SGOT-High 5. Bilirubin-High.
Questions to ask the Adolescent Patient: 1. When did you first use alcohol/drugs on your own, away from family/caregivers? 2. How often to you use alcohol/drugs? Last use? 3. How often have you been drunk or high? 4. Has your alcohol/drug use caused you problems with: your friendships, family, school, community? Have your grades slipped? 5. Have you had problems with the law? 6. Have you ever tried to quit/cut down? What happened? 7. Are you concerned about your alcohol or drug use?
Questions to ask the Parent/Caregiver: 1. Do you know/suspect your child is using alcohol/other drugs? 2. Has your child’s behavior changed significantly in the past six months: sneaky, secretive, isolated, assaultive, aggressive, hostile? 3. Has school, community or legal system talked to you about your child? 4. Has there been a marked fall in academic/extracurricular performance? 5. Do you believe an alcohol/other drug assessment might be helpful?
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