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Medical School Hot Topic: Alcoholism
For the majority of adults, moderate alcohol use is relatively harmless. Moderate alcohol use might be defined as no more than 14 units per week, spread evenly over three or more days. We should therefore consider when drinking might become a problem.
Alcohol abuse is defined as being a drinking pattern that results in recurrent, and significant, adverse consequences. The abuser may fail to complete their work on time or lose their job, fail to fulfil their obligations to their family, or fall behind at school or college. There may be problems with the law, like arrests for driving under the influence of alcohol. There may be problems with their relationship, or keeping a relationship, due to their drinking.
Alcoholism is technically known as alcohol dependence. It means that a patient has lost reliable control of their alcohol use. They may drink any type of alcohol, and the amounts drunk may vary radically from one person to another, but the core factor remains that they cannot stop drinking when they have begun. It is characterised by a tolerance for alcohol - meaning that they need to drink more and more over time to achieve the same effect that was previously achieved through less - and through the existence of withdrawal symptoms. These symptoms include sweating, nausea, anxiety and irritability, and convulsions or tremors and hallucinations (delirium tremens).
Roughly 7% of the US population will be either an alcohol abuser or an alcoholic at any one time, and drinking problems are prevalent among the young, with around 5 million people aged 12-20 engaging in binge drinking in the US.
What problems does alcohol cause?
In the short term, alcohol will cause memory loss, hangovers, and even blackouts, nausea and vomiting or death. In the longer term heavy drinking may cause heart problems, cancer, brain damage, cirrhosis, memory loss and stomach problems. Additionally, the mental problems that stem from both heavy drinking - anxiety and depression - and its effects on people’s lives, can lead to suicide.
Who is vulnerable to becoming a problem drinker?
There are multiple causative factors, including your genetics, psychological factors, and social factors. Some may be more motivated by the need to cope with deep seated psychological problems, others be easy access to alcohol and peer pressure, and others by social pressure. Extreme poverty or abuse will increase the likelihood of becoming reliant on alcohol. Genetic factors - an ability to drink more easily - also increase the risk of alcohol problems. Heavy drinking can become a vicious cycle in which the heavy drinker must continue to drink to avoid both the symptoms of withdrawal, and the pain that they now find themselves in.
Who Should Seek Help, and Help Available
It’s easy to deny a drinking problem. In the UK, a simple method used to find out whether someone might have a problem is the CAGE questionnaire. CAGE stands for Cut, Annoyed, Guilty and Eye-opener. The questions that one must answer are whether one has ever felt the need to cut down on drinking, whether people have annoyed you by criticising you for drinking, where you have ever felt guilty about your drinking, or whether you have ever needed a drink the first thing in the morning (an eye-opener) to steady your nerves and remove a hangover.
‘Two yeses’ is considered as positive in males, and one yes is seen as positive in females.If someone believes that they should seek help, they may still find it hard to admit this to themselves, or to take the requisite steps. They will often need the help of family members and friends, external groups like AA, or even medically supervised rehabilitation to help them come through an initial period of sobriety. Theory may then require psychological help and therapy to deal with any ongoing or remaining issues.
Many of those seeking help might go to their GP as a first port of call , who will be able to provide them with information and help as to who to speak to, advice leaflets and links to help them. They will also be able to refer on to psychologists or psychiatrists as needed, or refer to therapy. Many with alcohol problems suffer from other mental health problems too - like severe depression. These problems must be noted as well, and treated in conjunction with the alcoholism itself. If the alcoholism stems from depression, or trauma, then in order for the patient to move forward these issues must be dealt with.
Example Interview Questions
- What is alcoholism?
- How does one classify someone as having a drinking problem
- How might a problem drinker seek help?
- What might cause problem drinking?
- Is problem drinking common?
- How many units a week should someone drink at most?
Interview Questions & Example Answers
What is alcoholism?
Alcoholism is technically known as alcohol dependence and means that the patient has lost any form of reliable control over their use of alcohol. We should note that alcoholism is more severe than alcohol abuse - alcohol abuse is defined as a drinking pattern that results in recurrent and significant adverse consequences.
However, someone who is alcohol dependent will be unable to stop drinking when they have begun, have a tolerance for alcohol, meaning that they have to drink more over time to achieve the same effect, and have withdrawal symptoms. These include sweating, nausea, and tremors or hallucinations.
How does one classify someone as having a drinking problem?
To investigate whether someone has a drinking problem, one might use a simple tool such as the CAGE questionnaire. The CAGE questionnaire uses the following questions:
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
If the patient answers YES to two or more questions, or once if female, then we might judge that they have a drinking problem and begin considering treatment options.
How might a problem drinker seek help?
They might choose to contact drinkline, the national helpline for alcohol dependence. Groups like the AA, We Are With You, Al-Anon, Adfam, Nacoa and SMART Recovery are all also available to help.
They might choose to consult their GP for help or speak to friends and family first. There is no ‘right’ way to seek help - it is just important that help is sought.
After the first steps, they might need to undergo alcohol detoxification or intensive rehabilitation, depending on their circumstances. These may be provided either by the NHS or privately.
What might cause problem drinking?
There is no one cause of a drinking problem. Certain psychological conditions will predispose someone to alcoholism, like those who suffer from depression, bipolar or severe social anxiety. 20% of those with depression are dependent on alcohol. Certain personality types - like those who are more prone to disregarding risk - are more likely to drink heavily. Personal choices play a role too - those who avoid social situations where heavy drinking happens are less likely to become alcoholics, for example. Drinking history will affect the chances too, with those who have a long drinking history more likely to become problem drinkers. Genetics also has an impact, with biological children of alcoholics far more likely to become alcoholics than those born to non-alcoholics.
Is problem drinking common?
In 2008, 87% of the English population drank alcohol. 24% of the adult population were seen to drink alcohol in a way that could be ‘considered potentially or actually harmful to their health or their wellbeing’ - this being 33% of men and 16% of women. Four percent of UK adults are alcohol dependent (6% of men and 2% of women).
In the US, around 7% of the population will be either an alcohol abuser or an alcoholic at any one time. Drinking problems are particularly prevalent among the young, with around 5 million people aged 12-20 engaging in binge drinking in the US.
How many units a week should someone drink at most?
No more than 14 units per week, spread over three days or more.