First you take a drink, then the drink takes a drink and then the drink takes you –  F. Scott. Fitzgerald

People start drinking for refreshment  and slowly and steadily that inculcate into a habit and indulgence of that sort leads to dependence without the realization of the individual. So basically everybody denies dependence due to sheer unawareness of that fact. There is always a thin line between use and abuse and that’s where the complexity of the health issue lies.

One drink a day for women and two for men is in the healthy zone provided there are no other health ailments .

Binge drinking is more than 4 drinks in women and 5 drinks for men usually within 2 hours.

A standard drink varies from country to country. In US, a standard drink contain 12 ounce of alcohol.A carbonated drink mix increase the absorption of alcohol.

The first screening for Alcohol abuse should be done in routine health checkups in any known drinker with the CAGE questionnaire :-

C-    Have you ever felt the need to CUT down the number of drinks

A-   Have people ANNOYED you by criticizing your drinking?

G-   Have you ever felt GUILTY?

E-   Do you need an EYE OPENER drink?

If any >=2 are positive , it indicates Abuse.

Women are more susceptible than men for Alcoholic Liver Disease(ALD). It is a spectrum of diseases – Fatty Liver, Alcoholic Hepatitis, Cirrhosis. Threshold for liver disease is >60-80g/day of alcohol for 10 years.  

Drinkers with minor health issues or in routine checkup are often accidentally diagnosed with ALD. So , when one gets a diagnosis of deranged liver function tests and USG finding of fatty liver, they are advised to stop drinking so that the liver can regenerate back to its normal vitality. This is the actual progression of liver disease:-

People with Alcoholic Hepatitis or Cirrhosis  usually present with :-

• Decreased appetite, lactose intolerance, fatigue
• Jaundice, black stools, bloody vomiting, Bleeding per rectum
• Abdominal  distension

Liver Function Tests are enough for the diagnosis of ALD along with the proper clinical presentation in a known alcoholic.  An elevated  enzyme ratio AST:ALT > 1:1  is suggestive. Although GGT is often used an indicator for current drinking habits, it is actually not specific for alcohol abuse.

Management is :-

• Total abstinence from alcohol. THERE IS NO SAFE LIMIT TO DRINKING ONCE DIAGNOSED WITH ALD !!!  (Frequently encountered question out of dependence)
• Nutritional supplementation
• Medical Treatment – Steroids, Pentoxifylline
• ALCOHOL ABSTINENCE COUNSELLING AND MANAGEMENT-  this is the key to long term prognosis of the patient (but the most ignored aspect of treatment)

A  person who have been drinking for years is surely going to find it difficult to stop drinking as soon as the doctor demands. There must be a proper way to handle this issue.

Substance abuse is a field of expertise for the psychiatrist. They understand the needs of the patients and how to tackle them. There are a number of drugs like Methadone, Acamprosate, Naltrexone which help in mitigating the withdrawal symptoms (anxiety, restlessness, tremor, palpitation, increased blood pressure, insomnia, Seizures) and help in maintaining abstinence. It is not easy to handle these effects alone by the family members or in an OPD basis.

Proper Counseling for abstinence is also an adjunct to Abstinence Therapy.

Another factor contributing to substance abuse is underlying Depression or other unresolved psychiatric issues, which needs proper therapy.

Although many hesitate to take Psychiatric help for this health problem, it is actually the mainstay treatment of ALD. Without this, most fail to stop drinking and ultimately succumb to an early death. It is always  BETTER LATE THAN NEVER.

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