#What to Ask About Alcoholism

James O'Brien

Can you help me manage my drinking, or should I see someone else?

Most primary care doctors, including family physicians and internists, are capable of helping people manage alcohol problems.

Primary care physicians in general haven t seen that as their role. I think that s changing, said Dr. Michael Fleming, a family practitioner and professor at the University of Wisconsin School of Medicine and Public Health. He has been involved with several large studies on treating alcohol problems in primary care by using brief counseling sessions and medication. The evidence is there. It does work, he said.

If your doctor thinks you need additional help or more intensive care, he or she may refer you to someone who specializes in treating alcoholism.

Do I drink too much?

In terms of what s socially acceptable or customary, moderation is highly subjective. But in terms of health, most medical experts set limits on how much constitutes binge or excessive drinking. For men, that is generally no more than 4 drinks in a day, or more than 14 in a week. Women should have no more than three drinks in a day, and no more than seven in a week.

Studies show that at-risk drinkers usually cut down once they have been told about the recommended limits and the risks of drinking too much. Your doctor can discuss how much alcohol is safe to drink, depending upon your age, sex and any medical problems you have or medications you take.

Can I drink in moderation?

The health effects of alcohol follow what s called a J-shaped curve. At one end, there are people who never drink. Consuming no alcohol seems to be neither harmful nor beneficial, and most experts say if you don t drink, it s not wise to start. But men who have one or two drinks a day, and women who have one drink a day, are about 18 percent less likely to die from any cause compared with nondrinkers. At three drinks a day for men, and two for women, the risk of dying goes up, and climbs steadily with each additional drink per day.

If I m drinking too much, is it O.K. to just cut down?

The best treatment for alcoholism is still abstinence, said Dr. Robert Swift, professor of psychiatry and human behavior at Brown University Medical School. But he notes that it is possible for some people to achieve moderation. Particularly people with mild degrees of alcohol dependence, who aren t totally out of control, can go from a six pack a day to a couple of beers a day and stay there, he said. If they can t stop or they won t stop, but they go from six beers to two beers, I applaud that. I m not going to say, Get out of my office you ve failed.

Dr. Bankole Johnson, chairman of the department of psychiatric medicine at the University of Virginia Health System, said that while abstinence was still a goal, getting toward that goal is very important. You may not be able to get somebody to quit drinking immediately, but if you can get them to actually begin to reduce their drinking, they will begin to improve.

Are there medications to stop drinking?

There are medications that can help lessen the likelihood of having a relapse when you re trying not to drink. Ask your doctor what your options are; but remember that there isn t a medical cure for alcohol dependence. Most experts advise taking medication together with one-on-one counseling or support from a program like Alcoholics Anonymous.

Three drugs are approved to treat alcohol dependence: naltrexone (known by the brand names Depade, ReVia and Vivitrol), Campral and Antabuse. Naltrexone helps lessen cravings and mutes the pleasurable effects of alcohol by blocking opioid receptors in the brain. Campral works on other chemical pathways in the brain, and it can ease some of the longer-lasting symptoms of withdrawal, like anxiety and sleeplessness. Antabuse discourages relapses by causing an unpleasant reaction, like an allergy, if you drink any alcohol while the drug is in your system.

An antiseizure and migraine drug called Topomax has also shown promise as a treatment for alcohol problems. In a clinical trial, heavy drinkers taking the drug had fewer heavy drinking days than those taking a placebo. Those taking the drug also scored better on measures of quality of life, and had lower cholesterol. body mass index and blood pressure. Although the people studied were urged to stop drinking altogether, they started taking the drug while they were still drinking. The study shows that medications may be able to lessen the harmful health effects of heavy drinking, even if a drinker doesn t completely abstain.

Will I have a hard time going through withdrawal?

If you are physically dependent on alcohol, your doctor may prescribe medicines to ease the symptoms of withdrawal when you stop drinking. If you re severely dependent on alcohol, you may need to check into a hospital for medically supervised detoxification.

I take an antidepressant. Is it harmful to drink?

Many prescription and over-the-counter medications, including antidepressants. can interact adversely with alcohol. Ask about taking your medications with alcohol.

Are any of my current health issues related to drinking?

Heavy drinking causes or aggravates many health conditions. Ask your doctor if you can expect your health to improve after you quit drinking. It can be a good incentive to stay sober if you know that your health is getting better as long as you don t drink, and that you ll be in worse shape if you start drinking again.

What resources are available to me locally?

Various social services, support groups, complementary therapies and other resources for people with alcohol problems are likely to be available in your area. Your doctor may know about something local that could be especially helpful to you.