pulsion to drink causes persons to neglect social responsibilities and relationships in favor of drinking. It can lead to accidents, occasional arrest or job loss. In the early stages of alcohol-related problems, the physical examination provides little evidence to suggest drinking problems so the questionnaire is a good tool to use. Significant signs of alcohol overuse, include gastrointestinal disorders, enlarged and sometimes tender liver, spider angiomata, varicosities and jaundice; neurologic signs such as tremor, ataxia or neuropathies; and cardiac arrhythmias. If a patient arrives at the doctors office inebriated, one should suspect a long-standing drinking problem.Men who have more than 14 drinks per week or more than four drinks per occasion are considered at risk for developing problems related to drinking. Women who have more than 11 drinks per week or more than three drinks per occasion are at risk.The physician should direct intervention efforts based on consideration of two important factors: the severity of the alcohol problem and the patients readiness to change the drinking behavior. In patients who show evidence of alcohol dependence, the therapy should be abstinence from alcohol and referral to a specialized alcohol treatment program. Decisions about inpatient or outpatient treatment depend on the patients likelihood of alcohol withdrawal, resources, employment status, family support system, access to treatment programs and motivation. Patients who do not like formal treatment may prefer peer-directed groups, such as those offered by Alcoholics Anonymous, in conjunction with physicians counseling and support. Al-Anon groups are available for adult family members of alcohol-dependent individuals. In patients who are at risk for developing alcohol-related problems or who have evidence of current problems, the therapy should be drinking at low-risk limits: for men, no more than two drinks with alcohol per day...
