DOCTOR'S CHEAT SHEET FOR ALCOHOLISM & DRUG DEPENDENCE
By William Loving, MD, ABAM
"Clinical Rounds", Travis Cty Medical Society Journal, May/June 2001
Chemical dependency begins with abuse and is characterized by tolerance, compulsive use despite harmful consequences, and persistent futile attempts to quit.
End organ of all substances of abuse is the brain. Therefore, expect symptoms/signs of dysinhibition, poor judgment and insight, moodiness, poor communication, dysfunctional relationships, neurological signs (decreased balance, decreased coordination, etc.)
Psychologically expect denial and rationalization.
Dangerous withdrawal possible from alcohol, benzodiazepines, and barbiturates (opiates cause very uncomfortable withdrawal).
Tips a problem exists: Blackouts, DWIs, arrests, fights at home, ER visits, emotional irritability, medical problems related to the drug or route of administration.
Tell tale lab:
- Elevated MCV and GGT = likely alcoholic (also increased AST and ALT)
- Decreased platelets = may be alcoholic
- Positive HIV and abnormal liver function test may mean IV drug use
Physical signs: Enlarged liver, "track" marks, jaundice, signs of trauma, excoriated nasal membranes, elevated blood pressure, abnormal neurological signs, spider angiomata, seizures, chronic cough, pinpoint pupils.
Cocaine associated with seizures and arrhythmias. Opiates associated with "track" marks, pinpoint pupils, increased pain medication seeking. Marijuana associated with amotivational syndrome.
CAGE - 1 or 2 positive answers indicate an alcohol problem (works for drugs too)
- Have you felt the need to Cut down on your drinking?
- Have you been Annoyed at others who criticize your drinking?
- Have you felt Guilty about your drinking?
- Have you had an Eye opener or a drink in the morning to calm you or help a hangover?
FOY - Has your Family, Others or You been concerned about your drug or alcohol use? (one or two positives)
How much is too much alcohol? In Britain the recommendation is for no more than 21 glasses of wine or beers per week for males and no more than 14 for females with 2 drink free days per week. In my opinion this is too much. (Females reach higher BAL due to lack of alcohol dehydrogenase in the gut lining.)
