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Diagnosis of Alcoholism

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Diagnosing alcoholism can be tricky, since the diagnosis depends on the drinker being willing to honestly answer a series of questions about his or her drinking patterns and attitudes.
This is a problem because a common symptom of alcoholism is denial. An old adage about alcoholism is it's "the only disease that denies it exists and resists treatment." If someone is not willing to be honest about their drinking habits, it is difficult, if not impossible, to accurately diagnose alcohol abuse or alcohol dependence.

Family and Friends See the Problem

Long before drinking problems are diagnosed in a healthcare setting, they are usually recognized by the friends and family of the drinker. Those close to the drinker see someone continue to drink in spite of all the problems it causes in their lives, and they correctly diagnose that the person has a drinking problem.
The friends and family members may try to talk to the drinker about the problem and encourage him/her to get help, but again, denial comes into play. Denial is so common in people with alcohol abuse problems that denial itself is a warning sign of alcoholism. The drinker simply does not see, or refuses to admit, that alcohol use is the source of problems.

Moreover, alcohol problems are rarely diagnosed during routine visits to the doctor or even during hospitalizations. People with alcohol abuse disorders are diagnosed properly less than 30 percent of the time. Physicians routinely do not recognize the symptoms, and when they do, they may be relunctant to confront their patients about their drinking problems.

Over the years, there have been many diagnostic tests developed to screen for and evaluate drinking problems. To deal with the denial problem, most of these tests do not ask direct questions about how much the person drinks, but ask questions about problems associated with drinking instead.
There are hundreds of alcohol screening tests available, including many detailed examinations with dozens of questions. In recent years, shorter tests have been developed to encourage screening for alcohol problems in urgent care centers and primary healthcare settings, which have been shown to be excellent opportunities to reduce harmful drinking with brief interventions.

The shorter, four-to-five question alcohol screening tests are effective in the initial screening to detect alcohol abuse or dependence, while the longer, more elaborate tests are used to do more in-depth evaluation and assessment.

Regardless of what tool is used to determine the drinker's level of involvement with alcohol, medical professionals use the responses to determine how many of the seven major symptoms of alcohol dependence the drinker is experiencing.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the symptoms of alcohol dependence include:

Neglect of Other Activities: The drinker's alcohol use reduces or eliminates important social, work-related or recreational activities.

Excessive Use: The drinker begins to consume larger amounts of alcohol over a longer period of time than intended.

Impaired Control: The drinker makes repeated unsuccessful attempts to cut down or control how much he/she drinks.

Persistence of Use: The drinker continues to consume alcohol despite knowing that his/her drinking is causing or contributing to a persistent or recurrent physical or psychological problem.

Large Amounts of Time Spent in Alcohol Related Activities: The drinker spends an abnormal amount of time on activities involved with obtaining, using and/or recovering from the effects of alcohol.

Withdrawal: When the drinker stops drinking for a short period of time, he/she experiences symptoms such as nausea, sweating, shaking or anxiety.

Tolerance: The drinker needs increasing amounts of alcohol to achieve the same level of intoxication.

For those drinkers who may be trying to determine if their drinking has reached the level of alcoholism, or alcohol dependence, there are some common-sense questions that might provide the answers. Simply put, if you have to ask, you probably have a problem. "Normal" drinkers don't wonder if their drinking is a problem. They don't even think about it.
If you have tried to quit drinking - swore to yourself that you would never drink again - and found yourself a few days or a week later drinking again, you probably have a problem. If you have tried to quit and cannot do so, you are no longer in control; alcohol is in control of your life.
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