Care of the Alcoholic Patient

  • Gerald M. Cross
  • Kenneth A. Hirsch
  • John Allen


Individuals with alcohol problems are disproportionately represented in the primary care population. In that setting, 11% to 20% of patients meet diagnostic criteria for alcohol dependence or abuse.1 The family physician’s role in the care of patients with alcohol problems may include screening, brief intervention, identification of affected family members, pharmacotherapy for craving, detoxification, treatment of associated medical problems, and referral for consultation and rehabilitation.2,3


Alcohol Problem Alcohol Withdrawal Blood Alcohol Concentration Alcoholic Hepatitis Fetal Alcohol Syndrome 
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  1. 1.
    Bradley K. The primary care practitioner’s role in the prevention and management of alcohol problems. Alcohol Health Res World 1994;18(2):97–104.Google Scholar
  2. 2.
    Barry K, Fleming M. The family physician. Alcohol Health Res World 1994;18(2):105–9.Google Scholar
  3. 3.
    Alexander D, Gwyther R. Alcoholism in adolescents and their families. Pediatr Clin North Am 1995;42:217–30.PubMedGoogle Scholar
  4. 4.
    US Department of Health and Human Services. The seventh special report to the U.S. Congress on alcohol and headlth. Rockville, MD: Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1990:ix, xv, xxii, xxiv, 26, 27,33,34–36,46,119,123,141.Google Scholar
  5. 5.
    Blose J, Holder H. Injury-related medical care utilization in a problem drinking population. Am J Public Health 1991;81: 1571–5.PubMedCrossRefGoogle Scholar
  6. 6.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Press, 1987:173.Google Scholar
  7. 7.
    Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: Government Printing Office, 1991. DHHS Publ. No. (PHS) 91–50213.Google Scholar
  8. 8.
    Baer J, Stacy A, Larimer M. Biases in the perception of drinking norms among college students. J Stud Alcohol 1991;52: 580–6.PubMedGoogle Scholar
  9. 9.
    Smith D. Social and economic consequences of addiction in America. Commonwealth 1996;90(5):1–4.Google Scholar
  10. 10.
    Parker DA, Harford TC. Gender-role attitudes, job competition and alcohol consumption among women and men. Alcohol Clin Exp Res 1992;16:159–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Brower K, Blow F, Beresford T. Treatment implications of chemical dependency models: an integrative approach. J Subst Abuse Treat 1989;6:147–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Devor E. A developmental-genetic model of alcoholism: implications for genetic research. J Consult Clin Psychol 1994; 62:1108–15.PubMedCrossRefGoogle Scholar
  13. 13.
    Kaprio J, Viken R, Koskenvuo M, Romanov K, Rose R. Consistency and change in patterns of social drinking: a 6-year follow-up of the Finnish Twin Cohort. Alcohol Clin Exp Res 1992;16:234–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Wall T. Ehlers C. Acute effects of alcohol on P300 in Asians with different ALDH2 genotypes. Alcohol Clin Exp Res 1995;19:617–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Kranzler H, Anton R. Implications of recent neuropsychopharmacologic research for understanding the etiology and development of alcoholism. J Consult Clin Psychol 1994;62: 1116–26.PubMedCrossRefGoogle Scholar
  16. 16.
    DiPadova C, Worner T, Julkunen R, Lieber C. Effects of fasting and chronic alcohol consumption on the first-pass metabolism of ethanol. Gastroenterology 1987;92:1169–73.PubMedGoogle Scholar
  17. 17.
    Goldstein DB. Pharmacology of alcohol. New York: Oxford University Press, 1983:80.Google Scholar
  18. 18.
    Maddrey W. Alcoholic hepatitis: clinico-pathologic features and therapy. Semin Liver Dis 1988;8:91–102.PubMedCrossRefGoogle Scholar
  19. 19.
    Geokas M. Ethanol and the pancreas. Med Clin North Am 1984:60–7.Google Scholar
  20. 20.
    Bell G, Lau K. Perinatal and neonatal issues of substance abuse. Pediatr Clin North Am 1995;42:261–81.PubMedGoogle Scholar
  21. 21.
    Mattson S, Jernigan T, Riley E. MRI and prenatal alcohol exposure. Alcohol Health Res World 1994;18(1):49–52.Google Scholar
  22. 22.
    Day N, Richardson G. Prenatal alcohol exposure: a continuum of effects. Semin Perinatol 1991;15:272–9.Google Scholar
  23. 23.
    US Department of Health and Human Services. Moderate drinking. Alcohol Alert 1992;16:2–3.Google Scholar
  24. 24.
    Rimm EB, Giovannucci EL, Willet WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet 1992;338:464–8.CrossRefGoogle Scholar
  25. 25.
    Allen J, Maisto S, Connors G. Self-report screening tests for alcohol problems in primary care. Arch Intern Med 1995; 155:1726–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994: 176–83.Google Scholar
  27. 27.
    Connors GJ. Screening for alcohol problems. In: Assessing alcohol problems: a guide for clinicians and researchers. Washington, DC: DHHS, 1995:17–29.Google Scholar
  28. 28.
    Ewing JA. Detecting alcoholism, the CAGE questionnaire. JAMA 1984;252:1905–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Selzer ML. The Michigan alcoholism screening test: the quest for a new diagnostic instrument. Am J Psychiatry 1971;127: 1653–8.PubMedGoogle Scholar
  30. 30.
    US Department of Health and Human Services. Assessing alcohol problem. Rockville, MD: DHHS, 1995: Series 4:11, 22, 260. NIH Publ. No. 95–3745.Google Scholar
  31. 31.
    Litten RZ, Allen JP, Fertig JB. γ-Glutamyltranspeptidase and carbohydrate deficient transferrin: alternative measures of excessive alcohol consumption. Alcohol Clin Exp Res 1985; 19:1541–6.CrossRefGoogle Scholar
  32. 32.
    American Society of Addiction Medicine. Patient placement criteria for the treatment of substance related disorders. 2nd ed. Chevy Chase, MD: American Society of Addiction Medicine, 1996.Google Scholar
  33. 33.
    King A, Errico A, Parsons O, et al. Blood pressure dysregulation associated with alcohol withdrawal. Alcohol Clin Exp Res 1991;15:478–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Mander A, Young A, Merrick M, et al. Fluid balance, vasopressin and withdrawal symptoms during detoxification from alcohol. Drug Alcohol Depend 1987;24:233–7.CrossRefGoogle Scholar
  35. 35.
    Foy A, March S, Drinkwater V. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. Alcohol Clin Exp Res 1988;12:360–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Nutt D, Glue P. Neuropharmacological and clinical aspects of alcohol withdrawal. Ann Med 1990;22:275–81.PubMedCrossRefGoogle Scholar
  37. 37.
    Kramp P, Rafaelsen O. Delirium tremens: a double blind comparison of diazepam and barbital treatment. Acta Psychiatr Scand 1978;58:174–90.PubMedCrossRefGoogle Scholar
  38. 38.
    Koranyi E, Ravindran A, Seguin J. Alcohol withdrawal concealing symptoms of subdural hematoma—a caveat. Psychiatr J Univ Ottawa 1990;15:15–17.Google Scholar
  39. 39.
    Vaillant G. A summing up: the natural history of alcoholism. Cambridge: Harvard University Press, 1983:307–16.Google Scholar
  40. 40.
    Cross G, Morgan C, Mooney A, Martin C, Rafter J. Alcoholism treatment: a ten-year follow-up study. Alcohol Clin Exp Res 1990;14:169–73.PubMedCrossRefGoogle Scholar
  41. 41.
    Negrete J. The role of medical schools in the prevention of alcohol related problems. Can Med Assoc J 1991;143:1048–53.Google Scholar
  42. 42.
    Hoadley J, Fuch B, Holder H. The effect of alcohol beverage restrictions on consumption: a 25 year longitudinal analysis. Am J Drug Alcohol Abuse 1984;10:375–401.PubMedCrossRefGoogle Scholar
  43. 43.
    O’Malley P, Wagenaar A. Effects of minimum drinking age laws on alcohol use, related behaviors and traffic crash involvement among American youth: 1976–1987. J Stud Alcohol 1991;52:478–91.PubMedGoogle Scholar
  44. 44.
    Jones N, Pieper C, Robertson L. The effect of legal drinking age on fatal injuries of adolescents and young adults. Am J Public Health 1992;82:112–15.PubMedCrossRefGoogle Scholar
  45. 45.
    Mann R, Vingilis E, Gavin D, Adlaf E, Anglin L. Sentence severity and the drinking driver: relationships with traffic safety outcome. Accid Anal Prey 1991;23:483–91.CrossRefGoogle Scholar
  46. 46.
    Green R, French J, Haberman P, Holland P. The effects of combining sanction and rehabilitation for driving under the influence: an evaluation of the New Jersey Countermeasures Program. Accid Anal Prey 1991;23:543–55.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Gerald M. Cross
  • Kenneth A. Hirsch
  • John Allen

There are no affiliations available

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