Why Alcoholism?  A topic requested by a reader.

Alcoholism is defined as drinking so much alcohol that it creates a problem with living life.
Additionally, someone who is alcoholic, cannot stop drinking alcohol without some kind of
external help.

We do not have a clear understanding of why some people become alcoholics and others
do not.  It is no guarantee that an alcoholic parent will spawn alcoholic children, nor is
it a guarantee that abstinent parents will keep their children from alcoholism.

We do know the risk factors associated with alcoholism and it is well to know these
for reference and personal information.

Science has tried to shed light on what causes alcoholism and, we have some understanding
of the problem.  There is far to go, though, in getting this problem under control.  Recent
studies have even indicated that there are genes that specifically predispose to alcoholism.
These findings are far from firm and a lot of work remains between now and when we will
be able to use this information for treatment.

We've even figured out tests, both physical and psychological, that can help us make
a diagnosis of alcohol related illness. 

Signs and symptoms of alcoholism may vary from individual to individual but essentially
relate to living life poorly and having poor relationships either because of or in relation
to alcohol dependence.

For a good summary of alcoholism and alcohol related disease, the American Psychological
Association presents this article for review.

Recently, there has been a movement that advocates very limited drinking even as an
alcoholic.  The theory being that complete abstinence creates a sense of deprivation.

I have to say that for any doctor who has treated an alcoholic and their family,
this approach really defies reality if the disposition to drink is genetic.  It puts the family
in a position to have to monitor the alcoholic and "nag" them to stop at x-number drink.
This whole scenario has created all kinds of ill feelings on top of the already difficult
relationships that alcoholics have with their spouses and children.  In essence, it gives
an alcoholic the "out" of drinking but under sanction of knowledgeable authorities. 
"But, the counselor said I could drink just not much". 

A real problem that has emerged recently (from a treating doctor's perspective) is the
sense of news fatigue that alcohol is trouble.  So many people have acquired DWI's that
it seems that the "everyone does it" mentality has arrived.  In other words, it's no big
deal.

Recently, a patient of mine got a DWI and his wife nearly filed for divorce (after many
years of dealing with alcohol related issues but no legal matters to that point).  He lost
his license to drive for 3 months as he tested at twice the legal limit on alcohol breath test.
In the tangled aftermath, trying to solve all the issues that result from a DWI, the wife
reported that his parole officer told her husband "don't worry about it, lots of people get
DWI's".  His attorney had much the same advice (in addition to suggesting he fight the
charges in the hope that the consequences would be less than if he didn't contest the
charge).  His friends gave him pats on the back with "don't worry about it" "it happens
to everyone" sort of advice. 

This patient had more expensive insurance, had to pay for the expense of a parole officer,
had to pay for an attorney, had to get bailed out of jail, had to figure out a way to get
to and from work for 3 months, and very nearly lost his family.  Not cheap.

The sum total of an initial counselor's advice to him was "well, you just have to figure out
how much you can drink without getting into trouble and so you don't feel deprived". 
Oh, please! Like feeling deprived is some kind of torture.
Needless to say, this patient and his wife sought help elsewhere and were able to get
some real advice--advice that acknowledges that people are responsible for their actions
and that some of those consequences might be downright unpleasant.

For anyone wondering where I stand on this issue (I know you are waiting with bated
breath), let me start by saying that the first patient who ever died under my care as a
resident, was a severe alcoholic who died a very slow and agonizing death while his family
and friends watched.  He bled out because his liver quit working.  And, other than pain
control, there was not one thing I could do for him.  I learned to hate the effects of
alcohol then.  Although I cannot deny the potential beneficial effects of red wine and
red grape juice on the cardiovascular system, I have a very healthy respect for what
this substance can do to a person and their family.

Ultimately, alcoholism is a disease of families, not only because of genetics, but also because it
sucks every member of the family into the pathology of addiction and the games that
go along with that pathology.  The spouse who worries and constantly looks for clues
of alcohol consumption, the worry about safety while driving to and from work or with
the kids in the car, the possibility or reality of DWI charges (which have recently been
trivialized--"even the President of the United States has one"), the emotional terrorism
poured onto the children,  the depression, the physical/emotional abuse of family members,
the physical and psychological neglect at the hands of the alcoholic, and the eventual
physical illness and decline of the alcoholic in the absence of intervention.