How is alcoholism diagnosed?

In the USA a person must meet the criteria laid out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), published by the APA (American Psychiatric Association). This includes a pattern of alcohol abuse which leads to considerable impairment or distress. The patient should experience at least three of the criteria below during the past 12 months:

Alcohol tolerance - the patient needs a large quantity of alcohol to feel intoxicated. However, when the liver is damaged and cannot metabolize the alcohol so well, this tolerance may drop. Damage to the central nervous system may also reduce tolerance levels.

Withdrawal symptoms - when the patient abstains from alcohol or cuts down he/she experiences tremors, insomnia, nausea or anxiety. Typically, the patient drinks more to avoid these symptoms.

Beyond intentions - the patient ends up drinking more alcohol, or drinks for a longer period than he/she intended.

Unsuccessfully attempting to cut down - the patient is continuously trying to cut down alcohol consumption, but does not succeed. Or the patient has a persistent desire to cut down.

Time consuming - the patient spends a lot of time obtaining, using or recovering from alcohol consumption.

Withdrawal - the patient withdraws from recreational, social, or occupational activities. This did not used to be the case.

Persistence - the patient carries on consuming alcohol even though he/she knows it is harming him/her physically and psychologically.

Some signs and symptoms of alcohol abuse may be due to another condition, or simple aging, such as memory problems, or falling. Some patients may go to their doctor about a medical condition, such as a digestive problem, and not mention their alcohol abuse. It is not always easy for a doctor to identify candidates for alcohol dependency screening. If a doctor suspects alcohol may be a problem, he/she may ask a series of questions - if the patient answers in a certain way the doctor may go on to use a standardized questionnaire. A single question can identify unhealthy alcohol use in patients, a study revealed.

Blood tests can only reveal very recent alcohol consumption. They cannot tell whether a person has been drinking heavily for a long time.

If a blood test reveals that the red blood cells have increased in size it could be an indication of long-term alcohol abuse.

Carbohydrate-deficient transferrin (CDT) - this is a test which helps detect heavy alcohol consumption. It is a blood test.

There are other tests which can indicate whether the liver has been damaged, or whether a man has reduced testosterone levels - however, screening with a good questionnaire is seen as the most effective means for an accurate diagnosis.

Most alcoholics deny they have a problem and tend to minimize the extent of their drinking. Talking to family members may help the doctor in his/her diagnosis (permission will be needed for this).

Complications of alcoholism and alcohol abuse

Usually, drinking alcohol initially elevates the person's mood. However, after a long period of regular heavy drinking the person's nervous system will become depressed and the drinker will become sedated by alcohol. Alcohol may undermine a person's judgment; it can lower inhibitions and alter the drinker's thoughts, emotions and general behavior. Heavy regular drinking can have a serious effect on a person's ability to coordinate his/her muscles and speak properly. Heavy binge drinking could cause the patient to go into coma.

Eventually, regular heavy drinking may cause at least one of the following problems:

• Fatigue - the patient is tired most of the time.

• Memory loss - especially the patient's short-term memory.

• Eye muscles - the eye muscles can become significantly weaker.

• Liver diseases - the patient has a considerably higher chance of developing hepatitis, and cirrhosis. Cirrhosis of the liver is an irreversible and progressive condition.

• Gastrointestinal complications - the patient can develop gastritis, or pancreas damage. These problems also seriously undermine the body's ability to digest food, absorb certain vitamins, and produce hormones which regulate metabolism.

• Hypertension - regular heavy drinking invariably raises the person's blood pressure.

• Heart problems - regular heaving drinking can lead to cardiomyopathy (damaged heart muscle), heart failure, and stroke.

• Diabetes - alcoholics have a very high risk of developing diabetes type 2. Patients who have diabetes will invariably have serious complications if they are regular heavy drinkers of alcohol. Alcohol prevents the release of glucose from the liver, causing hypoglycemia. A person with diabetes is already taking insulin to lower his/her blood sugar levels - hypoglycemia could be devastating.

• Menstruation - alcoholism will usually stop menstruation or disrupt it.

• Erectile dysfunction - alcoholic men are much more likely to have problems getting an erection, or sustaining one.

• Fetal alcohol syndrome - women who abuse alcohol during their pregnancy are much more likely to have babies with birth defects, including a small head, heart problems, shortened eyelids, as well as developmental and cognitive problems.

• Thinning bones - alcoholics invariably suffer from thinning of the bones because alcohol interferes with the production of new bone. This means an increased risk of fractures.

• Nervous system problems - alcoholism often causes numbness in the extremities, dementia and confused/disordered thinking.

• Cancer - alcoholics have a much higher risk of developing several cancers, including cancer of the mouth, esophagus, liver, colon, rectum, breast, prostate and pharynx.

• An international study found that the key causes of bowel cancer are alcohol and smoking.

• In fact, even moderate alcohol consumption is linked to a higher incidence of cancer among women, a study found. Another study found that consuming just two or more drinks per day could increase a person's risk of pancreatic cancer by about 22%.

• Accidents - alcoholics are vulnerable to injuries from falls, car crashes, being run over, etc. The NIH says that over half of all American traffic deaths are alcohol-related.

• Domestic abuse - alcohol is a major factor in spouse beating, child abuse, and conflicts with neighbors.

• Work (school) problems - employment problems, unemployment, school problems, are often alcohol-related.

• Suicide - suicide rates among people who are alcohol-dependent or who abuse alcohol are much higher than among other people.

• Mental illness - alcohol abuse can cause mental illness and make existing mental illnesses worse.

• Problems with the law - the percentage of alcoholics who end up in court or in prison is significantly higher compared to the rest of the population.