100 Q&A About Alcoholism & Drug Addiction

301 Pages·2007·13.79 MB·English

by  Charles Herrick

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100 Questions & Answers
About Alcoholism
Charles Herrick, MD
New York Medical College
Charlotte A. Herrick, PhD, RN
Professor Emeritas
School of Nursing
University of North Carolina
Greensboro, North Carolina
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Library of Congress Cataloging-in-Publication Data
Herrick, Charles.
100 questions and answers about alcoholism / Charles Herrick and Charlotte A. Herrick.
p. cm.
ISBN-13: 978-0-7637-3918-8
ISBN-10: 0-7637-3918-9
1. Alcoholism—Miscellanea. 2. Alcoholism—Popular works. I. Herrick, Charlotte A. (Charlotte Anne),
1933- II. Title. III. Title: One hundred questions and answers about alcoholism.
RC565.H3735 2007
616.86’1—dc22
2006035895
2404
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this book may not be applicable to all patients; likewise, some patients may require a dose or experience a
side effect that is not described herein. The reader should confer with his or her own physician regarding
specific treatments and side effects. Drugs and medical devices are discussed that may have limited avail-
ability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical
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Contents
Introduction v
Acknowledgments ix
Part 1:The Basics 1
Questions 1–12discuss fundamental questions about alcohol, including:
• What is alcohol?
• Is alcohol a drug?
• When and how was alcohol discovered?
Part 2:Diagnosis 41
Questions 13–19discuss the recognition and diagnosis of alcoholism, including:
• What is the DSM-IV?
• What is alcohol dependency?
• What is alcohol abuse?
Part 3:Risk,Prevention,and Epidemiology 63
Questions 20-33discuss factors contributing to alcoholism, such as:
• What is the prevalence of alcohol use and alcoholism?
• What other risk factors are associated with alcoholism?
• How can I prevent my kids from drug and alcohol abuse?
Part 4:Treatment 93
Questions 34-60detail treatment options, including:
• Who is qualified to diagnose and treat alcoholism?
• What is AA, and how does it work?
• What is ASAM, and what are the criteria for placement in a particular program?
Part 5:Associated Conditions 157
Questions 61-74address concerns about other medical conditions associated with
alcoholism, for example:
• What are the medical consequences of alcoholism?
• Can alcoholism cause dementia?
• Are there other neurological effects of alcoholism?
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Part 6:Special Populations 187
Questions 75-89explain the effect alcohol has on different populations, such as:
• My baby was born with fetal alcohol syndrome. What is that, and what does it
mean for my baby?
• How do I know whether my child is just experimenting with alcohol and drugs
or has a real problem with them?
• How are men and women different in their response to alcohol?
Part 7:Surviving Alcoholism 231
Questions 90-100focus on survival, personal rights, and resources, including:
• Will I ever be able to drink again?
• I was arrested for a DUI. What should I do?
• What are my rights to privacy?
Appendix 257
Glossary 261
Index 281
iv
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Introduction
Perhaps no medical topic arouses more confusion,dismay,and pas-
sion in both the public and the medical profession than alcoholism.
Although alcohol is often associated with joy and celebration, rit-
ual, and reverence, alcoholism is associated with sorrow and moral
failing,disease,and death.No other disease entity can be conceived
as having such extreme attributes.This is particularly evident in our
country since its inception, where attitudes toward alcohol con-
sumption have swung back and forth from liberal use to strict pro-
hibition. The debates that stirred the American Revolution
occurred more often in taverns than churches. Witness the most
recent popular movie Sideways,in which wine brought out the best
and worst of two friends,arousing aesthetic appreciation,love,pas-
sion, anger, and betrayal, but ultimately humor. Wine was never
blamed, and sales of pinot noir increased dramatically. Contrast
that movie with an earlier one, Leaving Las Vegas, that also gar-
nered critical acclaim but with less popular appeal. It portrayed a
man who was inevitably successful in drinking himself to death.At
one extreme,alcohol represented bacchanalian reverence,and at the
other,it represented a living hell.
We currently live in a culture that has little tolerance for risk;
thus,drugs such as Vioxx and Ephedra are banned from the market
because of their perceived dangers.This perception of risk is based
on emotion, however, not on fact. Society’s decision to ban certain
substances while allowing others to be freely available has little to
do with the dangers inherent in any particular substance,and it has
more to do with the emotional outcry that a particular substance
engenders. For example, consider the seemingly benign over-the-
counter medication acetaminophen, or Tylenol. Tylenol was first
introduced in 1956. About 150 acetaminophen-related deaths are
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reported every year in the United States alone. Add to
that the associated morbidity and mortality from those
requiring liver transplants from Tylenol overdoses, and
the numbers become even greater. Contrast that with
Ephedra, a once hugely popular drug for weight loss
and bodybuilding that has been linked to a grand total
of 155 deaths. The deaths from Vioxx are more diffi-
cult to calculate because these deaths are primarily
from patients already suffering from cardiovascular
disease and not from the direct effects of the drug
itself.The estimates suggest up to 27,000 deaths since
its introduction in 1999. The outrage leading to its
removal had more to do with the company’s refusal to
Alcohol is the acknowledge the risks than the risks themselves.Alco-
single most hol, however, is responsible for approximately 85,000
unique intoxi- deaths annually from injuries or diseases directly
cant because it related to the use or abuse of alcohol. Thus, people
is a legal,non- often judge the risks and benefits of a particular sub-
prescription, stance based more on cultural, religious, and moral
and culturally beliefs than on scientific fact.Alcohol is a prime exam-
sanctioned ple (see Part 3 for more information about risk).
substance that Alcohol is the single most unique intoxicant
causes more
because it is a legal, nonprescription, and culturally
devastating
sanctioned substance that causes more devastating
effects to
effects to human lives than any other known drug,
human lives
whether available by prescription or over the counter
than any other
or on the street.Prohibition,the one attempt in Amer-
known drug,
ican history to prohibit alcohol use, was a miserable
whether
failure, with the cure being worse than the illness.
available by
Although it successfully cut the deaths from cirrhosis
prescription or
in half,it came at the cost of increased crime and social
over the
unrest.
counter or on
Ingesting anything—medicine, an illegal drug, or
the street.
even food—is an act that entails a degree of risk.
vi
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I
n
t
Therefore, people should understand the risks and the ro
d
alternatives before ingesting anything. Informed con- u
c
t
sent is both a legal and an ethical responsibility of io
n
healthcare providers to ensure that their patients are
knowledgeable about the drugs they are ingesting,
including over-the-counter medications, herbal reme-
dies, street drugs, food, and alcohol (see Question 99
for a more detailed discussion of informed consent).
This book on alcohol and alcoholism provides nec-
essary information for readers to make informed deci-
sions. Examining the topic of alcohol and addiction
will also provide readers with information about the
influence of alcohol on their own personal well-being.
Although the focus of this book is on alcohol and alco-
holism, many of the questions and answers pertain to
other addictive substances and behaviors as well, and
thus, this book may offer some useful insight into the
nature of addiction on a more general level.
We live in a time when there is a belief that scien-
tific facts will ultimately help in legislating morality.
The culture wars, whether they are fighting over
health care, the environment, or other social issues,
muster their troops of “scientific experts” when calling
on the “facts”to forge political,legal,and moral policy.
This is no more evident than the “war on drugs,” in
which both sides argue persuasively for the need to
continue or abandon current policies.
Although the institution of medicine has accepted
the concept of alcoholism as a disease, the larger cul-
ture with its personal values and beliefs, which
includes healthcare providers themselves, continues to
debate the issue, with many still viewing alcoholism as
a moral failing. This book examines the facts of alco-
holism. The following controversial perspective about
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alcoholism is discussed: Is it a disease or a moral fail-
ing? Hopefully a path may be developed in order to
find the way out of this no-man’s land, where emo-
tions, rather than reason, have left a field littered with
the broken lives of those who this horrible affliction
has devastated. Because of the controversy of alco-
holism as a disease or a moral failing, this book
explores the controversy at length so that the reader
can be properly informed about the issues and thus be
better prepared to understand them in a way that is
empowering rather than confusing.
Susan’s comment:
We celebrated when Ben recently had his 30th birthday.
Nearly 6 years ago,while driving,he lost control of the car.
The person behind him was very alert, stopped quickly,
and found him slumped over the wheel and foaming at the
mouth. When the ambulance arrived, Ben was awake but
didn’t remember what had happened. After many hours
and a battery of tests in the emergency room, a place that
would become very familiar in the coming years,the doctor
explained the diagnosis of an alcohol withdrawal seizure.
My reply, as well as his sister’s, was “thank you, but I was
interested in a medical report, not social work.” According
to Dr. Herrick, his psychiatrist and co-author of this book,
Ben is a “malignant alcoholic”who is still alive—30 hospi-
tal trips and 7 rehabs later.
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Acknowledgments
This book is dedicated to my family, particularly my wife, who
allowed me the time and provided me with invaluable assistance in
completing this book.
I would also like to thank my children,who had to put up with
my preoccupation with this book for so many weekends.
It is also dedicated to the many patients that I have had the
privilege to treat. I am constantly surprised and impressed by their
persistence in the face of adversity.
Finally, my hope is that this book may prove useful to not only
patients and their families, but to physicians and other healthcare
providers who continue to struggle with understanding this
unusual disease.
Charles Herrick,MD
I want to express the honor and pleasure that I have experienced by
co-editing a book with my son, Charles Herrick. I am a proud
mother!
I want to thank my husband, Bob Herrick, and Chuck’s father
for his support and patience in helping us to see this project to
fruition.
Most of all I would like to thank Ana Cristina Herrick,
Chuck’s wife, for being the liaison between the co-authors. She
coordinated our efforts, provided editorial comments and con-
tributed creative ideas to explore the issues.She was the “lynch pin”
who made it come together!
Charlotte A.Herrick,PhD,RN