Alcoholism - The Subtle Sickness
by Ray Fowler, MD
Copyright Jan 1, 1988

(Time in Space Home)

            Somewhere between 10 and 20 per cent of Americans will have a serious alcohol problem some time in their lives. An even larger number will flirt with alcohol dependence for many years. Our highways are splashed with the blood of dead, dying, or seriously wounded victims of drunken drivers. Who are these alcoholics? Do they know who they are? Why are they getting away with it?

            As someone who in his own life very much enjoys a glass of fine wine, and maybe even two glasses if I am at home, I often wonder what makes a person an "alcoholic" and how I can keep from becoming one, whatever it may be.

            I have been involved with the medical evaluation and treatment of some two thousand alcoholics over the last twenty years. I will discuss here general characteristics of alcoholics based upon my direct observations. Then, I want to challenge anyone reading this column to hold himself or herself up to this thinly shining light to see if any of the behavior fits. If it does, then you must think twice about any further use of alcohol.

            A few months ago a friend of mine, a sober alcoholic for 15years, noted that I enjoy a drink. He bet me that I could not go without a drink for 10 days. I took the bet ($20) and completed the 10 days without an incident. The one thing I did notice during that period was that I was accustomed to having good red wine with my Italian meals. Water with the meal, while healthy, just wasn't quite the right fit for me.

            However, no problems. It soon occurred to me that this was a very useful test to determine if someone is an alcoholic. Therefore, let me issue this challenge to anyone reading this column right now. If you drink alcohol and if you do so regularly, starting at this moment, do not take a drink for ten days. If you have shakes and tremors or if you cannot finish the ten days, you may have a problem that needs some professional evaluation.

            What are the signs of an alcoholic? Regular use of alcohol is a clue. To a NON-ALCOHOLIC two regular drinks (which is the same as two beers or about eight ounces of wine) every day or two is harmless. The new "mediterranean diet", approved by the World Health Organization, has included one glass of wine daily as a reasonable option to accent the diet and possibly reduce the risk of heart disease.

            To a known alcoholic, however, ANY alcohol use is a sign of relapse and must be treated. FAMILY MEMBERS OF KNOWN ALCOHOLICS PLEASE REMEMBER THIS!

            Beware of regularity of alcohol use even in moderate quantities. I saw a medical professional once who was in treatment because he drank a six pack of beer every day, at home in front of the TV not hurting anybody. After several years of this his wife insisted that he get treatment. Regularity of use was the key. He was dependent on that evening intoxication to get him through the next day.

            Drinking to drunkenness is a likely sign of alcoholism, or at least a clue of someone at risk of being an alcoholic. Somebody who gets blitzed once in his life at a fraternity party and never again is probably not a drinker. Somebody who weekly, maybe even monthly, drinks to being very drunk with slurred speech and a bad hangover the next day is an alcoholic. Sound familiar?? Ring any bells??

            Morning use of alcohol is a sure definition of the disease. Alcohol is both a food additive and a sedative. Someone having the need to down a few beers in the morning to get the day rolling is, in fact, having to keep his blood alcohol concentration (BAC) high enough to prevent withdrawal shakes from developing.

            One conviction for driving under the influence with a BAC of certainly makes one a candidate, and three DUI's brands one permanently. Anybody can get in trouble, get up and dust himself or herself off, and straighten out. Inability to stay out of trouble with alcohol implies dependency. Anyone who has had a DUI with a BAC higher than .14 is an alcoholic in my opinion UNLESS he or she can turn his or her back on alcohol and never use it again. Along that same line, if you have ever CAUSED an accident directly related to alcohol use while driving, you are an alcoholic unless a medical professional tells you otherwise. Stop drinking now. Get help if you cannot.

            Literally hundreds of alcoholics that I have treated have proudly told me over the years that they have never missed a day of work in their lives. That's all well and good, but I wonder how many days they've smelled of alcohol at work, or had "maybe just one beer" before work, or drank during lunch, or had to rush to the bar RIGHT AFTER work to have a quick six pack. Not missing work does NOT keep somebody from being an alcoholic.

            The blood alcohol concentration in a patient with a healthy liver drops at about .02 per hour. This means that if you weren't drunk last night, meaning less than .10, then you won't smell alcohol on your breath in the morning. Smelled alcohol on your breath in the morning lately? If you have, you highly intoxicated the night before, whether or not you realized it.

            Speaking of the night before, have you had nights where you COULDN'T REMEMBER the night before because of how much you drank? You were probably over twice legal drunk at that time (above .16, which is very drunk). Did you drive home? Do you remember if you drove home? Is there some part of that time that is just blacked out that you don't remember? You certainly have alcoholic characteristics.

            Do you ever C-R-A-V-E a drink? Gotta have one R-E-A-L bad?? Beware, then, because you are using a chemical to alter the way you feel. Craving is a sure sign of a problem. If you are just dying for that martini at the end of the day, try stopping off at the health spa instead. Have a Gatorade later.

            Have you had physical diseases related to drinking, such as cirrhosis of the liver, recurrent alcoholic pancreatitis, or alcoholic heart disease.? You're an alcoholic, and you better NEVER touch a drop again, not even "just one".

            Remember: Alcoholics cannot drink. There is no such thing as an alcoholic who can become a social drinker. They simply must stop drinking, because when they are drinking, they cannot stop.

            If you drink alcohol, start counting your drinks and don't drink over two drinks in a day. If you can't keep from drinking over two, then stop drinking. Get professional help if you cannot stop. Beware of regular alcohol use. Don't let yourself drink every day.

            Do this for yourself. Do it for your family. Start now to control a habit that too easily gets out of control.