Men who consume 15 or more drinks a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or more drinks per occasion at least once a week are all at risk for developing alcoholism. (One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor).

The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:

• Have you felt that you should cut down on your drinking?
• Do you ever drive when you have been drinking?
• Is someone in your family concerned about your drinking?
• Have you ever had any blackouts after drinking?
• Have you ever been absent from work or lost a job because of drinking?
• Do you have to drink more than before to achieve intoxication or the desired effect?

Some of the symptoms associated with alcoholism include:

• Drinking alone
• Making excuses to drink
• Need for daily or frequent use of alcohol for adequate function
• Lack of control over drinking, with inability to discontinue or reduce alcohol intake
• Episodes of violence associated with drinking
• Secretive behavior to hide alcohol related behavior
• Hostility when confronted about drinking
• Neglect of food intake
• Neglect of physical appearance
• Nausea and vomiting
• Shaking in the morning
• Abdominal pain
• Numbness and tingling
• Confusion

Alcohol withdrawal symptoms vary from mild to severe and may include:

• Rapid heart rate and sweating
• Restlessness or agitation
• Loss of appetite, nausea, or vomiting
• Confusion or hallucinations
• Tremors and seizures

All physicians should ask their patients about their drinking. A history may be obtained from family if the affected person is unwilling or unable to answer questions. A physical examination is performed to identify physical problems related to alcohol use.

• A toxicology screen or blood alcohol level confirms recent alcohol ingestion, which does not necessarily confirm alcoholism.
• Liver function tests can be elevated. GGPT (glutaryl transaminase) is often elevated more than other liver function tests.
• CBC (complete blood count) - MCV can be elevated (mean corpuscular volume or size of the red blood cells).
• Serum magnesium, uric acid, total protein, and folate tests may be abnormal.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:428-439.

Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: WB Saunders; 2004:79-80.