Asking about alcohol: What doctors need to find out

Physicians must be willing not only to listen but also to question. A whole range of illnesses may bring you patients who really need to be treated for problem drinking.

By Kathleen Phalen Tomaselli, AMNews correspondent. March 15, 2004.

Joseph A. Troncale, MD, was trained as a family physician and thought he knew about alcoholism. But it wasn't until he and several other family doctors were asked to take over a 28-bed detoxification and rehabilitation unit for the Lancaster (Pa.) General Hospital that he realized there were aspects he didn't completely grasp and that maybe he had overlooked patients in trouble. Often, he now admits, he didn't even think to ask about alcohol.

"When I was in regular family practice I lacked an understanding of the prevalence of addiction, so I took many symptoms at face value such as depression, GI distress, accidents, anxiety, marital strife," says Dr. Troncale, now certified in addiction medicine and a medical director for the Caron Foundation in Wernersville, Pa. "When I started doing addiction treatment as a large part of my practice, it became clear that the same person I would see in my office as depressed or as a chronic pain patient was really someone who needed treatment for their addiction."

Dr. Troncale's realization is supported by statistics that underscore the breadth of the problem. Nearly 18 million Americans with alcohol-use problems need treatment, but only about 4 million ever receive it. Moreover, alcohol-related disorders occur in up to 26% of general medical patients and more than 50% of hospitalized patients. These at-risk drinkers have a greater incidence of burns, falls, depression, anxiety, stomach upsets and sleep problems. Still, the root cause -- the drinking -- often continues without remark.