Alcoholism: A Guide for the Primary Care Physician by Henrietta N. Barnes, Mark D. Aronson, Thomas L. Delbanco,

By Henrietta N. Barnes, Mark D. Aronson, Thomas L. Delbanco, Julius B. Richmond, A. Abrams, M.D. Aronson, H.N. Barnes, R.D. Bayog, M. Bean-Bayog, J. Bigby, B. Bush, M.G. Cyr, J. Daley, T.L. Delbanco, J. Ende, A.W. Fox, P.A. Friedman, M.E. Griner, P.F. Griner

Based at the Commonwealth Harvard Alcohol learn and educating software, this clinically orientated paintings is designed to offer internists and first care practitioners the data and abilities essential to realize and deal with sufferers with alcoholism.

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Implications for the Practitioner Although the course, manifestation, and prognosis of alcoholism are extremely variable, the pessimism of the emergency room physician in the case presented at the beginning of the chapter does not seem warranted. Some alcoholics recover; many improve. If the goal with alcoholic patients, as with people who suffer from other chronic diseases, is to palliate suffering, lengthen periods of remission, and improve function, knowledge of the natural history ofthe disease will allow physicians to respond appropriately to their alcoholic patients.

12 How Does a Person Develop Alcoholism? Why someone continues to drink excessively when there are known adverse consequences is a question that frequently plagues physicians. Understanding how a person develops dependence on alcohol can begin to answer that question. Although it is impossible to predict who of those who are at risk for alcoholism will actually develop the disease, once the process has started there is a fairly characteristic pattern of psychologic and behavioral events. Drinking alcoholic beverages is a learned behavior.

Recovery rates with treatment are not significantly better than the rate for spontaneous recovery. However, they show that recovery is more closely associated with patient characteristics than with the particular type of treatment. 23 Premorbid social stability, particularly marital status and employment, is associated with a positive outcome. Although this association could be dismissed as a tautology indicating only that healthier people do better, it also suggests that early intervention in alcoholism may lead to a better outcome.

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