Alcoholism: early diagnosis and intervention

Alcoholism, more than any other illness, requires the integration of social and family history, physical symptoms and signs, and laboratory data in order to make a firm diagnosis. Common in alcoholism is the patient's minimization or denial of the disease and its symptoms, thwarting efforts at early diagnosis and intervention. If early diagnosis is to be made, several points should be remembered: 1. Life problems associated with alcohol use are the earliest signs of the disease. 2. There are few reliable early physical symptoms and signs. 3. Laboratory markers of alcoholism are neither sensitive nor specific when used alone as screening tools. 4. Alcoholism questionnaires, e.g., the MAST or the CAGE, should be a part of routine office practice in screening for alcoholism. Effective therapy is available, but early diagnosis is necessary for the best outcome. Gallant has reminded us of the "tragedy of delayed treatment." Early recognition of alcoholism puts the internist, as well as other primary care providers, in the best position to begin the process of healing the patients and their families.