Doing hospital medicine, we often have patients come in for complications of binge drinking: acute pancreatitis, gastrointestinal bleeding, trauma, hypothermia, etc. Many such patients know they are alcoholics, and have spent considerable time not drinking. Over time (often I am a slow learner) I have realized that most such patients are drinking to become numb.
I should have known. How often do we watch a television show or movie and see a character go off on a bender because of some traumatic event? Just last night I was watching Lethal Weapon (the TV show). Riggs (the main character) starts drinking very heavily as the anniversary of his wife's death approaches.
Patients often endorse this. They try to treat their situational depression with alcohol. Now alcohol is a miserable antidepressant. It likely enhances the depression.
As internists we have a responsibility to help these patients through a recognition of the trigger. Almost all patients will admit to the trigger and many want help. Diagnosing alcoholism without understanding the variety of the disease misses the point.
So as a reminder to myself, always ask the patient why they restarted drinking or why they have accelerated their drinking. It rarely happens randomly.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.