Management

Whereas recognizing that the patient has an alcohol problem and making a specific diagnosis are important, it is as important to treat the alcohol use problem as it is to treat the consequences. Once a diagnosis is made, it is important to discuss with the patient appropriate treatment options for treating the alcoholism. Discussing the diagnosis of alcohol dependence with a patient often is challenging. Attitudes and perceptions on the part of both the physician and the patient may create barriers to communication. These hurdles must be overcome if the patient is to accept treatment for alcoholism. Physicians may be reluctant to discuss the diagnosis because they believe that the problem is outside their realm of competence, that treatment is ineffective, or that the patient may be offended and seek treatment elsewhere. Some physicians view alcoholism as a moral weakness or lack of willpower. This ignores how powerful the addiction to substances is. For many people, the addiction to tobacco is as strong or stronger than the addiction to alcohol, yet most physicians do not view smoking as a moral weakness.

Patients are reluctant to admit that drinking is the cause of their problem out of a sense of shame or hopelessness. Because of these feelings, it is important that the physician present the diagnosis in a nonjudgmental manner. Because many alcoholics benefit from treatment, it is also important that the physician be encouraging that their problem can be treated. Patients need to understand that there is a spectrum of severity to alcohol dependence and that alcohol dependence is not a moral weakness or a personality disorder.

The discussion of treatment should begin as a mutual exploration that alcohol is the cause of the liver disease. Explaining the significance of the elevated liver function tests may motivate the patient to accept the need to change his or her drinking. The physician may recommend specialized treatment and, if the patient agrees, then he or she should be referred to an addiction specialist or an addiction treatment program as well as Alcoholics Anonymous. It is important that the patient be seen by the alcohol treatment program immediately after the referral. "No shows" should be followed up quickly with a telephone call or letter.

The physician should remain involved throughout the course of specialized alcohol treatment. In addition to continuing to care for the liver disease, monitoring drinking status and encouraging patient efforts in treatment are helpful ways in which the physician can participate.

Patients may not accept the diagnosis. At this point, the physician should accept this and continue to work with the patient. Subsequent visits provide opportunities to discuss these issues again and influence the patient to seek treatment.