Table 1.

Alcohol-related problems commonly seen in primary care

SYSTEMPRESENTING COMPLAINTCLUE THAT PROBLEM MIGHT BE ALCOHOL RELATED
MusculoskeletalTrauma

  • Recurrent

  • Due to violence or assault (as perpetrator or victim)

  • Not related to sports activities

  • Not consistent with mechanism of injury

  • Occurs during or after a social event

GIGastritis and esophagitis

  • Resolves with abstinence or reduced drinking

  • Not triggered by usual risk factors such as fatty meal, NSAIDs

HepaticFatty liver
Elevated GGT or AST
Signs of liver dysfunction

  • Not explained by other conditions (eg, obesity, diabetes, viral hepatitis, medication use)

CardiovascularHypertension

  • Relatively resistant to antihypertensive medications

  • Improvement in blood pressure within weeks of abstinence or reduced drinking

NeurologicGait instability

  • Often improves within several months of abstinence

NeurologicTremor

  • Onset 8–12 h and peak 2–3 d after last drink

  • Intention and postural (but not resting)

  • Resolves immediately with resumption of drinking

  • Often accompanied by other alcohol withdrawal symptoms such as sweating and anxiety

NeurologicPeripheral neuropathy

  • Affects vibration and position sense

  • Occurs distally and bilaterally

Reproductive healthSTIs, unplanned pregnancy

  • Recurrent STIs and unplanned pregnancies

  • Repeated requests for emergency contraception advice

SleepInsomnia
Sleep apnea

  • Alcohol-induced insomnia: no trouble falling asleep but sleep disturbed by vivid dreams in the middle of the night or early morning

  • Resolves within 1–2 mo of abstinence or reduced drinking

  • Alcohol-induced sleep apnea: central or exacerbation of obstructive sleep apnea

SocialProblems with relationships at home and work

  • Fails to meet work or family obligations because of drinking or recovering from drinking

  • Is argumentative, emotionally labile, or sleepy after 4 or more drinks

PsychiatricAnxiety, depression

  • Rapid improvement in anxiety or mood with first 1–3 drinks (although mood often worsens with 4 or more drinks)

  • Worse during periods of drinking, improves within 2–4 wk of reduced drinking or abstinence

  • Relatively unresponsive to medical or counseling interventions to improve anxiety or mood

  • AST—aspartate aminotransferase, GGT—γ-glutamyl transpeptidase, GI—gastrointestinal, NSAID—nonsteroidal anti-inflammatory drug, STI—sexually transmitted infection.