Alcoholism is a disease that manifests itself through social, medical, legal, and family consequences. Alcohol dependence and alcohol abuse are amenable to reliable diagnostic criteria. Subjectively, the alcoholic struggles with prolonged cravings for the substance, fear of functioning without alcohol, and doubts about his or her ability to abstain, and hence to recover. Concomitant with the ambivalent struggle to change, the alcoholic endures remorse, regret, guilt, and shame.
The physician, if not cognizant of the protean manifestations of this disease, or if blinded to the suffering of the patient by the alcoholic's often outrageous behavior, may miss or decline to take the opportunity for a life-changing clinical encounter. On the other hand, the physician prepared for the diagnosis and treatment of addictive disorders will find clinical experiences that contradict the pessimism often instilled during training years.
The psychiatrist's role in the treatment of alcoholism is especially pertinent given the significant issue of comorbidity and the biopsychosocial orientation of modern psychiatry. With an understanding of the overlapping relationships between substance use disorders and other psychiatric disorders, and an ability to establish treatment priorities, the psychiatrist is in a unique position to provide medical leadership to treat effectively this complex biopsychosocial disorder.
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