6 - Alcoholism, nicotine dependence, and drug abuse

Summary

Case: Mrs A., a middle-aged, smartly dressed woman who prided herself on her homemaker skills, came to see her family practitioner, Dr B., complaining of tiredness, depressed mood, anxiety, disturbed sleep, and weight gain. Dr B. knew that her husband, a well-known local politician, had recently left her for a younger woman, so he tactfully avoided that subject, asking instead after her grown children who lived out of state. After questioning Mrs A. about her symptoms, Dr B. concluded that she might be hypothyroid, depressed, anemic, or all three, and ran the appropriate tests. Several visits later, after normal test results and a failed trial of antidepressants, Dr B. was feeling baffled until Mrs A. finally broke down in tears and revealed the cause of her symptoms. She had been a heavy drinker in her youth but had managed to stop when she had decided to have children. However, the recent stress and humiliation of her husband's desertion and subsequent loss of self-esteem, social status, and role in life had been too much for her and she had taken to comforting herself during her long and empty days at home by drinking. Although she made great efforts to hide her drinking problem, she had now reached the point where she could no longer control her urge to drink and was frightened and desperate for help but feared the social stigma of being labeled an alcoholic.

Introduction

Mid life is a vulnerable time for women, both for the development of problem drinking and alcoholism and for the manifestation of the medical consequences of long-term addiction to alcohol and tobacco.