Beyond the Influence : Understanding and Defeating Alcoholism
By Katherine Ketcham
When you experience a crushing pain in your chest, you go to your doctor, who puts you through a series of tests and then, with a reliable degree of certainty, tells you whether you had a heart attack or a bad case of indigestion. When you have difficulty breathing accompanied by a high fever and exhaustion, you don't sit around in bed thinking nothing is wrong with you-you go to the doctor, who probes and pokes at your vital organs, sends you to the lab for blood work, and then offers you a firm diagnosis and several prescriptions. If you are experiencing serious gastrointestinal distress that lasts for weeks on end, your doctor uses scopes and probes to look inside you and figure out what is wrong.
The addicted brain does not reveal its secrets so readily. Scientists have not yet figured out how to design a test that will positively identify neurological addiction to alcohol or other drugs. (Someday, without a doubt, they will.) While certain laboratory' profiles are indicative of alcoholism, even the most highly sensitive tests cannot detect the disease in its early stages. In the liver, for example, fully one-third of the cells must be damaged before a liver function test shows up as abnormal. Thus, the symptoms and signs of alcoholism are often missed or misdiagnosed.
The sad truth is that you cannot diagnose alcoholism unless you recognize it, and few people are knowledgeable enough about brain addiction and the early stages of neurological adaptation to alcohol to recognize alcoholism in its early and middle stages. We all know what the late-stage drunk looks like; even a ten-year-old child can diagnose alcoholism at that stage. Early-and middle-stage alcoholics, however, go unrecognized and untreated, or they are mistakenly diagnosed as "problem drinkers" and advised to cut down on their drinking.
At this very moment, hundreds of thousands of early-and middle-stage alcoholics are carrying on their daily business as if nothing were wrong with them. Because of the stigma associated with the label "alcoholic," the fact that the disease affects logic and reasoning capabilities, and the prevailing confusion about early-stage symptoms, these "high-functioning" alcoholics will continue to drink, and their addiction will become more firmly entrenched.
A number of common laboratory tests offer information that may help in the diagnostic process. Because lab tests are highly variable, however, the absence of abnormalities should not be used to rule out alcoholism-many middle-stage alcoholics have absolutely normal laboratory tests. Also, the absence of abnormal results does not indicate normal functioning; as we have said, fully one-third of the liver's cells may be damaged before abnormalities show up on the tests.
The most common laboratory tests for alcoholism include liver tests, blood count, and blood fats.
SGOT, SGPT, GGTP, and alkaline phosphatase are cellular enzymes concentrated in liver cells. High blood levels indicate that the enzyme has leaked out of the cells into the bloodstream; thus, it can be assumed that the liver cells have been damaged.
Elevated liver enzyme levels do not tell what the specific cause of the damage is, but only that damage exists. In addition to injuries induced by alcohol, other possible causes are viral hepatitis, cancer, exposure to toxic chemicals, infections, or abscesses. In a heavy drinker, the most likely cause is alcohol.
The two liver function tests most indicative of alcoholism check levels of GGTP (gamma-glutamyl transpeptidase) and SGOT (serum glutamine oxaloacetic transaminase). If these two enzymes are elevated along with the MCV (mean corpuscular volume) in the blood count, alcoholism definitely should be suspected.
With abstinence and good nutrition, abnormal results on liver tests usually improve progressively over the first few weeks, resolving to normal by around four weeks. If the tests are still abnormal after several weeks of abstinence, other causes should be investigated.
In many alcoholics the number of red blood cells per unit of blood is reduced. Furthermore, the size of the cell, as indicated by the MCV, is often abnormally large. This indicates that the blood cell manufacturing system is faulty and is producing large, immature red blood cells, which are inefficient in their oxygen-carrying capacity. Enlarged red blood cells are commonly caused by alcohol's direct toxic effect on the bone marrow (the red blood cell manufacturing plant) and/or decreased levels of folic acid (a B vitamin that is needed for normal production of red blood cells).
This chart shows the range of normal lab values commonly seen in men and women on various blood tests. Anything outside this normal range-either higher or lower-could indicate a potential problem. Alcoholics in the middle-late and late stages of the disease tend to score outside the normal range on these tests. Liver tests and blood fats tend to be elevated in alcoholics. In the blood count tests, the RBC, WBC, and platelet counts are generally lower in late-stage alcoholics while MCV and MCHC indices are typically higher than normal.