Does This Patient Have an Alcohol Problem?

CLINICAL SCENARIO A 58-year-old man was admitted to the hospital for an elective cholecystectomy. At the time of admission, he smelled of alcohol, although he was not obviously intoxicated. On questioning he said he had come from a business lunch where he had "a drink." When questioned about his alcohol history he became angry and defensive. He said he was "offended by the implications of these questions." On the day following surgery he was found to be diaphoretic, tremulous, and hallucinating and was judged to be in alcohol withdrawal. Could other interviewing techniques have identified this man as one who was alcohol dependent and at risk of withdrawal? WHY IS THIS AN IMPORTANT QUESTION TO ANSWER WITH A CLINICAL EXAMINATION? It is estimated that more than 100 million Americans drink alcohol and that about 10% of those who drink have alcohol problems that adversely affect their lives and the lives