Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: Is there such a thing as a functional alcoholic? — Anon.
ANSWER: The term “alcoholic” is imprecise and no longer used. There are several conditions to describe problem drinking, including risky use of alcohol, which puts a person at risk for health consequences.
Although any given individual may have a greater or lesser tolerance for alcohol, people put themselves at an increased overall health risk if they have more than 14 drinks per day (a standard drink is 14 grams of alcohol — about the alcohol content of one 5-ounce glass of wine, 12 ounces of beer or 1 1/2 ounce of distilled spirits, although these also may vary) or four drinks on any day for men under 65. For women and men over 65, more than seven drinks a week or three on any day puts them at risk.
Alcohol use disorder, which may be what you are thinking of when you say “alcoholic,” is when alcohol use leads to significant impairment or distress. People who often drink more than they intended to, who are constantly trying to cut down, who spend time trying to get or recover from alcohol, or who get cravings are those likely to have alcohol use disorder; in fact, these are some of the criteria to make the diagnosis.
Problems with drinking are another part of the diagnosis. Being unable to function at home, work or school is a major red flag. So, when you say “functional,” it’s a bit of a leading question, since poor function is part of the diagnosis. But a person doesn’t need to have poor function in all areas.
Many people with very significant alcohol use disorder, one which has profoundly affected their personal and social lives, may nonetheless be an outstanding worker. I have known people who say they can’t have a problem with drinking because they are great at their job, but their drinking may have cost them relationships. Eventually, many people with alcohol use disorder will have problems at work as well.
There are many ways to get help with problem drinking, starting with your doctor or an addiction specialist for counseling (and sometimes medication), but also a mutual help group such as AA. Family members and friends may recognize someone with problem drinking, but unless the person themselves realizes it, it can be very hard to get them to get help.
DEAR DR. ROACH: What are the methods for getting rid of varicose veins? — M.M.
ANSWER: Varicose veins are swollen, twisted veins that often come just because valves fail as people get older, but can also occur after a blood clot or another injury to the vein.
Treatment depends on what the person’s concerns are. If the legs are swollen, compression stockings are the major treatment, along with good skin care, elevation and regular exercise. Many people want (and, alas, some physicians prescribe) diuretics, but these are not effective long-term treatments. For people with ulcers or bleeding, wound care and sometimes surgical procedures may be indicated.
If their appearance is a concern, there are many types of effective treatments, such as laser and injection of the veins with medicine to make the veins close up. These treatments do not prevent other complications and aren’t usually covered by insurance, unless they are also causing symptoms. Large, painful veins may be treated that way or with other options, including radiofrequency ablation and traditional excision (“stripping”). Treatment for symptomatic varicose veins is usually covered by insurance if conservative treatments have failed.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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