SPECIALIST’S PERSPECTIVE The General Internist

A1 has a significant impact on the practice of gener­ al internal medicine (Barnes et al. 1987; National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1990; Institute of Medicine [IOM] 1990; Fleming and Barry 1992). In the advanced disease, which is most widely recognized by internists, alcoholism’s symptoms include such medical complications as cirrhosis, hepatitis, or hypertension. Per­ haps more challenging, however, is identi­ fying the common problem of early stage alcohol abuse, which may not cause any symptoms and thus is missed on routine examination (IOM 1990). General in­ ternists should be equipped to recognize alcoholism in all of its forms, from asymp­ tomatic through advanced disease, and be able to participate in managing patients along the entire spectrum of alcoholism (Barnes et al. 1987; NIAAA 1990; IOM 1990; Fleming and Barry 1992). This article reviews some of the im­ portant epidemiologic and clinical fea­ tures of alcoholism and offers practical advice on its diagnosis and management for internists.