I was happy to see the article, "Alcohol Abuse and Dependence: Psychopathology, Medical Management and Dental Implications," by Dr. Arthur H. Friedlander and colleagues (June JADA). It is good to see the collaboration between medicine and dentistry, and also to see the article as a continuing education offering.
I find it interesting that a peer-reviewed journal would present alcoholism as a psychiatric illness as well as a psychiatric disorder. The diagnostic criteria for alcohol abuse and alcoholism are indeed found in the DSM-IV-TR, a publication of the American Psychiatric Association.1 Presenting alcoholism as only a psychiatric illness could be stigmatizing and overlooks the complexity of the disease.
Alcoholism/addictive disease is a very complex psychosocial, biogenetic disease that affects the entire person’s body, mind and spirit. The disease of alcoholism/chemical dependency is chronic, progressive and fatal if not treated. The number one symptom of the disease is the patients’ denial that they may indeed have a problem with alcohol or other addictive diseases.
Alcoholism/chemical dependency is a multifaceted disease that generally requires a treatment "team" approach. In my professional experience, I agree with the authors that alcoholism/addictive diseases are best viewed without moral implications. In fact, most alcoholic patients are relieved when they find out they have a treatable disease, because they "thought they were crazy." Many of these patients have sought the treatment of psychiatrists to help them stop drinking and were unsuccessful.
Seeing a patient in a chronic disease state begin the journey into recovery by entering treatment, completing treatment and embracing sobriety is nothing short of miraculous. There are certainly patients in all our practices who are in recovery from alcoholism/chemical dependency, and most are more than willing to share their stories.
There is a lack of information/articles in the dental literature as well as in continuing education offerings concerning treating the alcoholic/chemically dependent patient. These patients can be a challenge to treat. Since this disease affects all segments of our patient population, dentists and dental specialists should be comfortable treating these patients. We can also share our concerns about patients’ alcohol/chemical use and begin to break through their denial.
Again, perhaps the best source of information could come from one of your patients who is in recovery. In addition to learning about the disease concept, they can be an excellent source of information and referral for your patients in active disease. This disease is treatable, and resources for treatment are readily available.
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