PORTER: Faith, sir, we were carousing till the second cock, and drink, sir, is a great provoker of three things. MACDUFF: What three things does drink especially provoke?. PORTER: Marry, sir, nose-painting, sleep and urine. Lechery, sir, it provokes and unprovokes: it provokes the desire but it takes away the performance. Therefore much drink may be said to be an equivocator with lechery: it makes him and it mars him; it sets him on and it takes him off. –Macbeth (Act 2 Scene 3): William Shakespeare. Shakespeare said what needs saying. Equivocal is the central reality about alcoholism in primary care. Consider these primary care truisms and attitudes we hear stated often in teaching about this subject: Alcohol is protective; there is a J shaped curve, so you live longer if you have a drink a day and shorter if you have none or three. Alcohol is a major cause of deteriorating disease, of the liver, the blood system, the nerves, the brain, social function, and psychological well-being. It is a man's disorder – women worry, men drink. As a co-morbidity, it makes everything worse. Don't treat the other stuff until the alcoholism is controlled or you are spitting in the wind. If their hypertension, diabetes, anemia … is not getting better despite proper care, consider alcoholism.
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