Alcohol dependence and abuse are considered primary mental disorders. There may be a mood disorder (Cf. depression) or a somatoform disorder (Cf. pain) existing concurrently with the alcoholism. The major depression is, for example, considered a co-morbid diagnosis.
However, alcoholism cannot be the direct result of any injury. It is often referred to as a _disease_ of choice. An injury (or divorce or financial hardship) can be an alcoholic_s excuse for his/her substance abuse, but it is not the cause.
The alcoholic_s plight is made worse by those who _enable_ (reinforce, reward, support or even fail to confront the true nature) of the problem. Telling an alcoholic that his/her drinking is due to a spouse_s infidelity, for example, fails to address the very nature of that disorder.
It is very important to determine if someone taking narcotics is potentiating his/her pain medication with alcohol. This can be an exceedingly dangerous practice, and, at a minimum, merely adds one more chemical to the abuse picture.
An alcoholic injured worker may need to look at available sources for de-tox under his/her general health insurance. The patient unquestionably needs to be regularly involved in A.A. meetings and the family involved in related meetings.
We are of little benefit to injured workers when we fail to diagnosis a personal history, family history and current pattern of alcohol intake. The alcoholic very much wants us to ascribe causation to events and people outside him/herself, and we do a significant disservice to the patient if we fail to diagnose the true cause-effect relationship.