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Alcohol Use

Alcohol Use

1)†† Ask about patients current and past EtoH use and about family history

2)†† Identify and recognise their level according NH&MRC guidelines;

Drinks per day

Low

Hazardous

Harmful

Male

<4

5-6

>6

Female

<2

3-4

>4

3)†† Use a screening questionnaire to detect dependence;

a.†††††† CAGE††

†††††††††††††††††††††††††††† i.††††† Have you ever felt the need to CUT down?

†††††††††††††††††††††††††††††ii.†††††Do you get ANNOYED by criticism of your drinking?

†††††††††††††††††††††††††††††iii†††† Do you ever feel GUILTY about your drinking?

†††††††††††††††††††††††††††††iv.††† Do you ever want an EYE opener?

Remember that 1 positive response indicates the need for further assessment and 2 gives a sensitivity > 85% and a specificity of about 90% for a diagnosis of alcohol abuse and/or dependence.

4)†††Ask specific questions for alcohol abuse,

a.†††Failure to fulfil work, school or social obligations

b.†††Recurrent substance use in physically hazardous situations

c.†††Recurrent legal problems related to substance use

d.†††Continued use despite alcohol-related social or interpersonal problems

Or about alcohol dependence,

Tolerance

Withdrawal

Substance taken in larger quantity than intended

Persistent desire to cut down or control use

Time spent obtaining, using or recovering from alcohol use

Social, occupational or recreational tasks are sacrificed

Use continues despite physical and psychological problems

5)†††Assess co-morbidities which may affect treatment

a.††† Physical, social, emotional problems?

b.††††Physical complications of EtoH use?

c.††††Blood abnormalities?

6)†††Identify treatment goals;

a.††† Non-dependent: Controlled drinking if harms not severe, patient requests

b.††††Dependent/ Organ damage/ Controlled drinking failed: Abstinence recommended as only 55 reach a stable pattern

7)†††Stress benefits of decreased alcohol intake (e.g. FRAMES model Ė see below) and give drinking tips (harm minimisation approach Ė see below)

8)†††Treatment as appropriate

a.††††Brief Intervention Ė designed to increase motivation

†††††††††††††††††††††††††††††††i.†††Feedback on relationship of problems/ findings to EtOH intake

††††††††††††††††††††††††††††††ii.†††Responsibility of change rests with patient

†††††††††††††††††††††††††††††iii.†††Advice to change drinking habit

†††††††††††††††††††††††††††††iv.†††Menu of strategies offered

††††††††††††††††††††††††††††† v.†††Empathy expressed

†††††††††††††††††††††††††††††vi.††††Self-efficacy encouraged

b.††††Counselling

c.††††Pharmacotherapy

††††††††††††††††††††††††††††† i. ††††† Acamprosate

1.†††GABA agonist

2.†††commence when abstinent

3.†††Continue for 1 year

4.†††Rare side-effect of diarrhoea

††††††††††††††††††††††††††††††ii.††††† Naltrexone

1.†††u-opiate receptor aantagonist

2.†††once daily dose

3.†††Side-effcets include nausea, headache, dizziness, dysphoria, depression, Increased LFTs

4.†††Also start after abstinence

†††††††††††††††††††††††††††††iii.††††† Withdrawal

1.†††Some dependent drinkers will need to go through withdrawal. They can be supported by their LMO†if there is adequate support at home and when withdrawal is likely to be mild/ moderate. If they are likely to have a severe withdrawal (previous history of such, high level of recent EtoH cosumption, presence of intercurrent disorders such as significant liver disease, pancreatitis, malnutrition or infection) they may need to be hospitalised for monitoring and diazepam therapy.

d.††††Organise referral to a detox unit and adequate follow-up

9)†††Physical examination looking for;

a.†††Poor hygiene

b.†††Malnutrition

c.†††Ecchymoses

d.†††Parotiditis

e.†††Dupuytrons Contracture

f.††††AF

g.†††Dilated CCF

h.†††Cerebellar Signs

i.††††Peripheral neuropathy

j.††††Pneumonia/ TB

k.†††Signs of liver disease

l.††††Impaired cognition

Drinking Tips to Reduce Harm

Donít drink alcohol to quench your thirst. Use non-alcoholic drinks

Use spacers (alcohol free drinks) between alcoholic drinks to prevent excessive alcohol consumption

Drik low alcohol beverages

Count your drinks, keeping within the recommended guidelines

Donít refill your glass until it is empty

Donít gulp drinks. Take smaller sips

Eat before drining. Your drink will take longer to be absorbed

Donít drink if you are pregnant. It may damage the health of your unborn child

Donít drink if you ar operating machinery, you put your fellow workers as well as yourself at risk

If you are a regular drinker, have at least two alcohol free days each week

Donít drink to cope with stress. Exercise relaxation, meditation or talking to friends are safer ways of coping


Amount of alcohol in common drinks

Container size

Type of container

Alcohol Content

Beer

285ml

Middy

10g

427ml

Schooner

15g

375ml

Can/Stubby

14g

750ml

Large bottles

28g

1 carton

24 cans/ stubbies or 12 large bottles

336g

Table wine

120ml

Standard glass

10g

750ml

Bottle

60-80g

1L

Cask

100g

4L

Cask

400g

Fortified Wine e.g. port, sherry

60ml

Standard glass

10g

750ml

Bottle

120g

Spirits e.g. whisky, brandy, vodka

30ml

Nip

10g

750ml

Bottle

240g

Light beer usually has about half the alcohol content of normal beer.