12. Alcohol with SBI (role playing)

Question 1

Standard drink size

Answer 1

US: 14-15 g alcohol
UK: 8 gram
Europe : 10-18 g

Question 2

Moderate drinking

Answer 2

(low-risk for alcohol problems)
- ≤ 2 drinks per day for men,
- ≤ 1 drink per day for women

with at least 2 days of no drinking in a week
- Not more than 4 standard drinks per occasion

Question 3

Heavy drinking

Answer 3

(high-risk for alcohol problems)
- Men under 65: > 14 drinks/ week or > 4 drinks/ day
- Women and adults over 65: > 7 drinks/week or > 3 drinks/ day

Question 4

Binge drinking

Answer 4

(heavy episodic drinking)
- ≥ 6 standard drinks during one occasion or during a 2-hour period
- Pattern repeats at least once a month

Question 5

Alcohol use disorder

Answer 5

DSM-V definition
- Characterized by a problematic pattern of alcohol use leading to
clinically significant impairment or distress, as manifested by 11
specific psychosocial, behavioral, or physiologic criteria.
- Mild 2-3 symptoms
- moderate 4-5 symptoms
-severe ≥ 6 symptoms

Question 6

Effects of high-risk drinking

Answer 6

• aggressive, irrational behaviour, arguments, violence, depression, nervousness
  -oral and pharynx cancer
  -frequent colds, reduced resistance to infection, increased risk of pneumonia
  -liver damage
  -ulcer
  -trembling hands, numbness, painful nerves (hand, feet)
  -impaired sensation leads to falls
  -alcohol dependence, memory loss
  -premature aging. Drinkers nose
• weakness of heart muscle, HF, Anemia, impaired blood clotting
  -breast cancer
  -vit defiency, bleeding, gastritis, vomit, diarrhea, malnutrition
  -pancreatitis
  -impaired sexual performance in men
  -risk of giving birth to deformed retarded babies/ low birth weight

Question 7

screening tools for alcohol use

Answer 7

1. CAGE questionnaire
2. AUDIT test (alcohol use disorder identification test)
3. Brief intervention

Question 8

CAGE questionnaire questions

Answer 8

1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Question 9

CAGE questionnaire score

Answer 9

Score 2 or higher has a 93% sensitivity and 76% specificity for the identification of ‘excessive drinking’ and necessitate further work-up

Question 10

The AUDIT test (alcohol use disorder identification test) interpretation

Answer 10

Interpretation:
Score 0-7 Low-risk consumption- No further action needed
Score 8-15 Hazardous/harmful consumption- Feedback, brief intervention (BI)
Score 16-19 Harmful drinking/possible dependence- Intervention/referral
Score > 20 Probable dependence. - Referral to specialist

check questions of questionnaire in notes

Question 11

Brief intervention

Answer 11

• Give feedback and introduce the subject
• Give information (effects of high-risk drinking)
• Discuss the need to stop drinking or cut down
• Establish a goal to change drinking behavior, discuss alcohol limits
• Conclude with encouragement