Alcohol Abuse

Question 1

You are the FY2 doing a GP job

You suspect that the patient has a substance abuse and initiate a CAGE screen after relevant SOCRATES

What does CAGE stand for?

Answer 1

C - cut down have you ever felt the need to cut down
A - annoyed by the criticism
G - have you ever felt guilty about drinking
E - Do you need a drink to help you get up in the morning

Question 2

You are the FY2 doing a GP job

A 23 year old girl admits to having difficulty controlling how much alcohol she drinks.

Take a STRUCTURED HxPC
(technically SHx)

Answer 2

CAGE Screen
TOP ERA

T - How long have you been drinking
T - What is your drinking pattern during the day
T - What is your drinking pattern during the week
O - how did it start
P - Increasing / Decreasing / Staying the same

E - have you tried to stop
R -
A - sweating
A - vomiting
A - tremor
A - seizure
A - agitation
A - anxiety 

Associated Symptoms Rule out
- Depression

Question 3

You are the FY2 doing a GP job

A 29 year old man admits to having difficulty controlling how much alcohol he drinks.

Take a STRUCTURED PMHx

Answer 3

Ongoing medical conditions?
GP regularly?
Past Mental Health?

Question 4

You are the FY2 doing a GP job

A 29 year old man admits to having difficulty controlling how much alcohol he drinks.

Take a STRUCTURED FHx

Answer 4

FHx - alcohol or substance misuse

Question 5

You are the FY2 doing a GP job

A 29 year old man admits to having difficulty controlling how much alcohol he drinks.

Take a STRUCTURED DHx

Answer 5

Any Medications?
If yes
 - Name
 - Dose 
 - Frequency
 - reason
Over the counter?
Allergies?

Question 6

You are the FY2 doing a GP job

A 56 year old man admits to having difficulty controlling how much alcohol he drinks.

Take a STRUCTURED SHx

Answer 6

Smoking?
illicit drugs?
Impact on social life?
 if yes
 - mood
 - sleep
 - appetite
 - concentration

Question 7

You are the FY2 doing a GP job

A 56 year old man admits to having difficulty controlling how much alcohol he drinks.

You have finished the main elements of the history taking what should you do now?

Answer 7

Summary
Risk Assessment
Relevant Examination

Question 8

You are the FY2 doing a GP job

A 40 year old businessman admits to having difficulty controlling how much alcohol he drinks.

You are worried about him and decide to do a risk assessment
What should you ask?

Answer 8

Spiel - Often time alcohol related problems can accompany mental health problems so I just want to ask a few questions.

Suicidal thoughts?
Self harm?
Violent towards others?

Question 9

You are the FY2 doing a GP job

A 40 year old businessman admits to having difficulty controlling how much alcohol he drinks.

You have completed a risk assessment and deem him to be low risk. You have examined him.
What should you do know?

Answer 9

Management Plan

Igx - bloods to check vitamin level

Treatment for amount
- NHS specialisits services

If experiencing withdrawal

• chlordiazepoxide
• acamprosate

Vitamin deficiency
- pabrinex