Alcohol advice

Question 1

How is alcohol metabolised

Answer 1

in the liver

acetaldehyde –> acetate –> water

Question 2

What is the effect of alcohol intoxication

Answer 2

Mild sedative
Mild anaesthetic
Stimulates dopamine and serotonin

Question 3

What is the safe limit of alcohol

Answer 3

14 units

Question 4

Over how many days should drinking be spread

Answer 4

3 +

Question 5

What does the risk of developing health problems increase with

Answer 5

the more you drink regularly

Question 6

What are oral problems in chronic drinkers

Answer 6

Oral cancer (concurrent tobaco use)
Oral ulceration 
Dental neglect
Dental trauma (falls)
Lost dentures
Dental erosion

Question 7

What does (alcoholic) liver disease result in

Answer 7

Reduced synthesis of clotting factors in damaged liver
Combined with reduced absorption of vitamin K and hence effecting vitamin K clotting factors
Thromboytopenia (splenomegaly)
Fewer platelets
Platelet aggregation reduced

Question 8

What analgesic should be prescribed with caution with heavy drinkers

Answer 8

aspirin/NSAIDs

Question 9

Why must we be cautious on giving NSAIDs to heavy drinkers

Answer 9

Both gastric irritant, both have effect on bleeding

Question 10

What are the 3 types of drinking

Answer 10

hazardous drinking
harmful drinkings
dependent drinking alcohol

Question 11

What is hazardous drinking

Answer 11

risks for problems are likely

Question 12

What is harmful drinking

Answer 12

problems associated with alcohol are actually present

Question 13

What types of drinking are amenable to brief intervenetion

Answer 13

hazardous + harmful drinking

Question 14

What is dependent drinking

Answer 14

drink needed to function

Question 15

What alcohol screening tools are there

Answer 15

FAST
AUDIT
PAT

Question 16

What is the gold standard screening tool

Answer 16

AUDIT

Question 17

What sort of questions does AUDIT ask

Answer 17

How often
How many units
How many units on a single occasion
Guilt for drinking?
Injured someone because of drinking?
Anyone concerned about your drinking?
And a few more but these are easiest to remember

Question 18

What is a patients readiness to change

Answer 18

What change are they considering
How important is the change
How confident are you that you can make the change

Question 19

What is the cycle of change

Answer 19

precontemplative
contemplative
preparation
action
maintenance
relapse

Question 20

What is precontemplation

Answer 20

dont see a problem

Question 21

What is contemplation

Answer 21

Sees the problem, but says things like ‘i enjoy drinking though’

Question 22

What is preparation

Answer 22

Discussing possibility of cutting down in the future

Question 23

What is action

Answer 23

Cutting down right now

Question 24

What is maintenance

Answer 24

Keeping it going

Question 25

What is the framework for brief intervention

Answer 25

``` feedback responsibility advice menu of options empathic self efficacy ```

Question 26

What is feedback

Answer 26

give feedback to the px on their behaviour

Question 27

What is responsibility

Answer 27

change is placed on the patient

Question 28

What is advice

Answer 28

advise them to change | tell them about benefits of quitting

Question 29

What is meant by menu of options

Answer 29

giving the patient a menu of options to self direct change | can offer treatment if required e.g counselling / signposting

Question 30

What are simple tips for cutting down on alcohol consumption

Answer 30

``` make a plan (set a limit) set a budget (take only a specific amount out with you) let your family and friends know buy smaller sizes of drinks have lower strength drinks alternate water and alcohol have several drink free days a week ```

Question 31

What is meant by empathic style

Answer 31

be warm, respectful and understanding

Question 32

What is meant by self efficacy

Answer 32

empower patient that you believe they can make this change

Question 33

Feedback example

Answer 33

How often do you drink? What type of drinks? How many drinks do you have? *This is when to use screening tools*. Sum up what patient has said and give them feedback in relation to drinking guidance. Ask patient how they feel about that?

Question 34

Responsibility example

Answer 34

Ask patient about if they would like to change? How motivated are they? How ready are they? What is going on in their life that is preventing them from changing? Are they unaware? Are they stressed? Can they get through the day without a drink (addicted?)?

Question 35

Advice example

Answer 35

Two way conversation. Advice on benefits of cutting down. What benefits would the patient reap from quitting? Less hangovers, better health, saving money

Question 36

Menu of options example

Answer 36

NHS has alcohol addiction services, if underlying factors e.g stress or financial burdens than signpost. If only slightly over, could recommend use of non-alcoholic substitutes.

Question 37

Empathy example

Answer 37

show empathy to patients circumstances, try not to be judgemental

Question 38

Self efficacy example

Answer 38

tell them you believe they can change, have they ever made changes in other aspects in their life?