Alcohol History

Question 1

Sequence of events

Answer 1

Open question
Timeline
Drinking routine- qualify and quantify (how much, when where what why etc.)

NB- can use same approach when doing a recreational drugs history

Question 2

Dependence features

Answer 2

CCWTP

Compulsion- cravings for alcohol
Control- can you control drinking once started
Withdrawal- what happens if you don’t drink (ask about DT Sx eg. Autonomic (tremor, sweating, nausea) and neurological (headache, seizure, hallucinations))
Tolerance- do you have to drink more to get the sane effect you used to
Primacy- has it become a main priority in your life

Question 3

Impact on life

Answer 3

Has it caused any problems 
Work and finances 
Relationships- who is at home?
Law (driving)
Mood

Question 4

Complications

Answer 4

Physical- weight loss, appetite, diet, memory, swelling abdomen, painful abdomen, yellow eyes or skin
Depression and anxiety
Psychosis

Question 5

Risk

Answer 5

To you or others
Suicidal intent
Any attempts in the past?

Question 6

Patients perspective

Answer 6

Feelings and impact on life

ICE

Question 7

PMH

Answer 7

Any medical or psychiatric conditions

Ever tied detoxing? What happened. What made you do it. Why did you relapse?

Question 8

DH

Answer 8

Regulars

OTC Allergies

Question 9

FH

Answer 9

Any conditions

Any one with alcohol problems

Question 10

SH

Answer 10

Job- what does it involve. Impact on job
Home situation- occupants and difficulties
How is mood affecting home life
Support from family or friends
Smoke alcohol recreational drugs
Have you been looking after yourself and the home eg. showering and cleaning

Question 11

Insight

Answer 11

Do you think you have a problem
Do you want to stop or reduce your drinking
Would you be interested in accepting help if it was offered?

Question 12

Investigations

Answer 12

Physical exam (abdo and cardiac exams (AF and cardiomyopathy)), ECG
Bloods- FBC, UE, LFT, CRP, clotting, lipids, glucose, gamma GT, thiamine (B1), B12 folate 
Abdo USS (fibroscan),;and CT, echo (cardiac involvement)

Question 13

General measures and abstinence

Answer 13

Education about adverse effects
Vitamin supplements
Support and advice (financial, social (AA) support)
Community (or hospital) based detox
CBT
Medical abstinence- acamprosate (cravings), naltrexone (reduces pleasure from alcohol), disulfiram (unpleasant reaction if they drink alcohol)

Question 14

Psychiatric systems review

Answer 14

Psychosis- auditory hallucinations/ visual hallucinations/ altered sensations/ delusions of thought and control
Mania- energy levels/ have people said you are hyper/ spending habits/ libido
Depression- mood/anhedonia/ sleep/ future
Others- memory loss/ anxiety/ insight/ relationship with food

Question 15

What tools are available to assess alcohol use in patients?

Answer 15

CAGE questionnaire