Alcohol History Flashcards
Introduction
Wash hands, PPE
Introduction
Patient ID DOB
Explain purpose, get consent
-I’ve been asked to speak to you today regarding your alcohol intake, is that ok with you?
-Some of these questions might be difficult for you to answer but I really appreciate you coming in to talk to us today. If you would like me to stop at any time, please let me know.
CAGE screening tool
-when to use
DON’T BE AFRAID TO JUST GO FOR IT
-I’m going to ask some routine questions that we ask patients who have come to A&E in relation to alcohol
Have you ever felt you should cut down on your drinking?
Have people annoyed you by criticising your drinking?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
2+ => problematic drinking
Alcohol intake details
-key questions
When did they start drinking?
Has this changed over time?
Current drinking patterns
- what - units and type of alcohol
- when - time of day, how many days in a week
- where - pub/home alone/work?
Have you ever considered cutting down in the past?
- what happened?
- past detoxes, treatments?
Impacts of alcohol
-biological
Biological signs of dependence
Tolerance
-Do you have to drink more than you used to to feel the same effects? => tolerance
Autonomic withdrawal - tremor, sweating, N+V, palpitations
-if you stop drinking, do you notice any physical changes?
Neurological withdrawal
-agitation, headache, hallucinations, seizures, insomnia
Impacts of alcohol
-social
Relationships
- Has alcohol impacted your relationship with your family or friends?
- How has it affected them?
Occupation and travel
- Has alcohol affected your ability to work?
- Do you drive to work?
- Have you ever driven whilst under the influence of alcohol?
Diet
- What does your diet look like on an average day?
- Do you feel alcohol impacts they way you eat?
Forensics
-Have the police ever been involved as a result of your drinking?
Impacts of alcohol
-psychological
-risk assessment
Mood and risk assessment
Psychological signs of dependence
Compulsion - do you feel a compulsion to drink?
Dominates thoughts - how much time do you spend thinking about alcohol in a day
Impacts of not drinking - if you stop drinking, how do you feel?
-down, agitated, anxious?
Impacts on
- sleep
- mood
- appetite
- concentration
Depression screen
- during the past month, have you felt low or hopeless?
- have you had little pleasure and interest in doing things?
Self harm and suicide screen
- have you had any thoughts of hurting yourself
- have you ever thought of ending your life
- have you ever acted on these thoughts
- what would stop you from acting on these thoughts
Risk to others screen
-have you ever thought of harming others
Past medical history
- key questions
- alcohol related medical conditions
Do you have any medical conditions
-how is it managed? medication compliance?
Any past surgeries, procedures, hospital visits and why
- ALD, cirrhosis
- UGI bleeds
- pancreatitis
- dilated cardiomyopathy
Ever been under the care of mental health services?
Any medications - prescribed, OTC, herbal supplements
-any SE
Any allergies and reactions?
Social history
-key questions
Living
- accommodation
- who lives at home with you? any carer input? any dependents?
- are you independent at home? shopping, cooking, self care, cleaning?
Occupation - employment and finances
Substance use
Smoking - pack years?
Recdrugs?
Gambling? - Do you gamble? Do you think your gambling is a problem?
Closing the consultation
Thank you for taking the time to speak to me, I appreciate that you may have felt uncomfortable answering some of my questions but I want to thank you for your honesty and bravery in opening up about your alcohol use.
Would you like support in cutting down on your use of alcohol?
- if yes => we can make a follow up appointment to discuss an approach that would work for you
- support groups and charities - AA
- community alcohol team
- if no => and that’s absolutely fine, it is your choice. If you ever change your mind, here are some leaflets about alcohol dependence and the ways we can support individuals with alcohol dependence
What are the detox options for someone with alcohol dependence
VitB supplements for all!
Gradual reduction over time
Community detox - BZ/chlordiazepoxide or lorazepam if in liver failure
Hospital detox if past delirium tremens, poor response, lack of support
What are the methods of reducing relapses
VitB supplements for all!
- acamprosate - reduce cravings if abstinent
- disulfriam - unpleasant SE if alcohol taken
- naltrexone - block effects of alcohol
Assessing degree of alcohol dependence
Can formally assess with
- AUDIT - assess severity of alcohol misuse
- SADQ - severity of alcohol dependence
