Alcohol history

Question 1

Order of hx

Answer 1

Alcohol use
Social effects
Dependence 
Mood and Risk 
Rest of history

Question 2

Alcohol use

Answer 2

Current use

• what - type of alcohol and how much (U = %abv x L)
• when - time of day/week, continuous/binge
• where - pub, home, work
• why - social, stress, psych etc.

Past

• ever tried to cut down - what happened?
• treatments and detoxes
• relapse reasons

Question 3

Social effects

Answer 3

Self - injuries, medical conditions
Others
Work 
Finances
Interactions with police 
Driving

Question 4

Dependence

Answer 4

Physical

• tolerance
• autonomic withdrawal: tremor, sweat, N&V, palpitations
• neuro withdrawal: agitation, HA, hallucinations, seizure, insomnia

Psychological

• compulsion to drink
• lots of time spent drinking
• given up hobbies / spending time with family/friends

Question 5

Rest of hx

Answer 5

Effect on mood
Risk
Past psych hx
PMH - i.e. PUD, liver disease, UGIB, memory loss
DH
FH - alcohol
SH - recreational drugs, smoking, family/living/work

Question 6

Rough alcohol units:

Medium wine 
Beer can 
Beer pint 
Wine bottle
35cl spirit bottle 
70cl spirit bottle

Answer 6

Medium wine - 2
Beer can - 2
Beer pint - 3
Wine bottle - 10 
35cl spirit bottle - 15
70cl spirit bottle - 30

Question 7

Help available for alcoholism

Answer 7

Groups / charities - Alcoholics Anonymous
Community alcohol team

Detox options

• gradual reduction over time
• community detox - diazepam/chlordiazepoxide regime
• hospital detox - if prev. DT, poor response, lack of support

Help with reducing relapses

• Acamprosate - reduces cravings
• Disulfiram - creates unpleasant reaction in response to alcohol
• Naltrexone / nalmefene - block effects of alcohol

Vitamin B supplements - important for all