Alcohol history

Question 1

Main subheadings of alcohol history

Answer 1

ntro (as usual)

1. Screen for dependence (CAGE)
2. History of alcohol intake
3. History of alcohol impact (biological, withdrawal)
4. SH/ effects of alco on that
5. PMH
6. Drug Hx
7. SH/effects of alcohol on these
8. Psychological assessment

Question 2

Components of CAGE

Answer 2

The CAGE questionnaire comes in useful here! A score over 2 suggests problematic drinking.

“I’m going to ask some general questions about your alcohol use and how it affects you.”

C – Have you ever felt that you should cut down on your drinking?

A – Do you get annoyed if people comment on the amount which you drink?

G – Do you ever feel guilty about the amount you drink?

E – Have you ever had an eye-opener? (A drink first thing on the morning to stave off a hangover – ‘”to stop the shakes ” / “settle the nerves”)

Question 3

Details of alcohol intake - what questions to ask

Answer 3

DETAILS OF ALCOHOL INTAKE

• when the patient started drinking alcohol
• if their intake has changed over time
• current drinking pattern (How many days a week? / Time of day?)
• quantity and type of alcohol consumed

Question 4

Assessment of the impact of alcohol

Answer 4

ASSESS THE IMPACT OF ALCOHOL

A. Biological signs of dependence (sweating / vomiting / tremor)

B. Psychological signs of withdrawal (agitation / anxiety / compulsion- need to drink)

Question 5

Effects on daily living, questions

Answer 5

Effects on daily living

Diet – adequate intake? / type of food (balanced?) / eating pattern

Occupation –is the patient working? / what is their job? / is it impacted by drinking?

Relationships – has alcohol impacted friendships/relationships?

Alcohol-related crime? – particularly aggression, drunk and disorderly, drink driving

• “Have you been in contact with the police as a result of alcohol-related incidents?”

Living situation? – where do they live / who do they live with?

Previous attempts at abstinence:

• “Have you ever tried to stop drinking before? Why?“
• “Why do you think it was unsuccessful?“

If not already revealed, assess desire to stop drinking

Question 6

PMH section - what to assess for in general

Answer 6

PAST MEDICAL HISTORY

• Alcohol related illness
• Alcohol related trauma
• Other medical conditions
• Mental health issues

Question 7

Questions about alcohol-specific injuries

Answer 7

Alcohol-use specific

Liver disease / peptic ulcers /pancreatitis /ischaemic heart disease

• “Have you ever had to go to hospital for drink-related illnesses/injuries?”

Question 8

Components of ‘psychological assessment’ in alcohol history

Answer 8

PSYCHOLOGICAL ASSESSMENT

• Mood
• Sleeping pattern
• Appetite
• Concentration
• Thoughts of self harm
• Suicidal ideation
• Thoughts of harming others

Question 9

What else to ask in alcohol history - in terms of risk assessment

Answer 9

• who is at home -> any dependants? (safeguarding issues)

Question 10

How to calculate units of alcohol?

Answer 10

(amount in ml x %) / 1000

e.g. 25 ml of a 40% of spirit

(25 ml x 40% ) /1000 = 1 unit