Alcohol problems Flashcards
Excessive & harmful drinking, how much?
For men, excessive drinking is > 4 SDs/d.
For women, drinking becomes a serious problem at >2 SDs/d.
This level can also affect the foetus of the pregnant woman.
High-risk or harmful drinking occurs at more than;
- 6 drinks a day for men and
- 4 drinks a day for women.
NHMRC guidelines to reduce risks from drinking alcohol
Healthy men and women;
- No more than 2 SDs/day
- No more than 4 SDs on a single occasion
Children and young >18 years;
- Don’t drink if <15 y and delay as long as possible
Pregnant and breastfeeding women;
- Abstinence is safest option
Laboratory investigations
The following blood tests may be helpful in the identification of excessive chronic alcohol intake:
- blood alcohol
- serum GGT ↑ in chronic drinkers (returns to normal with cessation of intake)
- MCV: >98 fL (i.e. macrocytosis)
- carbohydrate-deficient transferrin ↑ in chronic drinkers
Measuring alcohol intake
One SD contains 10 g alcohol—1 middy (or pot) of standard beer (285 mL)
- 2 middies of low-alcohol beer or
- 5 middies of super-light beer
These are equal in alcohol content to;
- one small glass of table wine (120 mL)
- one glass of sherry or port (60 mL) or
- one nip of spirits (30 mL).
Approach to management
The challenge is early recognition of the problem.
Early intervention and brief counselling by the doctor are effective in leading to rehabilitation.
Pts expect their family doctor to advise on safe drinking levels
They will listen and act on our advice.
Rx is more effective if offered before dependence or chronic disease has developed
A brief practical management plan
A six-step early intervention program is as follows;
1) Feedback results of your assessment, spec the degree of risk associated with their daily alcohol intake and bout drinking.
* Emphasise any damage that has already occurred.
2) Listen carefully to their reaction.
* They will need to ventilate their feelings and may respond defensively.
3) Outline the benefits of reducing drinking
* e.g. save money, better health
4) Set goals for alcohol consumption, which you both agree are feasible.
- For men: aim for fewer than 12 SDs/week.
- For women: aim for fewer than 8 SDs/week.
- For pts with severe ill effects and who are physically dependent on alcohol, long-term abstinence is advisable.
5) Set strategies to keep below the upper low-risk limits, e.g:
- Quench thirst with non-alcoholic drinks before having an alcoholic one.
- Switch to low-alcohol beer.
- Take care which parties you go to.
- Explore new interests, e.g. fishing, cinema, social club, sporting activity.
6) Evaluate progress by having pts monitor their drinking by using a diary.
- Make a definite appointment for follow-up and give appropriate literature such as Alcohol and Health.
- Obtain consent for a telephone follow-up
Minimum intervention technique plan (5–10 mins)
1) Advise reduction to safe levels
2) Outline the benefits
3) Provide a self-help pamphlet
4) Organise a diary or other feedback system
5) Obtain consent for a telephone follow-up
6) Offer additional help (e.g. referral to an alcohol and drug unit or to a support group)
Follow-up (long consultation 1 week later)
Review pt’s drinking diary.
- Explore any problems
- summarise
- listen
- provide support
- encouragement
If appointment is not kept, contact the pt.
‘Anti-craving’ drugs
The following show a modest effect on assisting abstinence:
1) Acamprosate 666 mg (o) tds
2) Naltrexone 50 mg (o) daily (close supervision required)
A combination of these is more effective in preventing relapse than individual drugs.
Recommended treatment for early withdrawal symptoms
Diazepam 20 mg (o) every 2–6 h (up to 60–100 mg (o) max. daily)
- titrated against clinical response (taper off after 2 d)
If psychotic features, add haloperidol 0.5–2 mg (o) bd
Thiamine 300 mg IV daily for 5 d, then 300 mg (o) daily
Vitamin B group supplement (o) or IM daily
