Alcohol risk assessment

Question 1

What should be asked with regards to amount of alcohol intake?

Answer 1

• type (includes beer, wine and spirits)
• amount
• place
• time

Question 2

what should you ask to establish alcohol dependance?

Answer 2

• compulsion to drink
• primacy over other activities
• drinking alone
• narrowing of repertoire
• increased tolerance
• withdrawal symptoms
• do they drink to avoid withdrawal symptoms?
• reinstatement after abstinence

Question 3

what should you ask in psych history?

Answer 3

• depression

- risk assessment

Question 4

what should be asked in a medical history?

Answer 4

• peptic ulceration
• pancreatitis
• liver disease
• peripheral neuropathy
• ischaemic heart disease

Question 5

what should be asked in the social history?

Answer 5

• employment
• housing
• marital problems
• financial problems
• legal problems
• are they driving

Question 6

what else should be obtained to gain a clearer picture?

what investigations might you order?

Answer 6

• informant history
• Bloods: FBC, GGT raised in 80%, ALP in 60%
• blood/ urine toxicology for other substances

Question 7

what non-pharmacological treatment might you offer?

Answer 7

• simple advice and support e.g. appraising any problems/ goal orientated plans

Question 8

what pharmacological treatment can be given initially for dependance?

when might they need to be admitted to hospital for this?

Answer 8

• reducing course of benzodiazepines instead of alcohol
• (chlordiazepoxide 20mg QDS reducing daily over 5-7 days)
• Thiamine 200mg OD
• comorbid psychiatric disorder, convulsions or delirium tremens

Question 9

After detox has occurred, what may the non-pharmacological/ pharmacological treatment might you give?

Answer 9

• Abstain from alcohol (better prognosis than controlled drinking)
• encourage abstinence with Naltrexone
• acamprosate (enhances GABA neurotransmission and mimics CNS depressant effects of alcohol)
• Disulfiram: alcohol sensitising deterrent drug that blocks the oxidation of alcohol by inhibiting the enzyme aldehyde dehydrogenase leading to accumulation of acetaldehyde

Question 10

When can disulfiram be started?

what is it contraindicated in?

Answer 10

• when blood alcohol levels reach zero

- contraindicated in coronary artery disease and cardiac failure (arrhythmias)

Question 11

what other non pharmacological therapy can you provide them with?

Answer 11

• AA
• Psychotherapy
• CBT
• Family therapy
• Social skills training

Question 12

what is the prognosis?

Answer 12

• 20-50% of patients remain abstinent after one year of detoxification (chronic relapsing condition)