Alcohol_Misuse_QA Flashcards
What blood tests should be performed for someone with suspected alcohol misuse?
FBC, LFT, B12, folate, U&E, clotting screen, glucose
What additional tests can be used to confirm alcohol misuse?
Blood alcohol level or breathalyser, urine drug screen, rating scale (e.g. AUDIT, CIWA-Ar, APQ), Severity of Alcohol Dependence Questionnaire (SADQ)
What support should be offered to the family or carers of someone with alcohol misuse?
Offer a carer’s assessment if necessary, consider offering guided self-help for families and provide resources about support groups, consider offering family meetings, usually at least 5 weekly meetings
What formal assessment tools are used to assess the severity and nature of alcohol misuse?
AUDIT – alcohol use disorders identification test, SADQ – severity of dependence, CIWA-Ar – clinical institute withdrawal assessment of alcohol scale, APQ – alcohol problems questionnaire
What is the best treatment goal for alcohol misuse and what should be done if comorbid mental health issues do not improve?
Abstinence is the best treatment goal. If comorbid mental health issues don’t improve within 3-4 weeks of abstinence, consider referring for specific treatment
What are the principles of interventions for alcohol misuse?
Carry out a motivational interview, offer interventions to promote abstinence, offer residential rehabilitation services for homeless individuals, routinely monitor outcomes, provide information about Alcoholics Anonymous, SMART Recovery, and Change, Grow, Live (CGL), care coordination, case management
What interventions should be offered to harmful drinkers and those with mild alcohol dependence?
Offer psychological intervention (e.g. CBT, behavioural therapy, social network and environment-based) focused on alcohol-related cognitions, offer behavioural couples therapy, consider acamprosate or naltrexone alongside psychological therapy if no response to above
What is the management for assisted withdrawal in alcohol misuse?
Give Pabrinex if at risk of Wernicke’s encephalopathy, consider community-based assisted withdrawal if >15 units/day or >20 on AUDIT, consider inpatient assisted withdrawal if 30+ units/day, 30+ on SADQ, history of epilepsy, delirium tremens or withdrawal-related seizures, need concurrent withdrawal of alcohol and benzodiazepines, significant psychiatric comorbidity or significant learning disability, children (10-17)
What drug regimens are used for assisted withdrawal in alcohol misuse?
Fixed-dose or symptom-triggered regimen, preferred medication: chlordiazepoxide or diazepam, consider lorazepam if liver impairment, titrate initial dose based on severity of alcohol dependence/daily alcohol consumption, gradually reduce the dose over 7-10 days
What should be done after successful withdrawal from alcohol misuse?
Consider acamprosate or naltrexone with individualised psychological intervention, consider disulfiram if above options are unsuccessful/unacceptable, usually prescribed for up to 6 months
What should be assessed and advised for someone with alcohol misuse?
Carry out thorough medical assessment to establish baseline before starting medication (including U&Es and LFTs), establish risks (driving, suicide, dependents), assess social issues and advise accordingly (SAFEGUARDING), establish goals (elimination or moderation)
What should be explained to someone undergoing withdrawal from alcohol misuse?
Explain that symptoms of withdrawal are worst in the first 48 hours and should pass after 3-7 days, advise against stopping drinking abruptly, explain referral to drugs and alcohol service and the process of assisted withdrawal (benzodiazepines, psychological treatment and relapse prevention)
