- Thought about Cutting down?
- Annoyed/Angered by people commenting
- Feelings of Guilt
- Have you had any Eye openers?
Others include TWEAC (Tolerance, Worried, Eye openers, Anger/Annoyed, Cut down) and AUDIT (the Alcohol User Disorders Identification Test).
Lab tests aren’t commonly used in screening but are useful in monitoring any secondary disease and response to treatment.
- GGT (gamma-glutamyl transpeptidase) is an indicatory of the degree of induction of the hepatic enzymes (that metabolise alcohol)
- NB ALP is usually normal
- Carbohydrate deficient transferrin is used to identify men drinking >5units/day for over a year.
- MCV is usually raised (macrocytic anaemia)
Normal limits for men are 3-4 units per day with at least two alcohol-free days a week (formerly 21units/wk) and, for women, 2-3 units per day with at least two free days a week (formally 14 units/wk).
Hazardous (or at risk) drinking is anything above 4 units/day for men and 3 units/day for women. More likely to develop harmful drinking and have physical/mental health risk.
Harmful drinking is a pattern of alcohol consumption that is causing mental or physical harm. Typically >50 units/wk (men- 8/day) or >35 units/wk (women- 6/day). Usually have developed an alcohol dependence.
Brief interventions are used in hazardous drinkers. They last 5-15 mins (GP consultation) and are comprised of (FAMES):
- Feedback- review problems experienced due to alcohol
- Responsibility- Is the patient willing to change? If not, a brief intervention is unlikely to work.
- Advice- Advise reduction or abstinence, recognising achievable goal and setting them with the patient.
- Menu- provide options for changing behaviour
- Self-efficacy- should always be encouraged
Consider specialist referral if:
- the patient shows signs of moderate-severe dependence
- have failed to benefit from a brief intervention (or who are already harmful drinkers)andan extended intervention and wish to receive further help.
- the patient shows signs of a severe alcohol related impairment or have an alcohol-related comorbidity.
Specialist management may include detoxification (withdrawal) in the hospital setting. Once initial detoxification has been done, relapse prevention is key.