Alcohol addiction

Alcohol Screening

CAGE

  • 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)

Consumption

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.

Management

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
  • Empathy
  • 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.

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