Alcohol History

Question 1

1. Introduction

Answer 1

Patients name, age, occupation

Question 2

2. Purpose

Answer 2

I’ve been asked to talk to you about your health and in particular about your drinking habits. Has anyone spoken to you about this before?

Question 3

Alcohol History

Answer 3

1. Type
2. Amount
3. How often do you have alcohol?
4. How many units do you drink on a typical day
5. Intake Pattern
6. Pressure
7. Cause
8. Compulsion
9. Primacy
10. Failure
11. Tolerance
12. Withdrawl

“CHIP CHAT WTF P”

Question 4

Alcohol History: Type

Answer 4

Type → What type of beverages do you drink? Beer, wine or spirits?

Question 5

Alcohol history: Amount

Answer 5

Amount → How much do you drink a day? How much do you drink a week? How much do you spend on alcohol a week? Where do you get money for your alcohol?

Question 6

Alcohol History: How often

Answer 6

How often do you have a drink containing alcohol?

How often during the last year have you found that you were not able to stop drinking once you had started?

Question 7

Alcohol history: How many units

Answer 7

How many units do you drink on a typical day when you are drinking?

How often do you have six or more units of alcohol on one occasion?

Question 8

Alcohol History: Intake pattern

Answer 8

Intake Pattern → Is there a certain time you drink?

Can you tell me your typical drinking day?

Question 9

Alcohol History: Pressure

Answer 9

Do you feel like you are pressured into drinking?

Question 10

Alcohol History: Cause

Answer 10

Reason → What causes you to drink like this?

First Start → At what age did you first start to drink? Was there a reason why you started at this age?

Question 11

Alcohol History: Compulsion

Answer 11

Compulsion → Do you crave for alcohol when you are unable to drink?

Question 12

Alcohol History: Primacy

Answer 12

Primacy → Would you say alcohol was a priority over other aspects of your life?

Question 13

Alcohol History: Failure

Answer 13

How often during the last year have you failed to do what was expected of you because of your drinking?

Question 14

Alcohol History: Tolerance

Answer 14

Tolerance → Are you drinking more alcohol to get the same effect?

Question 15

Alcohol History: Withdrawl

Answer 15

Withdrawal →Do you suffer symptoms when you go without alcohol for a period of time?

o E.g. Anxiety/ Tremors/ Sweating/ nausea/ Fits/ Hallucinations?

• Relieved → Are these symptoms relieved by drinking more alcohol?

Question 16

CAGE Questionnaire

Answer 16

• Cut Down → Have you tried to cut down?
• Angry → Have you felt angry at the remarks of others regarding your drinking?
• Guilty → Have you felt guilty about how much you drink? How often in the last year have you had a feeling of guilt or remorse after drinking?
• Eye Opener → Do you ever drink first thing in the morning? How often in the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

Question 17

CAGE questionnaire: Other WHO questions

Answer 17

• Other questions (WHO):

o How often during the last year have you been unable to remember what happened the night before because you were drinking?

o Have you or someone else been injured as a result of your drinking?

o Has a relative, a friend or a doctor /health care worker been concerned about your drinking or suggested you cut down?

Question 18

Beliefs about Alcohol

Answer 18

• Harmful →Do you believe alcohol is bad for you?
• Effects → Do you know what effects alcohol has on your health if you drink too much?
• Impact

o Do you have any particular concerns or worries about how much you drink?

o How has your drinking affected your life and your family? Work?

Question 19

Attempts to Reduce Alcohol

Answer 19

• Have you ever tried to reduce your alcohol consumption, if yes what brought this on?
• Have you ever joined an organization to reduce your alcohol intake?
• How many times have you tried and how long for?

o Have you had any relapses in your abstinence? What brought that on?

Question 20

PMH

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Answer 20

• Psychiatric illness:

o Have you ever had depression, anxiety, eating disorders, misused other substances?

o Have you ever attempted suicide?

• Have you ever had peptic ulcers/ pancreatitis/ Hypertension or Liver Disease?
• Have you noticed any changes in yourself which may be caused by alcohol?

Question 21

Treatment History

Answer 21

• Are you on any medications? Are you taking any over the counter preparations?

ANY ALLERGIES

Question 22

Family history

Answer 22

• Did anyone in your family drink alcohol excessively?

Question 23

Forensic history:

Answer 23

• Have you ever had any criminal convictions?
• Were these due to violence?
• What is your longest sentence
• Do you have any outstanding issues?
• Were these related to alcohol?

Question 24

Social History

•

Answer 24

Social History
• Do you smoke or take any recreational drugs?

• Stress → Any relationship or financial problems?
• Work → What do you do for a living? How is your work? Any stress?
• Family → Are you single or currently in a relationship?

Question 25

Insight:

Answer 25

o Do you feel you need help? Would you accept help If it was offered to you?

Question 26

Management: Explaining to patient

Answer 26

* "There a number of medications that are given in hospital for alcohol withdrawal, these include vitamin supplements known as thiamine as it is likely that you are deficient in this. Lack of thiamine can cause something called wernicke-korsakoffs psychosis, which involves a variety of symptoms including abnormal eye movements, abnormal walking pattern and seizures, so it is important we give thiamine to prevent this." * As you are no longer drinking alcohol you are probably experiencing quite a few symptoms such as tremors, restlessness, nausea etc, so we will give you a type of medication called benzodiazepines. These medications will be given to you over a 5 day period, with the dose being reduced each day until you have completed the course. This medication will help to reduce the symptoms of your alcohol withdrawal.

Question 27

o Nutritional supplementation:

Answer 27

• Thiamine (oral)/ pabrinex (IM)

Question 28

o Benzodiazepines in alcohol detoxification:

Answer 28

* A reducing dose of chlordiazepoxide over 5-7 days is commonly used: * Day 1: 20 mg chlordiazepoxide four times daily. * Day 2: 15 mg chlordiazepoxide four times daily. * Day 3: 10 mg chlordiazepoxide four times daily. * Day 4: 5 mg chlordiazepoxide four times daily. * Day 5: 5 mg chlordiazepoxide twice daily.

Question 29

Adversive and anticraving medications

Answer 29

o Adversive: Disulfiram o Anti-craving: Acamprosate/naltrexone