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Alcohol History

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name, DOB and what they like to be called
  • Explain and obtain consent

Alcohol use

  • Current use
    • What: how much (units = %abv. x litres volume), type of alcohol
    • When: times of day, days of week, continuous/binge
    • Where: pub, home alone, work
    • Why: social, underlying issues (family, relationships, depression etc.), availability, stress, psychiatric problems
  • Past (alcohol timeline)
    • 5 year intervals – any personal correlations?
    • Ever tried to cut down – what happened?
    • Treatments and detoxes and how they went
    • Relapse reasons

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Units by alcoholic drink type

Social effects

  • Effect on self (e.g. injuries, medical conditions)
  • Effect on family/friends
  • Effect on work
  • Effect on finances
  • Any trouble with police related to alcohol
  • Driving

Dependence

  • Physical dependence
    • Tolerance
    • Autonomic withdrawal symptoms: tremor, sweating, nausea/vomiting, palpitations
    • Neurological withdrawal symptoms: agitation, headache, hallucinations, seizures, insomnia
  • Psychological dependence
    • Compulsion/persistent desire to drink
    • Lots of time spent drinking
    • Given up activities/hobbies or spending less time with family/friends

Mood and risk

  • Effect on mood
  • Assess risk of self harm/suicide

Rest of history

  • Past psychiatric history: any disorders including anxiety and depression
  • PMHx: physical health problems due to alcohol/drugs (e.g. peptic ulcer disease, liver disease, upper GI bleeding, memory loss)
  • DHx
  • FHx: family alcohol use
  • SHx: recreational drug use, smoking, family/living/working situation

Want to test yourself?

What help is available to people struggling with alcohol use?

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A patient tells you they drink 3 bottles of wine a day. What is their approximate weekly alcohol unit intake?

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What are the options for undertaking an alcohol detox?

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Now try some OSCE stations!

  1. Alcohol-related problems
  2. Pancreatitis
  3. There are lots more where these came from!
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