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

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!