Communication Skills: Discussing Alcohol Abuse

OSCE stations on alcohol can take a number of different formats, including: screening for alcohol abuse in a new patient, taking a thorough alcohol history to ascertain severity of abuse, or to approach the topic of stopping drinking with a known alcoholic. Each needs a different approach. Below are elements which you can use in your discussions with patients.

• Wash hands, introduce self
• Depending on the OSCE scenario, you need to guage how direct you can approach the topic of alcohol
• If screening a patient for alcohol abuse then you can use the CAGE questionnaire:
  • Ever thought about Cutting down on your drinking?
  • Ever got Angry at somebody criticizing your drinking?
  • Ever feel Guilty about amount drunk?
  • Eye opener in mornings?
• If you need to investigate further, it is important to characterise their drinking habits:
  • How much alcohol consumed per week? (specify and approximate with units)
  • What types of alcohol and when?
  • Describe a typical day – when is the first drink of the day?
  • Amount drunk changed over time?
  • Repertoire changed over time?
  • Tolerance increased?
    • I.e.: have to drink more in order to get drunk?
  • Drink alone or with friends?
• Withdrawal symptoms
  • Tremor
  • Mood changes
  • Sweating
  • Delirium tremens
  • Hallucinations
• Effect on mood
  • Low mood?
  • Assess risk of self-harm/suicide attempts
• Effect on life
  • Family
  • Friends
  • Relationships
  • Work
  • Finances
• Ever had trouble with the police related to alcohol consumption
• Ever tried to cut down amount drunk?
  • If so, what happened?
• Past medical history
  • Hospital admissions
  • Problems associated with alcohol
    • Peptic ulcer disease
    • Liver disease
    • Jaundice
    • Haematemesis/melaena
    • Clotting problems
    • Memory loss
    • Concentration changes
• Drug history:
  • Currently use of medication to assist with cutting down alcohol consumption?
  • Vitamin supplements to counteract possible deficits
  • Concurrent medication use that might be affected by significant alcohol consumption (ie medication that is metabolized by the liver)
  • Family history of alcohol abuse
  • Social history
    • Smoking and drug abuse
    • Housing situation

• Advice in the community can greatly increase the chances of someone reducing the amount that they drink
• Ask if they think they drink too much
• Would they like to try and reduce the amount that they drink?
• Explain benefits of stopping:
  • Reduced risk of illness such as liver disease and gastric disease
  • Improvement of mood
  • Improvement in relationships and work life
• If so, you can help and will offer them support
• Groups and charities available for you to join, e.g.: alcoholics anonymous
• Refer to the community alcohol team
• Helps to have support from family and friends
• Methods:
  • Reduce drinking over time with regular follow up
  • Detoxification in the community
    • Chlordiazepoxide over 1 week
      • Prevents or reduces withdrawal symptoms of alcohol
  • Detoxification in hospital or specialist detoxification unit
    • If previous delirium tremens or poor response to detoxification in the past, little home or social support
  • Maintenance of detoxification
    • Acamprostate
      • Helps to ease craving symptoms
    • Disulfiram
      • Produces an unpleasant response if you drink alcohol
    • Vitamin B1 supplements

• Ensure they have regular follow-up to provide support
• Ask if they have any questions or if they want to go over anything again
• Provide with leaflet and arrange follow up appointment

Downloads / Links

download pdf here

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Comments:

gilmyers says...

The CAGE questionnaire is a screening tool for alcohol use so it doesn't really fit in here as there is already an assumption of alcohol abuse.

POSTED ON: 23/04/12, 07:17

celine_lakra says...

Hi there,

Thanks for the comment!

The reason why I included it at the beginning of this history is because of that reason - it's a screening tool. If the patient answers 'yes' to 2 or more of these questions, it is worth delving in deeper and going into a full alcohol history. If not, there may be little point of you doing this history anyway.

I understand that in an OSCE it's a little forced, and you know that you have to take an alcohol history anyway. In terms of real life, I would always include it in my alcohol history.

POSTED ON: 23/04/12, 08:30

Zap says...

POSTED ON: 07/06/22, 07:49

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