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.
History:
- 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
Alcohol cessation advice:
- 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
To conclude the consultation:
- 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
written by: celine_lakra; joel_cunningham, first posted on: 28/03/12, 16:04
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Comments:
POSTED ON: 23/04/12, 07:17
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
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