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:

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

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