Alcohol History - Burton Flashcards
What should you do before starting?
Introduce yourself to the patients
Establish a rapport
Explain that you would like to ask him some questions about his drinking habits, check if this is OK
Wash hands
What are the steps to an alcohol history?
Specific alcohol history (CAGE) Psychiatric and medical history Drug history Forensic/Social history Informant history Family history
What things should you enquire about in the specific alcohol history?
Alcohol intake in a typical day
Onset and duration of alcohol problem
Features of alcohol dependence
CAGE (Cut down, Annoyed, Guilty, Eye opener)
How do you further elicit alcohol intake in a typical day?
Type (what)
Place (where)
Amount (how much)
Time (when)
What are the features of alcohol dependence?
Compulsion to drink
Primacy of drinking over other activities
Stereotyped pattern of drinking (narrowing repertoire)
Increased tolerance to alcohol
Withdrawal symptoms
Relief drinking to avoid withdrawal symptoms
Reinstatement after abstinence
What should you ask about in the psychiatric and medical history?
Psychiatric:
Depression and anxiety
Physical: Peptic ulceration Oesophageal varices Pancreatitis Liver disease Ischaemic heart disease Stroke Peripheral neuropathy
What should you ask about in drug history?
Prescription and recreational drug use
Bear in mind of interaction with NSAIDS, anti-epileptics, antidepressants, antibiotics, and warfarin
What should you ask about in forensic/social history?
Alcohol misuse in other family members
Effect of misuse on relationships, particularly on partner and children, if any
Effect on employment, finances, and housing
Any problems with the authorities e.g drink driving, brawling
What should you do after finishing?
Give the patient feedback on his drinking habits (e.g. number on units drunk versus guidelines), and, if appropriate suggest ways for them to cut down
Ask if they have any questions or concerns
Thank them for their cooperation
