|
Alcohol
|
All patients should be asked about the quantity and frequency of alcohol intake and number of alcohol free days each week from 14 years of age (B).
Those with at risk patterns of alcohol consumption should be offered brief advice to reduce their intake (A).
|
Epidemiology
Drinking at risk levels is most common for men and women 30-45 years of age. The proportion of men drinking at risk levels, especially binge drinking is one and a half to two times that of women at all ages. In Australia it has been estimated that alcohol is associated with 44% of fire injuries, 34% of falls and drowning, 30% of car accidents, 47% of assaults, 16% of child abuse, 10% of suicides and 7% of industrial machine accidents. At 0.05 blood alcohol concentration, the risk of being involved in a road crash doubles. Brief advice in general practice has been demonstrated to have resulted in reductions of 19 to 34% in alcohol use. Alcohol is a risk factor for some types of cancer especially mouth, pharynx, larynx, oesophagus, liver and breast. Alcohol consumption tends to be higher among young people and the unemployed.
Who is at higher risk of developing alcohol related complications?
|
Who is at higher risk?
|
What should be done?
|
How often?
|
|
Average risk
|
|
|
|
• All patients 14 years of age or over
|
Ask about the quantity and frequency of alcohol intake and number of alcohol free days each week. As some patients may be sensitive to your question, it is important to be nonjudgmental
|
Every 3 years
|
|
Increased risk
|
|
|
|
• People with:
high blood pressure,
liver disease,
major organ damage
|
• Ask about the quantity and frequency of alcohol intake and number of alcohol free days each week
|
Every 12 months
|
|
• Pregnant women or those planning to be pregnant
|
• Provide advice on the benefits of low levels of alcohol consumption
|
|
|
• Those with a first or second degree relative with/had alcohol or mental health problems
|
|
|
|
• Those taking medication or other drugs
|
|
|
Clinical Considerations
- Alcohol misuse includes “risky/hazardous” and “harmful” drinking that places individuals at risk for future problems. “Risky” or “hazardous” drinking has been defined in the United States as more than 7 drinks per week or more than 3 drinks per occasion for women, and more than 14 drinks per week or more than 4 drinks per occasion for men. “Harmful drinking” describes persons who are currently experiencing physical, social, or psychological harm from alcohol use but do not meet criteria for dependence. Alcohol abuse and dependence are associated with repeated negative physical, psychological, and social effects from alcohol. The USPSTF did not evaluate the effectiveness of interventions for alcohol dependence because the benefits of these interventions are well established and referral or specialty treatment is recommended for those meeting the diagnostic criteria for dependence.
- Moderate drinking has been defined as 2 standard drinks (e.g., 12 ounces of beer) or less per day for men and 1 drink or less per day for women and persons older than 65.
- The Alcohol Use Disorders Identification Test (AUDIT) is the most studied screening tool for detecting alcohol-related problems in primary care settings. It was developed by the World Health Organization in 1982 as a simple way to screen and identify people who are at risk of developing alcohol problems. It is one of the most accurate alcohol screening tests available, rated 92 percent effective in detecting hazardous or harmful drinking. Unlike some alcohol screening tests, the AUDIT has proven to be accurate across all ethnic and gender groups. The test contains 10 multiple choice questions on quantity and frequency of alcohol consumption, drinking behavior and alcohol-related problems or reactions. It is sensitive for detecting alcohol misuse and abuse or dependence and can be used alone or embedded in broader health risk or lifestyle assessments (see Appendix II).
- The 4-item CAGE is the most popular screening test for detecting alcohol abuse or dependence in primary care
- High risk people should be assessed for readiness to reduce alcohol consumption, offered brief tailored intervention, consider referral for drug and alcohol service, counseled about the dangers of operating motor vehicle or any dangerous activities after drinking. Pregnant women should consider abstaining from alcohol. These interventions should be done at first consultation and follow up monthly (A).
|
The CAGE Test
|
|
One of the oldest and most popular screening tools for alcohol abuse is the CAGE test, which is a short, four-question test that diagnoses alcohol problems over a lifetime.
C - Have you ever felt you should cut down on your drinking?
A - Have people annoyed you by criticizing your drinking?
G - Have you ever felt bad or guilty about your drinking?
E - Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
|
|
Two "yes" answers to the CAGE test indicate problems with alcohol.
|
|
Intervention
- Patients should be encouraged to stop drinking
- Patients should be encouraged to set their own goals.
- Let patients assess their own motivation and confidence in making a change.
- High risk situations should be identified and avoided
- Provide appropriate social support such as friends or family.
- Monitor progress at a follow up visit
- Consider referral to specialized clinic.
|
